Wednesday, March 21, 2007

Cultural (in)Competence

"Cultural Competence" was a term I first heard back in the late 1980s when I worked in the family planning field. I remember taking courses that used the term, and trying to plan workshops on cultural competence for the family planning counselors I was charged to train. It confused me. What exactly did it mean? I got the gist of it, which is being "competent" in dealing with people of a culture different from one's own. In my case, it meant training family planning counselors from many different cultures (African American, Haitian, Latino, Asian, etc.) as a middle-class white woman. But I never really figured out how to implement it.

Did it mean having a workshop with representatives of different cultures speaking? But then you ended up with this sense that each culture was monolithic: "all Latinos feel this way, all African-Americans feel this way." So THAT didn't work out well. Did it mean only having providers serve clients who were of the same culture as they were? This was difficult to do in a multi-cultural city like Boston. And what about information that I felt was really the same no matter what the culture, but that people still disagreed about? For example, I trained the family planning counselors how to talk to women with unplanned pregnancies. They needed to present all three of the options: continuing the pregnancy, abortion, and adoption. But what of those counselors who said: "we don't DO this in our community"? What then?

Fast forward about twenty years, and now it's 2007 and I'm at a new job in a new agency. I go to a brown-bag lunch about -- you guessed it -- cultural competence. "Wow," I thought, "maybe they've finally figured it out!" I brought my salad to the workshop and waited excitedly for the talk to start.

Guess what. They still haven't figured it out.

I won't repeat what was said at the workshop, but suffice to say, people were still asking: "what is cultural competence, anyway?" People still didn't have great definitions. They had a sense that it had to do with comfort with other cultures, but it seemed more that the U.S. government is requiring grantees to discuss their plans for making programs culturally competent, and this was the basis of the discussion. There was a lot of talk about frameworks and committees and plans. I was still confused.

The speaker gave us information about a program that he thought was a great example of a culturally competent program. In it, a Western practitioner and a local person worked together to create a suicide prevention program that truly met the needs of the target population because -- duh -- it was based on the culture and values of that population! This isn't rocket science, folks. Or maybe it is...

I've worked in human services for a long time, and I've seen lots of different programs. It seems clear to me that you need to have representatives of the population you intend to work with (typically under-served minority populations) as part of the planning and also the implementation of a social service or public health program, if it's going to be successful. This seems obvious to me. Yet, it seems to me that lots of people in the helping professions are of a different culture than that of the folks they want to help. So there's the rub. How do these well-intentioned folks figure out how to work with people who have backgrounds and communities and feelings and traditions that are VERY DIFFERENT than theirs? Cultural competence....

So now I've come full circle. I don't understand cultural competence, but apparently we need it in order to serve the populations that we serve. And maybe, as in many other things, the question is more important than the answer, and the definition is in the struggle itself...

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