Cultural Competence in Child Maltreatment Prevention and Intervention

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Cultural Competence in Child Maltreatment
Prevention and Intervention

Shanti Raman Sydney South West Area Health
Service Deborah Hodes Camden PCT and University
College Hospital London
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PLAN

• Case studies UK Australia
• Conceptualising Culture
• Definitions
• Child protection literature
• Culturally competent services

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Case Study Australia

• 7 yo girl with Prader Willi, found at school with
  bruise marks to bottom, no history
• Lebanese background, no speech, moderate delay
• Lives with parents and 4 sibs, extended family
• Brought to ED for exam unusual bruising,
  inadequate explanation Child at Risk!
• Parents informed later, interpreter not available
• Child removed and placed in temporary care
• Family caring, attend all health visits, keep
  weight down
• Parents distraught

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Case Study UK

• 5 yo girl with Down Syndrome, Somali background
• Unusual circumferential lesions around both
  ankles
• Concerned GP worries about abusive practices
• Family, including siblings interviewed by police
• Child removed from family for 3 weeks
• Single mother with 3 other children, loving and
  caring
• Forensic investigation reveals rubber bands
  used to hold socks up

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Questions

• What are the health and child safety issues?
• What cross-cultural interactions occurred?
• What went wrong?
• What was handled well?
• How could you handle this is in a culturally
  competent fashion?

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Why bother about Culture?

• Migration universal phenomenon
• Many cities/regional centres dynamic
  multicultural
• Globalisation traditional boundaries between
  people and societies shrinking
• Rapid social change
• Positive and negative results
• Differential effects on the poor

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Culture

• A way of life the blueprint for living which
  guides thoughts, feelings and actions, and which
  assists individuals to identify with others who
  share a similar way of life.

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Culture(Frisby, 1992)

• As a pattern of living, customs, traditions,
  values, attitudes
• as significant artistic/humanitarian/scientific
  achievement
• as race consciousness -guide individual
  identification
• as values, norms of the immediate context (eg of
  the family, streets, etc)
• as refers to superficial differences between
  macro and micro groups (ie clothing, music,
  speech)
• as refers to outer appearance (culturally
  different)

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Definitions

• Ethnicity ethnic self-identity
• ascribed ethnic identity
• cultural identity
• racial identity
• nationality
• descent
• Race measure of social exclusion/inclusion

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Cultural Identity

• incorporates diversity and pluralism
• there are a number of different selves at
  different levels
• their true psychological integration will lead to
  better psychological functioning
• distinct process that occurs as part of
  personality formation

Bhugra 1999
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Features of Culture

• Culture changes over time
• Culture is shaped by place and circumstances
• Socio-economic factors impinge on culture
• Culture affects everyone not just ethnic groups
• Culture is not only the shaping factor,
  individual experience and choice also determine
  behaviour and lifestyle

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Acculturation/Enculturation

• Acculturation those phenomena which result when
  groups of individuals with different cultures
  come into continuous first hand contact
  subsequent changes in both groups (Redfield et
  al, 1936)
• Enculturation individual socialised into their
  own cultural group

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Defining Child Abuse

• ?Universal
• Occurs everywhere
• Mainly studied in Western societies
• ?Culture Specific
• No community that sanctions child sexual abuse
• Problematic definitions of PA, neglect, emotional
  abuse

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Culturally Responsive Definitions of CAKorbin
1991

• Acknowledgement of cultural differences in child
  rearing practices
• Deviations from culturally appropriate child
  rearing of any cultural group are considered
  abusive by that group
• Circumstances where societal harm undermines
  childrens wellbeing beyond the control of the
  parent (eg poverty)

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Cultural differences in Goals of Development

• Western world career, marriage, house, car, TV
• Traditional (Aboriginal) achieving full tribal
  status
• Immigrant families children better off than
  parents, security, pride in childrens success
• Factors influencing
• Parents own status
• Migration story refugee, economic, push/pull
  factors
• Religious affiliations
• Political environment
• Gender

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Consider Parents Views

• Own history
• Value child, beliefs, expectations
• Interpretation of culture
• Child rearing practices

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Parents viewof the value of the child

• Decreased risk
• Economic
• Family lines
• Pleasure

• Increased risk
• poor health
• disabled
• gender
• temperament
• unwanted

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Continuum of cultural practices

beneficial
harm
Parent Professional
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Continuum of cultural practices Koramoa 2002
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Culture and Child Maltreatment What the
literature says

• Behl 2001 Content analysis 7 focussed on
  ethnicity, ½ reported on ethnicity of
  participants
• Miller 2006 13 focussed on ethnicity, ¾
  reported on ethnicity of participants
• Ethnic minorities over represented (Chibnall
  2003)
• Asians generally under-represented (Pelczarski
  2006)

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CM Characteristics and Patterns Among Asian
American Families (Rhee, Chang 2006)

• Asian families more likely to be reported to CPS
  for PA and neglect, less likely for CSA
• PA occurred under conditions of family stress eg
  divorce, single parenthood or remarriage, or
  corporal punishment
• Majority of victims abused by biological parents
  MothergtFather
• Emotional abuse children witnessing domestic
  violence
• PA most prevalent abuse type for Chinese, Korean,
  and Vietnamese families
• Child neglect most frequently reported abuse for
  Cambodians

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Cultural Competency ? Necessary

• Cultural competence requires individuals to
• Understand concept of culture and its influence
• Be open and willing to explore own cultural bias
• Be open and willing to explore from anothers
  perspective
• Identify useful and culturally appropriate
  strategies for working with diverse cultural
  backgrounds

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Cultural Competence Steps

• Critically examine culture, cultural identity,
  acculturation, ethnocentricity and stereotyping
• Consider the socio-cultural determinants of
  health particular focus on inequalities in
  health
• Understand the psycho-social and cultural issues
  affecting the health behaviours of ethnic/cult
  gps
• Be aware of the importance of culturally
  appropriate communication

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Developing Cross Cultural Competence

• 1. Start with Self awareness
• 2. Culture-specific awareness and understanding
• Gathering culture-specific information
• studying and reading about culture
• talking/working with cultural guides or mediators
• participating in the daily life of another
  culture
• learning the language of another culture

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Effective Cross-Cultural Communicators

• Respect individuals from other cultures
• Make continued and sincere attempts to understand
  the world from others view
• Are open to new learning
• Are flexible
• Have a sense of humour
• Tolerate ambiguity well
• Approach others with a desire to learn

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Conclusions

• Great need for quality research in culturally
  diverse populations
• Abusive practices should be a concern for the
  family and culture before intervention
• Develop culturally sensitive interventions that
  respect cultural/ biological variations in
  parenting and child development