Cultural Sensitivity for the Clinician

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Cultural Sensitivity for the Clinician

• Sources
• Barbara Naki, TIFFE
• C. Kimo Alameda, Ph. D.
• Jackie Hong, LSW and Rebecca Beardsley, PH.D.
  Department of Health-Adult Mental Health
• www.Hawaii.gov

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Introductions

• Tell us about yourself
• What is your position, what areas of Hawaii
  Island do you work in
• Tell us something about one or two of the
  cultures you identify with

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What is culture?
The integrated pattern of human behavior that
include the language, thoughts, communications,
actions, customs, beliefs, values, and
institutions of racial, ethnic, religious or
social groups.
Attributing everything to ethnicity is as
dangerous as attributing nothing.
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Definitions

• Stereotype A stereotype is an oversimplified,
  false, or generalized portrayal of a group of
  people. Stereotyping does not allow for
  exceptions or individual differences
• Prejudice A preformed judgment or opinion about
  an individual or group. The term often denotes
  an unfavorable or hostile attitude toward other
  people based on their membership.

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Definitions

• Discrimination to make distinction on the basis
  of preference or prejudice. Involves any
  situation in which a group or individual is
  treated differently and/or unfairly based on
  their membership in a socially distinct group or
  category.

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Definitions

• Racism 1)Any attitude, action, or practice
  backed up by institutional power that
  subordinates people because of their color. This
  includes the imposition of ethnic groups culture
  of other races. 2) The socially constructed
  system of domination that benefits one racial or
  ethnic group at the expense

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Why is culture and cultural sensitivity
especially important when working in our fields?
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• Cultural will play a large role in whether youth
  or families even seek help in the first place,
  and if they do seek help, culture influences
• -what types of help they seek
• -who they prefer to treat them
• -how they see the world

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Western and traditional Native Hawaiian Practices

• Hawaiian Healing Practices
• Focus on spiritual/interpersonal complaints and
  causes
• Causal models based on imbalance in
  relationships/life roles
• Treatment involves prayers, herbs, repairing
  relationships
• Faith-based

• Western Healing Practices
• Focus on physical/
• psychological signs, symptoms, and causes
• Organic or psychological causal models
• Treatment involves medicine, cognitive
  restructuring, lifestyle changes
• Evidence-based

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Cultures influence on peoples world views
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So where do we start?
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We start with ourselves!!!

• We dont see things as they are, we see them as
  we are (Anias Nhim)
• Humans have a natural tendency to categorize
  things in order to make sense of our world and
  build on our past experiences

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• What is the functionality of being able to
  discriminate effectively as an innate function
  of survival?
• What happens when our radars are not accurate?
• Are we able learn to adapt and begin to form
  more categorieschallenge our faulty beliefs?

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Prejudice

• A prejudice is an implicitly held belief, often
  about a group of people. Race, economic class,
  gender or sex, ethnicity, sexual orientation,
  age, and, religion are other common subjects of
  prejudice. It can be used to characterize beliefs
  about other things as well, including "any
  unreasonable attitude that is unusually resistant
  to rational influence."

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Hawaii Census 2000
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Hawaii is very diverseSubtle prejudice in
Hawaii

• That boy works hard for one Hawaiian
• Eh, you smart for one Portuguese
• How can that gay couple raise kids
• That girl no good thats how the family
• She probably dont know cause she dont speak
  English

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If you dont think you have any prejudices, ask
yourself

• How did your parents express their feelings about
  other ethnicities and/or races?
• Was it expressed openly or in off-hand remarks,
  jokes, etc?
• Were threats made if you dated someone from
  another ethnicity or religion?
• How would your family respond if you were gay?

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• Cultural Identity
• Where do you stand?

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Insensitive

• Denial
• Your culture is the only culture that exists.
  You deny and are disinterested in cultural
  differences.
• Defense
• You experience your culture as the only good
  culture. You acknowledge cultural differences
  but see them as threatening. You use mechanisms
  such as stereotyping to defend yourself.
• Minimization
• You experience elements of your culture as
  universal. You minimize differences between
  cultures and believe that human similarities
  outweigh any differences.

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Sensitive Competent

• Acceptance
• You recognize and value culture differences and
  you are curious about different cultures.
• Adaptation
• You experience other cultures by acknowledging
  the behaviors acceptable to that culture. You
  change your behavior to communicate more
  effectively in different cultures.
• Integration
• You value a variety of cultures and continuously
  define your own identity in contrast and in
  conjunction with a number of cultures. You move
  easily in and out of varying worldviews.

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• It is difficult to be truly understanding and
  sensitive to someone elses culture until one has
  gained some knowledge and appreciation for ones
  own culture
• (Lynch Hanson, 1998)

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• Seek first to understand, then to be understood
• Obtain basic knowledge of the cultural groups you
  are likely to serve.

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Activity

• Slipper on or slippers off?
• Hug or handshake?
• Pidgin or no pidgin?

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Nowas a clinician who works with a diverse
population
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Make the Connection

• Pay attention to how we use language
• Know basic hello and goodbye protocol
  (handshake, head nod)
• Know some basic non-English sayings in the
  language most common to the consumer
• Be aware of communication styles and nonverbal
  cues
• Learn how the culture prioritizes their values

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What do you know about the culturally diverse
populations you work with?

• What are their social norms?
• How did they wind up here in Hawaii?
• Are you informed about their basic historical
  pasts?
• How can you become more familiar with this
  culture?
• Do you need an interpreter?
• Are there other clinicians you can use to learn
  more about the culture that you will be working
  with.

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What if you are not comfortable working with a
particular culture?

• Is it okay to ask to work only with specific
  cultural groups?
• How do you become comfortable working with a
  variety of cultures?
• What does it feel like to be comfortable working
  with a specific culture.

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Political Correctness

• Avoid expressions or actions that can be
  perceived to exclude or marginalize or insult
  people who are socially disadvantaged or
  discriminated against.
• Examples
• Asian (non Oriental)
• Black or African American (not colored or Negro)
• White or Caucasian (use Haole with caution
  depends on context, tone of voice, etc)
• Be careful with ethnic jokes not funny to all
• person with schizophrenia not a schizophrenic

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6 Guidelines for Creating Culturally Relevant
Services

• Be respectful
• Watch your assumptions
• Be careful of labels
• Be open to new experiences
• Be able to culturally assess yourself
• Be able to adapt your style to different cultures

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Activity

• Develop a basic culturally informed information
  gathering process.

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• What else?
• Questions?
• comments?

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References
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Mahalo