The need for cultural competence

More and more it seems that the health and other helping professions are introducing "cultural competence" as a standard. At its simplest, the idea calls for professionals to be able to understand and respond effectively to issues that people in a multicultural society bring.

In an ideal sense, practitioners would have the skills, knowledge and attitudes to enable them to respond to needs of a patient or client who is of a different culture. In theory, a culturally competent practitioner provides effective services, enabling people to make optimal use of those services in their respective communities.

But in the real world, when the concept of cultural competence is introduced into most service settings, people question whether a provider of one culture can really be helpful to a client of another culture. It also raises the concern that providers in today's society are drawn predominantly from one cultural background and the people who need services come from a variety of backgrounds.

Cultural issues are just as important in research and educational endeavors as in services ones, but the challenge is most evident in settings where people with serious difficulties find little or no relief because they are not able to communicate critical information to an insensitive provider.

Becoming culturally competent

While psychologists have attended to some interesting aspects of culture, particularly as culture has been implicated in personality and behavior, anthropology has been the science that has focused on cultural issues, developing specific ways to study and understand behavior of people in groups such as family, community, tribe, etc. Yet it is obvious that psychology and anthropology share the idea that culture as a major shaper of behavior is acquired through the process of learning.

Without such learning, human beings could neither survive nor thrive within a societal context. Within families or a social facsimile, young children are enculturated to become individuals that use the oral and behavioral languages that each cultural group values and believes will add to its continuity.

Much has been written by social and behavioral scientists about the ways and conditions under which these important behaviors are acquired. In essence, each individual is taught by mentors, who try to ensure that their mentees are culturally competent. Not culturally competent to provide useful professional services, but competent to understand, interact and be understood within family, community and country in order to play important roles, sometimes preordained, according to race, age, gender, ethnicity, etc.

However, in discussions of cultural competence, there is an intuitive utility in the concept that raises an interesting question. One might phrase the question as "Who and under what set of conditions can become 'competent' in more than one culture?"

Cultural competence and multiculturalism

In a multicultural society, how are important services, particularly health-preserving ones, to be provided and by whom?

The simplest answer if cultural competence is the sine qua non, is that these services should only be provided, except in life threatening emergencies, by culturally competent providers. On the other hand, the real answer, is that on any given day, especially for people of color, the cultural match is atrocious.

It is most evident, particularly in the United States, when language is involved. People speaking any language other than English--particularly if they are poor and working-class people--are not likely to encounter many culturally competent providers or have predictable access to "cultural interpreters." When the language spoken is English, providers are often lulled into a false sense of security, assuming a mutual understanding of important issues where in fact little exists. When the communication is nonverbal or behavioral--posture, glances, touch, dress, etc.--all bets are off.

What can psychology do?

Psychology, particularly professional psychology, could, at first, require all students from all cultural backgrounds to demonstrate cultural sensitivity--i.e., realize that people might communicate meaningfully in different ways, come from families and communities that value different behaviors, etc. As a next step, begin to require that the nation's multiculturalism be reflected in curricula taught to multicultural students by multicultural faculties.

For psychologists already in the profession, there should be at least a requirement of sensitivity. Licensing or certification boards should require demonstrated efforts to acquire cultural competence or, at a minimum, cultural sensitivity. No group should be excluded from attainment of cultural sensitivity or competence; every psychologist should garner skills, knowledge and attitudes that move her or him toward a goal of at least biculturalism.



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