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Presented by: Fatima Saleem
Joe Enright
Culturally Responsive
Practice
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What is Culture?
Definitions:
*Culture is a set of shared assumptions where people can predict each
others actions in a given circumstance and react accordingly (Haviland,
1975 as cited in Lee, Blando, Mizelle, & Orozco 2007).
*It is the customary beliefs, social norms, and material traits of aracial, religious, or social group. (Merriam-Webster, 2006)
* Integrated pattern of human knowledge, belief, and behaviour that
is both a result of and integral to the human capacity for learning
and transmitting knowledge to succeeding generations. Culture thus
consists of language, ideas, beliefs, customs, taboos, codes,institutions, tools, techniques, works of art, rituals, ceremonies, and
symbols. An individuals attitudes, values, ideals, and beliefs are
greatly influenced by the culture (or cultures) in which he or she
lives. (Encyclopedia Britannica, 2011)
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What is Culture?
The A.D.D.R.E.S.S.I.N.G. Model: Potential Sources of
Cultural Influence (Hayes, 2008):
*Age
*Developmental and acquired Disabilities,
*Religion
* Ethnicity
* Socioeconomic status
* Sexual orientation
*Indigenous heritage
*National Origin
*Gender
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Importance of
Culture in Practice (Lee, Blando, Mizelle, & Orozco 2007)
*Counseling occurs in a cultural context.
*Assessment of clients problem (culture).
*Counseling itself is culturally based.
*Culture itself may be the focus of
counseling.
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Ethical Issues Surrounding
Culturally Responsive Practice
Principle I: Respect for the Dignity of PersonsCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)
VALUES:
* Psychologists acknowledge the equality of all persons, and that
the value of a person is not determined based on cultural
background or other characteristics.
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Ethical Issues Surrounding
Culturally Responsive Practice
PRINCIPLE I STANDARDS
General Caring
* I.2 - Not engage publicly (e.g., in public statements,
presentations, research reports, or with clients) in degrading
comments about others, including demeaning jokes based on
such characteristics as culture, nationality, ethnicity, colour,
race, religion, sex, gender, or sexual orientation.
Non-Discrmination
* I.9 Not practice, condone, facilitate, or collaborate with any
form of unjust discrimination.
* I.10 Act to correct practices that are unjustly discriminatory.* I.11 Seek to design research, teaching, practice, and business
activities in such a way that they contribute to the fair
distribution of benefits to individuals and groups, and that they
do not unfairly exclude those who are vulnerable or might be
disadvantaged.
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Ethical Issues Surrounding
Culturally Responsive Practice
PRINCIPLE I STANDARDS
Freedom of Consent
* I.30 Respect the right of persons to discontinue participation or
service at any time, and be responsive to non-verbal indications
of a desire to discontinue if a person has difficulty with verbally
communicating such a desire (e.g., young children, verbally
disabled persons) or, due to culture, is unlikely to communicatesuch a desire orally.
Privacy
* I.38 Take care not to infringe, in research, teaching, or service
activities, on the personally, developmentally, or culturallydefined private space of individuals or groups, unless clear
permission is granted to do so.
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Ethical Issues Surrounding
Culturally Responsive Practice
Principle II: Responsible CaringCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)
VALUES:
*Psychologists are responsible for ensuring that cultural ignoranceor bias is not a threat to cause harm to clients.
* In order to ensure this, psychologists recognize the need for
competence and self-knowledge.
*Self-knowledge is attained through reflection on how their own
values, attitudes, experiences, and social context influence
their actions, interpretations, choices, and recommendations
*They consider incompetent action to be unethical due to the risk
of harm. They engage only in those activities in which they have
competence..
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Ethical Issues Surrounding
Culturally Responsive Practice
PRINCIPLE II STANDARDS
Competence and Self-Knowledge
* II.6 Offer or carry out (without supervision) only those activities for which they
have established their competence to carry them out to the benefit of others
* II.7 Not delegate activities to persons not competent to carry them out to the
benefit of others.
* II.8 Take immediate steps to obtain consultation or to refer a client to a colleague
or other appropriate professional, whichever is more likely to result in providing the
client with competent service, if it becomes apparent that a clients problems are
beyond their competence.
* II.9 Keep themselves up to date with a broad range of relevant knowledge, research
methods, and techniques, and their impact on persons and society, through the
reading of relevant literature, peer consultation, and continuing education
activities, in order that their service or research activities and conclusions will
benefit and not harm others.* II.10 Evaluate how their own experiences, attitudes, culture, beliefs, values, social
context, individual differences, specific training, and stresses influence their
interactions with others, and integrate this awareness into all efforts to benefit and
not harm others.
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Ethical Issues Surrounding
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PRINCIPLE II STANDARDS
Risk/Benefit Analysis
* II.13 Assess the individuals, families, groups, and communities involved in their
activities adequately enough to ensure that they will be able to discern what will
benefit and not harm the persons involved.
* II.14 Be sufficiently sensitive to and knowledgeable about individual, group,
community, and cultural differences and vulnerabilities to discern what will benefit
and not harm persons involved in their activities.
* II.15 Carry out pilot studies to determine the effects of all new procedures and
techniques that might carry more than minimal risk, before considering their use on
a broader scale.
Maximize Benefit
* II.21 Strive to provide and/or obtain the best possible service for those needing and
seeking psychological service. This may include, but is not limited to: selecting
interventions that are relevant to the needs and characteristics of the client andthat have reasonable theoretical or empirically-supported efficacy in light of those
needs and characteristics; consulting with, or including in service delivery, persons
relevant to the culture or belief systems of those served; advocating on behalf of
the client; and, recommending professionals other than psychologists when
appropriate.
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Ethical Issues Surrounding
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PRINCIPLE II STANDARDS
Minimize Harm
* II.31 Give reasonable assistance to secure needed psychological services or
activities, if personally unable to meet requests for needed psychological services
or activities.
* II.35 Screen appropriate research participants and select those least likely to be
harmed, if more than minimal risk of harm to some research participants is
possible.
Offset/Correct Harm
* II.41 Act also to stop or offset the consequences of harmful activities carried out by
another psychologist or member of another discipline, when the harm is not serious
or the activities appear to be primarily a lack of sensitivity, knowledge, or
experience, and when the activities have come to their attention outside of a
confidential client relationship between themselves and the psychologist or
member of another discipline.
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Ethical Issues Surrounding
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Principle III: Integrity in RelationshipsCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)
VALUES:
* Trustful relationships are based on honesty, straightforwardness and
openness about potential bias or conflict of interest.
* Openness and honesty is enhanced by self-knowledge and the use of
critical analysis. Personal values and self-interest can affect every
aspect of service.
* Psychologists are not expected to be value-free or totally without
self-interest. However, they are expected to be open and honest
about the influence of such factors, and to be as objective andunbiased as possible.
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Principle III: Integrity in RelationshipsCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)
VALUES (cont.):
* There are times when fully open and straightforward disclosure might notbe needed or desired by others and, in some circumstances, might be a
risk to their dignity or well-being (Principle I) or considered culturally
inappropriate.
* Situations that present real or potential conflicts of interest can lead to
distorted judgment and can motivate psychologists to act in ways that
meet their own interests at the expense of the best interests of membersof the public.
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Ethical Issues Surrounding
Culturally Responsive Practice
PRINCIPLE III STANDARDS
Objectivity/lack of bias
* III.10 Evaluate how their personal experiences, attitudes,
values, social context, individual differences, stresses, and
specific training influence their activities and thinking,
integrating this awareness into all attempts to be objective andunbiased in their research, service, and other activities.
* III.38 Seek consultation from colleagues and/or appropriate
groups and committees, and give due regard to their advice in
arriving at a responsible decision, if faced with difficult
situations.
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Ethical Issues Surrounding
Culturally Responsive Practice
Principle IV: Responsibility to SocietyCANADIAN CODE OF ETHICS FOR PSYCHOLOGISTS, Third Edition (CPA, 2001)
VALUES:
* Psychologists convey respect for social structures and policies that havedeveloped over time and avoid unwarranted or unnecessary disruption.
* On the other hand, if structures or policies seriously ignore or oppose the
principles of the Code of Ethics, they have a responsibility to speak out
and advocate for appropriate change.
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PRINCIPLE IV STANDARDS
Respect for Society
* IV.15 Acquire an adequate knowledge of the culture, social structure, and customs
of a community before beginning any major work there.
* IV.16 Convey respect for and abide by prevailing community mores, social customs,
and cultural expectations in their scientific and professional activities, provided
that this does not contravene any of the ethical principles of this Code.
* IV.17 Familiarize themselves with the laws and regulations of the societies in whichthey work, especially those that are related to their activities as psychologists, and
abide by them. If those laws or regulations seriously conflict with the ethical
principles contained herein, psychologists would do whatever they could to uphold
the ethical principles. If upholding the ethical principles could result in serious
personal consequences (e.g., jail or physical harm), decision for final action would
be considered a matter of personal conscience.
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Ethical Issues Surrounding
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PRINCIPLE IV STANDARDS
Development of Society
* IV.24 Consult, if feasible and appropriate, with groups, organizations, or
communities being studied, in order to increase the accuracy of interpretation of
results and to minimize risk of misinterpretation or misuse.
* IV.25 Make themselves aware of the current social and political climate and ofprevious and possible future societal misuses of psychological knowledge, and
exercise due discretion in communicating psychological information (e.g., researchresults, theoretical knowledge), in order to discourage any further misuse.
* IV.26 Exercise particular care when reporting the results of any work regarding
vulnerable groups, ensuring that results are not likely to be misinterpreted or
misused in the development of social policy, attitudes, and practices (e.g.,
encouraging manipulation of vulnerable persons or reinforcing discrimination
against any specific population).
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Culturally Responsive
VS.
Culturally Competent
Whats the difference?
*For definitional and operational purposes, they are
interchangeable. However
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Culturally Responsive VS. Culturally Competent
*Culturally responsive is used in lieu of cultural
competency due to the emphasis of a patient-centered
care model. Through use of the word competency,
cultural competency alludes to a misleading sense of
finality, when in reality life-long self-reflection and new
learning are required. (Ring, 2009)
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What does it mean to be
Culturally Responsive ?
*There is no universally accepted definition of culturalcompetence. (Bonder et al., 2002)
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What does it mean to be
Culturally Responsive ?
* The provision of ethical and responsive treatment to clients of diverse
cultural backgrounds. (Parham & Carter, 2009)
* A practitioners ability to understand and address a persons needs within
the individuals socio-cultural context. (Lynch and Hanson, 1998)
* Being aware of and respecting cultural, individual and role differences ofthe client, and practicing only within the boundaries of their
competence, while making a reasonable effort to obtain the competence
required. (APA, 2002)
* The capacity to be aware of ones own assumptions, values and biases;
the possession of knowledge and understanding of the world-views ofculturally different clients; and the ability to accordingly develop
appropriate intervention strategies. (Sue et al., 1992)
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What does it mean to be
Culturally Responsive ?
Attempt at a broad comprehensive definition:
*Congruent behaviors, knowledge (including
knowledge of self), attitudes and policies thatcome together to enable effective work in cross-
cultural situations. (Cross, Bazron, Dennis, and Isaacs , 1989;Ring, 2009)
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Three Components of
Cultural Competence (Sue, & Sue, 2008)
*Awareness (Principle II: Responsible Caring)
*Knowledge (Principle II: Competence and self knowledge)
*Skills (Principle II: Maximize benefits)
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Potential Barriers(Truscott, & Crook, 2004)
*Culturally Encapsulated Counselor/Culture Blind
*Discrimination
(Sue & Sue, 2008)
*Culture-bound values: individual centered,verbal/emotional/behavioral expressiveness,communication patterns from client to counselor,openness and intimacy and clear distinctionsbetween mental and physical wellbeing.
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Potential Barriers Cont.
*Class-bound values: strict adherence to time
schedules (50-minute, once or twice a week
meetings), ambiguous or unstructured approach to
problems, and seeking long-range goals or
solutions
*Language variables: use of Standard English and
emphasis on verbal communication.
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How do we become Culturally
Responsive as a Discipline?
*Increased training, further research on
intergroup differences.
*Development of instruments that are free ofcultural bias or alternatively, culturally
localized.
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How do we become Culturally
Responsive as Practitioners?
*Twelve Practical Suggestions for Achieving
Multicultural Competence. (Stuart, 2004)
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How do we become Culturally
Responsive as Practitioners?
STEP 1
Develop skill in discovering each persons unique culturaloutlook.
* Change is easier and more meaningful when grounded in acceptance. New ideas are
better comprehended when delivered in the clients literal and figurative
languages.
* Use open-ended questions and ethnographic interviews. See DSM-IV Appendix I
(APA, 1994).
STEP 2
Acknowledge and control personal biases by articulatingyour ownworldview and evaluating its sources and validity.
* Unchecked bias lead to perceptions that reveal more about therapist than client.
* Psychologists can benefit by periodically rearticulating their beliefs about human
behavior and its management* Bidirectional flow between the evolving knowledge base of psychology and
clinicians practice wisdom is the only way to achieve responsible operational
theories.
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How do we become Culturally
Responsive as Practitioners?
STEP 3
Develop sensitivity to cultural differences without overemphasizingthem.
* Despite prominent differences, many aspects of group beliefs and behavior may be
common across cultures.
* Avoid the trap of overgeneralizing
STEP 4
Uncouple theory from culture.
* Researchers have discovered differences between cultures that may be relevant to
intervention.
* Rather than coupling these differences with ethnicity, it may be more helpful to
describe the individual traits of the client
* Focus on the individual, culture is introduced as a mediator or moderator when
relevant.
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How do we become Culturally
Responsive as Practitioners?
STEP 5
Develop a sufficiently complex set of cultural categories.* People have far more diversity than is reflected by labels used by many
multiculturalists (eg. Black, Asian, Latino, Middle Eastern, etc.)
* Better to describe rather than categorize clients identities.
STEP 6
Critically evaluate the methods used to collect culturallyrelevant databefore applying the findings in psychological services.
* Cross-cultural research often suffers from methodological flaws.
* Translation doesnt guarantee shared meaning.
* Subjectselection, sample size, and measurement invalidity, are all
common weaknesses in literature.
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How do we become Culturally
Responsive as Practitioners?
STEP 7
Develop a means of determining a persons acceptance ofrelevantcultural themes.
* Individuals differ in acceptance of peer-group and cultural beliefs.
* Many instruments have been developed for this purpose, some more useful than
others.
* Most do not reveal which specific beliefs and practices are accepted, strength of
acceptance, or whether acceptance is situation specific.
* Results may be useful sources of general information to be validated and refinedthrough sensitive, nondirective interviewing.
STEP 8
Develop a means of determining the salience of ethnic identityfor eachclient.
* Ethnicity or culture is only one component that contributes to identity and affect
decision making.* May not be most salient component at a given moment, or situation.
* Sensitive assessment involves asking clients to articulate the sources of their
perspectives rather than arbitrarily overweighting any one of them solely on the
basis of demographics.
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How do we become Culturally
Responsive as Practitioners?
STEP 9
Match psychological tests to client characteristics.* Selected test must be free of value assumptions and culturally sensitive.
* Unfortunately most instruments are developed in one culture to evaluate clients
identified with another.
* Normalizing deviant responses to compensate for ethnic influences distorts findings.
* Evaluate the appropriateness of each instrument, and acknowledge potential
cultural bias when reporting results.
* Benefit of the doubt given when interpreting any abnormal or substandardresponses and to consider alternative explanations
STEP 10
Contextualize all assessments.
* Easy to find commonalities in the behavior of members of subgroups of a population
and attribute these to group typical traits.* First identify any common challenges and/or environmental stresses and then
consider whether traits could be relabeled as adaptations or coping responses.
d b l ll
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How do we become Culturally
Responsive as Practitioners?
STEP 11
Consider clients ethnic and world views in selecting therapists,intervention goals, and methods.
* Helping people make changes is difficult.
* Intervention not likely to succeed when providers do not earn clients trust, use
language or concepts that are not understood, or require behavioral or cognitive
skills that the clients lack.
* Intelligent matching removes unnecessary obstacles to effective therapy and
enhances outcomes (Morris, 2001).STEP 12
Respect clients beliefs, but attempt to change them whennecessary.
* Being culturally sensitive is to understand the unique way in which cultural values,
beliefs, and practices help to create meaning for a client.
* Insensitivity can decrease the prospect for therapeutic effectiveness.
*Empathic therapists see the world from the clients perspective, but do notnecessarily accept everything in the clients view as healthy.
* May be appropriate for therapists to attempt to change selected beliefs
* Knowledge of the belief system helps contextualize problem behavior.
* Obligation to prevent harm takes precedence over the mandate to respect diversity.
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Age: 76
Religion: Islam
Language: Non-Native English speaker
Nationality: Immigrated to Canada from
Oman.