CULTURAL COMPETENCY PRACTICE WITH SOUTHEAST-ASIAN FAMILIES IN
CHILD WELFARE
Yoriko Sakuma
B.A., California State University, Sacramento, 2004
Ana Nguyen
B.A., California State University, Sacramento, 2008
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2010
CULTURAL COMPETENCY PRACTICE WITH SOUTHEAST-ASIAN FAMILIES IN
CHILD WELFARE
A Project
by
Yoriko Sakuma
Ana Nguyen
Approved by:
__________________________________, Committee Chair
Francis Yuen, DSW, Professor
____________________________
Date
ii
Students: Yoriko Sakuma and Ana Nguyen
I certify that these students have met the requirements for format contained in the
University format manual, and that this project is suitable for shelving in the Library and
credit is to be awarded for the project.
__________________________, Graduate Coordinator
Teiahsha Bankhead, Ph.D., LCSW
Division of Social Work
iii
___________________
Date
Abstract
of
CULTURAL COMPETENCY PRACTICE WITH SOUTHEAST-ASIAN FAMILIES IN
CHILD WELFARE
by
Yoriko Sakuma
Ana Nguyen
The association between culturally competent practice and treatment outcomes among
Southeast Asians has become recognized in the field of social work. However, crosscultural challenges continue to exist, particularly in one field of social work – child
welfare practice. In an attempt to ameliorate cross-cultural challenges child welfare
workers face, this descriptive study provides recommendations of how child welfare
agencies, particularly Sacramento County Department of Health and Human Services
Child Protective Services, can improve its practice with its Southeast Asian clientele.
Thirty six Sacramento County child welfare workers discussed their knowledge,
challenges, agency resources, familiarity with services relevant to the needs of this group,
and their perceptions of what should be systematically changed in order to improve
services delivery to this group. The results showed that cultural competency is important
in child welfare practice, but is, however, limited in all three of the micro, meso, and
macro levels. The study’s findings show that current child welfare workers are limited in
their skills to effectively service Southeast Asian clients as a result of ineffective and
inadequate training, lack of consultation support, and lack of programs and community
iv
resources, particularly family therapy and mental health outreach programs. To ensure
better outcome, these researchers recommend the focus of cultural competency training
be shifted more towards knowledge acquisition and skill development. The researchers
also recommend increasing bicultural workers in the child welfare workforce, and
providing workers with consultation and support regarding service delivery and decision
making. Lastly, the researchers recommend increasing the collaboration between the
child welfare agency and the Southeast Asian communities by expanding community
resources. Yoriko Sakuma and Ana Nguyen worked together and contributed equally to
this research project.
_______________________, Committee Chair
Francis Yuen, DSW, Professor
_______________________
Date
v
ACKNOWLEDGEMENT
This research study would not have been possible without the support of many
people. We would first like to express our gratitude to our thesis advisor, Professor
Francis Yuen, who offered invaluable assistance, support and guidance. We would also
like to convey thanks to all of the study’s participants for their contribution during the
course of this study. Last, a special reference to our family, for their unconditional love
and moral support throughout our academic journey.
vi
TABLE OF CONTENTS
Page
Acknowledgement ............................................................................................................. vi
List of Tables ...................................................................................................................... x
Chapter
1. INTRODUCTION .......................................................................................................... 1
Introduction ....................................................................................................... 1
Statement of Collaboration ............................................................................... 3
Background of the Problem .............................................................................. 4
Statement of the Research Problem .................................................................. 6
Purpose of the Study ......................................................................................... 7
Theoretical Framework ..................................................................................... 8
Definition of Terms......................................................................................... 11
Assumptions.................................................................................................... 12
Justification ..................................................................................................... 13
Limitations ...................................................................................................... 14
2.
REVIEW OF LITERATURE ................................................................................. 16
Introduction/Overview .................................................................................... 16
Cultural Competence ...................................................................................... 17
History of the Southeast Asian Population ..................................................... 23
Theoretical Foundation ................................................................................... 25
vii
Cultural Concerns ........................................................................................... 29
Factors Contributing to Child Maltreatment ................................................... 35
Asian Americans in the Child Welfare System .............................................. 37
Current Practice .............................................................................................. 41
An increase in Bi-cultural child welfare workers ........................................... 43
Interpretation Services .................................................................................... 44
Increase the Quality of Trainings .................................................................... 46
Outreach Programs.......................................................................................... 48
3.
METHODOLOGY ................................................................................................. 53
Introductions ................................................................................................... 53
Study Design ................................................................................................... 53
Sampling Procedures ...................................................................................... 54
Data Collection Procedures............................................................................. 55
Instruments ...................................................................................................... 55
Data Analysis Approaches .............................................................................. 57
Protection of Human Subjects ........................................................................ 57
Summary ......................................................................................................... 58
4.
FINDINGS .............................................................................................................. 59
Introduction ..................................................................................................... 59
Demographics ................................................................................................. 59
Cultural Competency of Child Welfare Workers ........................................... 61
viii
Community Resources and Support by the Agency ....................................... 70
Recommendations for Effective Practice with Southeast Asian clients ......... 79
Summary ......................................................................................................... 85
5.
CONCLUSION ....................................................................................................... 90
Summary ......................................................................................................... 90
Conclusion and Recommendations ................................................................. 91
Implications for Social Work Practice and Future Studies ............................. 95
Appendix A Letter of Consent Form .............................................................................. 98
Appendix B Survey Questionnaire ............................................................................... 100
References ..................................................................................................................... 103
ix
LIST OF TABLES
Table
Page
1.
4.1 Ethnicity of the Study Participants .................................................................... 60
2.
4.2 Special Skilled and Non-Special Skilled Workers............................................ 61
3.
4.3 Familiarity: Southeast Asian v. Non-Southeast Asian Workers ........................ 63
4.
4.4 Important Factors in Practice: SEA v. Non-SEA............................................... 66
5.
4.5 The Cultural Practice Hard to Accept ................................................................ 67
6.
4.6 The Cultural Practice Hard to Acccept: SEA v. Non-SEA ................................ 68
7.
4.7 The Challenges in Working with SEA Clients .................................................. 69
8.
4.8 The Challenges: Special Skilled v. Non-Special Skilled ................................... 70
9.
4.9 Important Factors: Trained v. Untrained ........................................................... 73
10.
4.10 Challenges: Trained v. Untrained .................................................................... 74
11.
4.11 Resources Available in the Community .......................................................... 78
12.
4.12 Ranked Significant Factors .............................................................................. 80
13.
4.13 Factors to Minimize Cultural Barriers ............................................................. 81
14.
4.14 Factors to Ameliorate Issues of SEA Families ................................................ 82
15.
4.15 Resources Needed for SEA Families ............................................................... 84
16.
4.16 Resources Needed: SEA v. Non-SEA ............................................................. 85
x
1
Chapter 1
INTRODUCTION
Introduction
Cultural competency, the development of skills to interact effectively with in
cross-cultural situations, is the one of the most often discussed concepts in social work
practice. This is evident by the ample amounts of research articulating this subject. The
teaching of cultural competency has been implemented in various educational
curriculums over several years, such as the school of Medical Health, Psychology,
Gerontology, and Social Work. In the last decade, practitioners have relied heavily on
cultural competency practice, and social work was no exception. Cultural competency
began to spread throughout social work universities and human service agencies. The
National Association of Social Work (NASW), for instance, has mandated cultural
competency practice since 1996. For more than a decade, social work professionals have
decreed the importance of cultural competency in social work practice. For example,
cultural competency is not only outlined in the NASW Code of Ethics, but also mandated
by the Council of Social Work Education (CSWE). Within the NASW Code of Ethics,
specific standards were implemented to assure and provide a context for service delivery.
The standard of cross-cultural knowledge, for example, mandates social workers to have
and continue to develop “specialized knowledge and understanding about the history,
traditions, values, family systems, and artistic expressions of major client groups that
they serve” (NASW, 1996). In addition, the standard of cross-cultural skills instructs
social workers to use “appropriate methodological approaches, skills, and techniques that
2
reflect the workers’ understanding of the role of culture in the helping process” (NASW,
1996). In addition, the American Psychological Association requires mental health
professionals to be aware of racial, linguistic, gender, and socioeconomic status of their
clients (APA, 1992).
To some extent, the changing ethnic profile in the United States has sparked the
demand for culturally competent practice. The heightened interest in cultural
competency was also due to research that found that this practice is a mechanism to deal
with diversity issues and their accompanying challenges. In past years, organizations
throughout the United States are responding to this requisition by offering translation
services, employing cultural workers, and providing written materials in various
languages. In addition, organizations are now calling out for culturally competent
professionals. Health, social work, health, and other human service professionals require
integration of cultural references into their work with all people. The reason is that
cultural competency has been recognized by scholars and researchers to improve the
quality of health care, treatment outcomes, and service participation.
The discussion of cultural competency first progressed from multiculturalism to
cultural sensitivity and then to cultural competency. Within recent years, a more
innovative concept has emerged from research – this concept of cultural considerations.
These new studies not only examine the values and beliefs of various cultures, but also
propose interventions that are consistent with one’s cultural values and beliefs. For
example, in a study of psychiatric diagnosis among Chinese Americans, one of the ethical
and cultural considerations identified was utilizing cultural knowledge to change the
3
process of interpersonal communication that is accessible to patients (Yueng and Kam,
2009). The discussion of cultural competency in social work rapidly emerged in the past
decade, in part, due to the staggering number of immigrants and the recognition of
disparities in the quality of services delivered to them.
Among the ethnic and racial groups in the United States, Asian- and PacificIslander- Americans constitute one of the fastest growing groups, increasing by 72%
between 1990 and 2000 (U.S. Census Bureau, 2002). More recent is the influx of
Southeast Asian immigrants (accounting for 68% of the 72% referred earlier by 2003—
U.S. Census Bureau, 2003), which resulted from the United States’ involvement in the
Vietnam War during the early 1970s. Although these Southeast Asians are comprised of
several ethnically diverse groups, including the Vietnamese, Cambodian, Hmong, Mien,
Laotian, and Thai, they share a common immigration history. Moreover, unlike
voluntary immigrants, this group has endured further conflict, compounded by
acculturation issues, environmental influences, and social barriers. Despite this, literature
that addresses cultural considerations within Southeast Asian American communities is
limited in many disciplines, including social work. Although there are studies of
Southeast Asians in the area of health care, mental health, and educational system, few
have focused on the interaction between this group and the child welfare system and/or
ethnic disparities of services offered to this group in the child welfare system.
Statement of Collaboration
The work for this paper is a collaborative effort between Ana Nguyen and Yoriko
Stenhouse.
4
Background of the Problem
More than 70,000 Asian Americans call Sacramento, California home, 17.6
percent of the city’s population (Fong & Kim 2006). While the national poverty rate is
5.1 % in general, the poverty rate among Asian Americans is slightly higher (U.S. Census
Bureau, 2006). In Sacramento County, one of four Asian- and Pacific-Islander
Americans lives in poverty (Fong & Kim 2006). This is worthy to note, since poverty is
the most commonly distinguished and documented risk factor for child maltreatment.
Due to its demographic growth and poverty rates, it is projected that the Asian American
community will increasingly come to the attention of the child welfare system, as
expected in every growing community. According to the Sacramento Department of
Health and Human Services, 2.8% (137) of children in placement during fiscal year
2002/2003 (4,851) were Asian/Pacific Islander, and the number increased to 4.8 % (187)
out of 3,882 during the fiscal year 2007/2008.
In child welfare setting, culturally competent practice is inevitably important.
However, child welfare workers today are generally affected by the lack of available
funds, heavy caseloads, overburden, and insufficient staff training for them to respond to
the growing number of families and children entering into the system. These issues have
become hindrance, contributing to social workers’ inability to provide their clients with
culturally effective services. This poses an immense problem in child welfare agencies,
being that families and children approaching the system are overly represented as ethnic
minorities. Cultural competency is the ability to deliver effective services that are
respectful and consistent with one’s culture (Williams, 1997). Based on this definition,
5
social workers in any organization must take into consideration their clients’ ethnic
background, linguistic needs, religious beliefs, and cultural demands in order to
effectively serve clients of diverse backgrounds.
Asian- and Pacific-Islander Americans, however, remain at the margins of the
current child welfare system since they have difficultly navigating the system. While the
general Asian American families are relatively underrepresented among reported cases of
child maltreatment, Southeast Asian families suffered the most because they share the
difficulty of navigating the system but also have higher incidence of child maltreatment.
According to Pelczarski and Kemp (2006), the reported case of child maltreatment is
higher among Southeast Asian families than that of non-Southeast Asian families.
Anecdotal materials show the increased risk for child maltreatment among Southeast
Asians is the consequence of the stress and difficultly resulting from those families’
recent immigration experience and acculturation issues. As a result, this group has a more
difficult time obtaining meaningful employment, while experiencing intergenerational
conflict, mental illness, and substance abuse problem. These dynamics, therefore, often
place them at a higher risk of interacting with child welfare system.
It is also important to note that the Asian population is not homogeneous. It
includes many groups who differ in language, culture, and length of residence in the
United States. While, Japanese and Chinese in the United States have been represented
in the United State for several generations, Southeast Asians tend to be comparatively
recent immigrants. Many Asian families who come to the attention of the child welfare
system are primarily Southeast Asians, and the reason is that of cultural differences,
6
language barriers, and economic disparity. Recent reports show that Southeast Asians
tend to have lower income and educational attainment and higher poverty rates, when
compared to Japanese, Chinese, and Asian-Indian Americans (U.S. Census Bureau,
2004). Next to Hispanic immigrants, Southeast Asians have the second highest poverty
rates in the United States (Fong & Kim 2006). However, the data on the number of
Southeast Asians in child welfare are unavailable since it is generally put into a more
general category of “Asian- and Pacific-Islander Americans.”
Statement of the Research Problem
In view of the limited amount of empirically based information available, crosscultural challenges exist in one particular field of social work today – child welfare
practice. The rapid growths of racial, ethnic, and linguistic groups present a challenge to
delivery of services in the child welfare system. Cross-cultural issues proliferate as
ethnic minorities increasingly face the child welfare system. Faced with barriers such as
language skills and inexperience with the child welfare system, Southeast-Asian
Americans are likely to avoid services necessary for successful family reunification. In
child welfare practice, certain skills are required to work with people from different
cultures. Although child welfare agencies across the nations are seeking to respond to the
rising ethnic minorities, the lack of exploration in this area has contributed to the lack of
knowledge among child welfare workers and hinders child welfare agencies from
providing appropriate services. For example, the Sacramento County Department of
Health and Human Services (DHHS) Child Protective Services (CPS) has made
systematic efforts to overcome current cross-cultural barriers, including cultural
7
competency training and employing special skills workers and language interpreters.
There is, however, a lack of dedicated time and resources to ensure that cultural
competency training is implemented on a regular and needed basis. Cultural competency
trainings are also applied to all ethnic minorities, making them vague and unspecific to
the Southeast-Asian population. Additionally, there is a lack of mandated training
requirements in the area of language, interpretation, and cultural competency for the
staffs. The agency’s current practice, therefore, seldom addresses the cross-cultural
issues that this group experiences. Nevertheless, the inability of any organization to
provide culturally relevant services prevents practitioners from effectively working in
cross-cultural situations.
To generate higher cultural competency practice among the Sacramento child welfare
agency, there is a compelling reason to study various cultural practices pertinent to the
needs of Southeast-Asian Americans that may serve as a reference source for the
Sacramento County CPS workers and/or practitioners to work with Southeast-Asian
families. This will ensure greater outcome and success, and ultimately contribute to the
systematic change within the child welfare system.
Purpose of the Study
There is evidence that shows that the rising number of ethnic minorities in the
United States will result in an increasing number of ethnic minorities in the child welfare
system. With a large and growing population of Asian Americans in Sacramento County,
Southeast-Asians will increasingly encounter the child welfare system. Unfortunately,
child welfare workers are unprepared to provide culturally relevant approaches to this
8
group. In lieu of this, the study explores the importance of the cultural understanding of
Southeast Asian Americans in child welfare practice. The purpose of the study is to
present various cultural competency practice, gathered from research and Sacramento
CPS workers’ perspectives, with the objective of providing recommendations to the
agency as to how to improve their practice with Southeast-Asian clients. These
recommendations will include whether education and trainings in cultural competency
within CPS should be added or altered and/or whether the agency’s institutional system
should be altered, and/or what services and outreach program should be expanded.
The study will yield information that will provide a better understanding of the
issues and problems concerning Southeast Asian families to assist child welfare workers
when working with Southeast-Asian families. Additionally, information obtained from
this study can help child welfare agencies to identify, plan for, and provide support,
culturally appropriate services, and effective interventions to enhance the well-being of
Southeast Asian clients.
Theoretical Framework
The theoretical approaches that support the aim of the research will include the
ecological system theory and acculturation theories. The ecological systems theory
recognizes the influence of environment as well as internal factors in individuals (Payne,
2005). This theory views the individual at the micro, meso, and macro levels as well as at
the interactions and influences each of these systems have on each other (Payne, 2005).
The ecological system theory focuses on the interactions of structures within a system
and the interaction of structures between systems, and recognizes the bi-directional
9
influences within and between the systems as a vital factor. A change in one level of the
systems, therefore, will creates a domino effect on all the levels of the systems. It views
each existing element within an ecosystem as playing an equally important role in
maintaining the whole. While a system close to the individual has a direct impact, other
outside factors also have a powerful impact on the individual. Changes can occur both
from external environments and from inside the individuals. Additionally, people are
capable of choosing and constructing their own setting, which is affected by the person’s
physical and logical characteristics, experience, and environment. People are both
products and creators of their own environments (Hepworth, Rooney, Rooney G., StromGottfried, & Larsen, 2006).
The ecological system theory allows us to view the experiences of Southeast
Asian families involved in the child welfare system on multiple levels. Cultural
competency, therefore, needs to be included at the individual, agency, and larger policy
levels in order to prevent disparities in services delivered to ethnic minorities. It is
critical for social workers to consider the Southeast Asian immigrant clients’ family
functions, heritage background, immigration experiences, acculturation processes, and
their relationships with the child welfare agency, the community, and the larger society.
An ecological system theory is valuable in that it examines not only the immediate and
apparent impact, but examines the effect on multiple levels.
Acculturations theories help understand the experiences of Southeast Asian
families, who have lived and learned in a cultural context, and then try to adapt to a new
cultural context. The experience in two essentially different cultures and acculturation
10
differences between the immigrant parents and their immigrant or U.S.-born children
have great impacts on Southeast Asian families (Ying & Han, 2007, 2008). Acculturation
is an important variable in the development of Southeast-Asian immigrants’ cultural
identify, in part, because they contribute to the understanding of the extent to which these
individuals have integrated the dominate culture into their lives (Leong & Lee, 2006).
Other theoretical models that develop within the acculturation framework also
guide in the understanding of Southeast-Asian Americans: Unilinear and Orthogonal
models (Oetting, 1993). Contrary to the acculturation theory, the unilinear models
assume individuals need to abandon their original culture in order to adapt to a new
culture. For example, this model of acculturation assumes that the bond of one’s culture
of origin is weakened once Southeast-Asian immigrants as well as other ethnic
immigrants accommodate and familiarize themselves within the host culture (Ryder,
Alden, & Paulhus, 2000). However, this was not true for many Southeast-Asian
immigrants. Acculturation is a multidimensional or multilinear process, where
individuals are able to maintain contact with one culture while adapting to another,
forming a bicultural identity and skills (Berry, 2003).
Orthogonal models further suggest that identification with one culture is
independent of identification with any other culture (Oetting, 1993; Valencia & Johnson,
2008). This model explains an individual can have any combination of cultural
identification; he or she may exhibit a single cultural identity, a bicultural identity, a
strong identification with one culture and a modest one with another, or a weak
identification with any culture (Oetting, 1993). Assimilation, integration, separation, and
11
marginalization are also distinguished in various ways in which acculturation could take
place (Berry, 1980, 2003). It is when individual follow integration strategy of
acculturation that they are likely to be well adapted to another new culture
psychologically, socioculturally, and economically (Berry, 2003). Each group or
individual takes different path to acculturation outcomes depending on many factors at
multiple levels, including the nature of cultural contact, the attitude of the host culture,
the governmental policies, social ecology, vitality, and individual psychological factors
(Berry, 2003). Accordingly, Southeast Asian immigrant families have their own unique
cultural traits, immigration history, and acculturation outcomes. When providing services
to the family, social workers, therefore, need to assess the extent of acculturation in order
to provide relevant services. When coordinating ethnic/racial matching of clients and
social workers, the acculturation degree of both parties also might need to be looked at.
Definition of Terms
-Asian- and Pacific-Islander Americans: Americans whose primary ethnic identification
and familial descent are of Asian and Pacific origin, which include Chinese, Filipino,
Indian, Vietnamese, Laotian, Korean, and Japanese.
-Southeast-Asian Americans: Americans whose primary ethnic identification and familial
descent are of Southeast-Asian origin, from region including Brunei, Cambodia,
Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam.
-Cultural Competence: the ability to deliver services in a way that is respectful of a
different culture, builds on the strengths of the culture, and is consistent with the culture.
12
-Immigrant Families: Family who has migrated to the United States from another country
and has members whose legal categories fall into: either legal permanent resident;
naturalized citizens; refugees; or undocumented immigrants.
-Child Welfare System: A system of services designed to promote the well-being of
children by ensuring safety of the children and strengthening families to care for their
children.
-Child welfare worker: people who provide direct service to clients in Child Welfare
System.
-Cultural Worker: Child welfare workers with a special skill status.
-Ethnic Matching: Matching clients with child welfare workers of the same race and
ethnic background
-Cultural Matching: Matching clients with child welfare workers of the same or similar
cultural background, which include age, ethnicity, gender, and sexual orientation.
Assumptions
This study stands on several assumptions regarding the cultural considerations
necessary when working with Southeast-Asian families. Here, it is assume that culturally
competent practices can better serve children and families in the child welfare system. In
addition, social workers play a key role in the experience and outcome of families in the
Child Welfare System. It is furthermore postulated that all participants will use the
correct procedures to answer the questions as outlined on the given instrument.
13
Justification
As summarized in the National Association of Social Worker’s Code of Ethics
(1996), the mission of social workers includes being receptive to their clients’ cultural
and ethnic diversity and making every effort to end discrimination and oppression. The
importance of learning the issues of Southeast-Asian Americans and the cultural
considerations most effective when working with this particular group demonstrates
cultural competency and therefore, is significant in the profession of social work.
Given the rapid growth of ethnic minorities in the child welfare system, it is,
therefore, important that CPS social workers uphold these standards in an effort to give
surety to their responsibility and enhance the welfare of their families and children. The
knowledge acquired in this research will help with the finding of cultural considerations
necessary to work with Southeast-Asian Americans in the child welfare system.
The study’s findings will guide the development of a model for culturally
competent practice in the Sacramento County child welfare system. Lack of cultural
competency should be of great concern to social work practitioners, scholars, and policy
makers. It is important for social work professionals to understand that the current model
of child welfare services has failed to meet the needs of the Southeast-Asian populations,
and acknowledge the racial and cultural issues that affect service outcomes. Social
workers are obligated by their profession to educate themselves further about various
multicultural practices.
The lack of cultural sensitivity and awareness while working with SoutheastAsian immigrants in child welfare can lead to discriminatory practices and affect success
14
of outcomes. The reason is that Southeast-Asian immigrants have distinct cultural values
and practices; additionally, they have experienced hardships through immigration, low
educational attainment, low socio-economic status, and language and cultural barriers.
Research findings may help Sacramento County develop a service model to provide
culturally appropriate services to the Southeast-Asian population and improve outcomes.
Information collected will better inform the researchers what aspects of policies,
programs, and existing models are effective in meeting the needs of this population.
Without appropriate culturally competent interventions and services geared towards
Southeast-Asian immigrant families, it will be difficult to achieve equal service
outcomes. In addition, enhancing the lives of this population will be difficult.
Limitations
The value of any study depends heavily on the accuracy of the data collected.
Studying cultural considerations of Southeast-Asians in child welfare has clear
limitations. First, as this study utilized a small sample (n=30) of respondents and is
limited to Sacramento County, the results may ineffectively represent the general
population. In addition, the small sample of cultural workers and Asian workers
employed at Sacramento County CPS limits the comparison between the two groups.
Second, the measure of cultural competency practice of Sacramento County CPS worker
were based on self- assessments and may be inaccurate due to social desirability that may
affect the participants’ choices. Third, this study targets Southeast-Asian Americans and
may be inapplicable to other ethnic population. Furthermore, the majority of the subjects
in this study have limited direct experience working with the Southeast Asian population,
15
and, therefore, this study focuses more on their perceptions and beliefs rather than their
actual experience in the field. Therefore, these limitations may affect the quality of the
data.
16
Chapter 2
REVIEW OF LITERATURE
Introduction/Overview
The importance of cultural competency practice in child welfare appears well
established (Hosley, Gensheimer, & Yang, 2003; Lu, Landsverk, Ellis-Macleod, Newton,
Ganger, &Johnson, 2004; Lu, Organista, Manzo, Wong, & Phung, 2001). The
association between cultural competency practice and treatment outcomes among
Southeast Asians has become recognized in the field of social work as well. Little
research, however, has distinctly focused on culturally competent child welfare practice
within the Asian American community. Those who have attempted are Anh (1994);
Fong (1994); Humphreys, Atkart, and Baidwin (1999); Pelczarski and Kemp (2006); and
Perry and Limb (2004). Culturally competent child welfare practice in social work is an
essential component to the quality of services social workers can provide to their clients.
It is not until social workers identify the unique cultural considerations of Southeast
Asians in child welfare practice that they can better meet the needs of this group. The
review of past and current literature, as well as reports from the Sacramento County’s
Department of Health and Human Services, Child Protective Services’ (DHHS, CPS) will
lead to significant findings regarding cultural competency practice and Southeast-Asian
Americans. In addition, understanding of the pre- and post-immigration difficulties that
Southeast Asian Americans have experienced will help promote a better understanding of
various cultural issues, including maltreatment, among this group. Awareness of these
issues, taken together, will assist social workers and other human service providers to
17
provide culturally competent services catered to the needs of the Southeast Asian
communities.
Cultural Competence
Cultural competence in social work practice should be integrated in every aspect
of work with clients. Understanding clients’ cultures – their customs, norms, beliefs, and
values – not only shows respect to the client, but also is central to positive outcomes,
including building good rapport and engaging clients in services. Cultural competency
reflects the agency’s goals to deliver effective services that are respectful and consistent
with one’s culture. It is a key factor that enables social workers to understand families’
experiences and engage them in a meaningful way (Williams, 1997). The consequence
of cultural incompetence of social workers may incline them to make harmful decisions,
fail to build on the strengths of families and communities, and blame families for their
failure (Williams, 1997), ultimately bringing harm to children, families, communities,
and the child welfare system as a whole.
Although the concept of cultural competency is defined and measured in several
different contexts, many scholars have agreed that cultural competency is integral in
providing culturally relevant, appropriate, and consistent services that enhance one’s
well-being. For example, the Child Welfare League of America (2002) defines cultural
competence as the ability to respond effectively and respectfully to all cultures, races,
ethnic backgrounds, sexual orientation, and religions, and in such a manner that
recognizes and values the worth of individuals, families, tribes, and community, as well
as protecting the dignity of each. Lum (2003) discusses cultural competency in term of
18
cultural awareness, knowledge acquisition, skill development, and inductive learning.
Lum (2003) contends that culturally competent practice should include certain skills,
behavior, attitudes, and policies in a system that enables professionals to provide
effective service deliveries in cross-cultural situations. Fong (2003) posits that cultural
competence should involve the four dimensions that Lum (2003) suggested, all of which
needs to be included at micro, meso, and macro levels. Along with race, culture, and
ethnic background, the power and acculturation levels of the individuals were also
considered as part of being culturally competent by Green (1999), Pinderhughes (1995),
and Williams (1997).
Cultural awareness is a critical component in cultural competence practice.
Cultural competence involves self-awareness of one’s culture and how it may influence
the interaction practitioners have with their clients (Christensen, 1988; Fong, 2003; Lum,
2003; Pinderhughes, 1995). In social work practice, practitioners may bring with them
their own sets of value, cognition, attitude, and behavior, including racism and prejudice,
to their work with clients. However, being unaware of this may not only increase the
disparities in services but can place clients in danger (Lum, 2003). Pinderhughes (1995)
argues that the confusion and negativity about one’s own cultural background can
seriously undermine the practice of practitioners as this may lead to their own discomfort
in interacting with clients. It is, therefore, crucial that social workers be aware of their
own cultural background and identity and be able to confront their own racism and
prejudice.
19
In social work practice, considering families’ cultural backgrounds is essential
when determining risk and safety assessments (Pinderhughes, 1991). Considering a
family’s cultural background means understanding the family’s cultural viewpoints
(Horejsi, Craig, & Pablo, 1992, 1992; Yueng & Kam, 2009), the family’s perspectives of
the problem, as well as their inputs on how to solve the problem (Green, 1999).
Differences in language, culture, and experience of the Southeast Asian population prior
to moving to the United States are important to recognize and must be respected. Yueng
and Kam (2009) note that understanding how Southeast Asian families view child abuse
and other family violence can better prepare social workers to plan culturally competent
programs and deliver services that meet the needs of these communities.
Along with this, knowledge acquisition can enhance social workers’
understanding and effectiveness in providing culturally competent services to
multicultural clients (Fong, 2003; Lum, 2003). The knowledge that social workers have
of their clients should include the following: the demographic profiles; the history of
oppression of the cultural group, including immigration history; the social, political, and
economical environments of the family's country of origin as well as the host country;
traditional cultural values of the country (especially in regard to the family unit); helpseeking behaviors of the people in that country; coping behavior of the people in that
country; and assimilation and acculturation (Fong, 1994; Lum, 2003; William, 1997).
Obtaining this information can be quite difficult due to the diversity even within a
cultural group. Thus, Green (1999) suggests the use of an ethnographic approach with
social workers’ willingness to discover and accept new information from clients. The use
20
of critical thinking as a means to analyze obtained knowledge is also critical in the
understanding of one’s culture (Lum 2003), as well as forming hypotheses regarding
cultural differences, creating ways to test hypotheses, and acting on the basis of the
acquired data (Sue, 1998). In addition, scholars have pointed out that having the
flexibility to change false beliefs and to recognize that one’s way of thinking is not the
only way (Pinderhughes, 1995), having the ability to be flexible in generalizing, and
knowing when to be inclusive and be exclusive can help social workers avoid
stereotypical overgeneralization and appreciate the importance of culture (Sue, 1998).
Skill development is another component of cultural competence practice.
Cultural competency skill is the ability to apply cultural awareness and knowledge to
interact effectively with clients, and requires the use of culturally based interventions and
translating interventions into culturally consistent strategies (Lum, 2003; Sue 1998).
Cultural competency skills are involved in each of the four stages of the changing
process: engagement, assessment, intervention, and termination. The building of crosscultural relationships is critical in effective service delivery and it requires professional
self-disclosure, effective communication styles relevant to the culture, and understanding
the ethnic community and relationship protocols of the culture (Lum, 2003).
Assessment skills involve a biopsychosocial perspective that analyzes individuals
and their environment and is essential to understand, respect, and appreciate the role of
cultural values in the biopsychosocial functioning of the clients (Lum, 2003;
Pinderhughes, 1995). This means that the clients’ experiences should be perceived
through their own cultural lens rather than that of the practitioner (Green, 1999;
21
Pinderhughes, 1995), which also can be achieved through ethnographic interviewing
(Green, 1999). Traditional values of ethnic groups should be viewed as strengths in the
assessment process (Fong, 2003). It is also important for social workers to understand
that cultural values play major roles in micro, macro, and meso levels of the client
system. For many ethnic groups, macro-societal values dominate the meso and micro
levels of the functioning of family and individuals, which is especially true for Asian
groups (Fong, 1994). The community is the key player in offering support, and the
family is the basic unit of functioning, which has an impact on the individual’s biological,
psychological, and social functioning in the population. This is because a core value
among Asian families is the appreciation of the both the immediate and the extended
family members.
In the intervention and termination process, social workers should strengthen
cultural identity, use the client’s support systems, serve as a “cultural broker”, and select
relevant strategies based on problem identification and assessment (Green, 1999; Lum,
2003). To improve services provided to Asian clients, social workers need to evaluate
whether the traditional Western interventions foster the Asian cultural values and whether
programs are accessible, available, and accountable to the community, and then modify
the traditional Western interventions to meet the needs of the clients as necessary (Fong,
2003; Russell & White, 2001). For social workers to be truly culturally competent, they
also should be able to code switch, not only linguistically but also culturally, between the
boundaries of cultural communities (William, 1997).
22
Cultural competency needs to be included at not only the macro (practitioner)
level but also at meso and macro levels in order to provide effective service delivery in
cross-cultural situations. Meso cultural competence addresses the agency or program
level to integrate a set of policies, practices, and procedures that allow them to respond to
different groups and to deal with a number of dimensions in diversity (Williams, 1997).
Thus, the child welfare system must promote cultural sensitivity in practice and create
policies that promote diversity consistent with ethnic/racial diversity of clients so that
systems can reduce cultural and linguistic barriers as well as to adapt to diversity and
effectively serve clients (Cox & Ephross,1998; Pinderhughes,1991). It is also important
to create a culture within an agency that supports multicultural issues involving client to
worker relationships to build collaborative relationships between the agency and
communities (William, 1997). Moreover, training diversified staff members and
collaborating with communities are essential to ensure a competent organization.
Cultural competency at meso level is necessary for social workers to be culturally
competent in micro level. Macro cultural competence refers to large systemic efforts to
address cultural competence issues and it intends to replace the context of discrimination,
segregation, and distinct boundaries with a context of multiculturalism, celebration of
diversity, promotion of cross-cultural interaction, and social justice (Lum, 2003).
In summary, cultural competency is an ongoing process that occurs when
practitioners continue to learn new patterns of behaviors, values, and attitudes of a
particular culture and apply them to practice. Cultural awareness, knowledge acquisition,
and skills development are some of the essential elements that can contribute to a higher
23
degree of culturally appropriate services and interventions. The practice of cultural
competency emerged, particularly in social work practice, as evidence of the disparity in
services among minority groups became known. The Southeast Asian population is a
special case, as it is one of the slower acculturating groups with various cultural and
linguistic barriers. It is, therefore, critical that social workers, who work with Southeast
Asian clients, have cultural competence. Social workers should be culturally aware of,
and have knowledge of, the immigration experience, adjustment difficulties, and other
acculturation issues that they are facing, and should have the ability to apply the
awareness and the knowledge to interact with the client at multiple levels.
History of the Southeast Asian Population
While Asian Americans, such as the Japanese and Chinese, have been represented
in the United State for several generations, the majority of Southeast Asians are relatively
recent immigrants. Many Southeast Asians came to the United States as refugees after
the U.S. involvement in the Vietnam War in the 1960s and 1970s. Since the evacuation
of American soldiers from Vietnam in 1975 that ultimately resulted in the collapse of the
Cambodian and Laotian government, over two million refugees had little choice but to
leave their homeland if they wanted to survive (Green, 1999; Tenhula, 1991). Because of
the collaboration between the United States and the non-communist regions, many
Southeast-Asians refugees were able to flee to the United States (Tenhula, 1991).
The Southeast Asian refugees were of various distinct ethnic, cultural, and
linguistic groups of people in Southeast Asia. By 1975, 128,000 people from South
Vietnam, 5,000 from Cambodia, and 2,000 from Laos entered the United States with
24
refugee status (Tenhula, 1991). These refugees were the “initial wave”, which lasted until
early 1978. After the fall of South Vietnam, the Vietnamese communist regime attempted
to restructure the country by sending hundreds of thousands of people to re-education
camps. The severe conditions that many Vietnamese people faced forced them to escape
in small, overcrowded boats even though they knew of the potential risks (Tenhula,
1991).
In contrast to the “first wave” of immigrants, which included a higher proportion
of the middle-class and well educated, the “second wave” of immigrants arrived in the
late 1970s (Green, 1999; Tenhula, 1991). This group of refugees, mainly farmers and
merchants, were those who stayed back and were forced into the refugee camps for
several years. The second wave were off a more diverse background of minority ethnic
groups, such as Cham, Hmong, Khmer, and Chinese refugees, and were generally
uneducated, unskilled, had a rural background, and were illiterate (Green, 1999; Rhee &
Chang, 2006, Tenhula, 1991). Different from the prior Southeast Asian immigrants,
“second wave” refugees risked their lives and their families’ lives to escape the severe
social circumstances they faced under the new communist governments.
Many Cambodians arrived in the mid-1970s as political refugees. The United
States and South Vietnamese forces invaded Cambodia to gain control of the country
with the intention of destroying the Cambodian communist party. Beginning with the
massive U.S. bombing attacks and continuing through the rise of the Cambodian
communist party, the Khmer Rouge from 1975 through 1979, 1 to 3 million people were
25
estimated to be tortured, raped, forced to kill their own family members, and to witness
loved ones killed (Tenhula, 1991; Rhee & Chang, 2006).
In addition to the Vietnamese and Cambodian populations, the Laotian and
Hmong populations were uprooted by the same war. The United States recruited
thousands of Laotian and, particularly, Hmong men as allies during the war. The military
action of the United States government ultimately left one-third of the Laos and Hmong
populations dislocated during the war (Tenhula, 1991). After being persecuted under the
new communist regime and relocated to the reeducation camps in Laos, thousands of
Hmong, Cambodians, and Laotians escaped and fled across the Mekong River, where the
majority of them made it to Thailand, and eventually to the United States.
Since then, the United States has experienced a rapid increase in the number of
immigrants from various Southeast Asian countries. The passage of the Family
Reunification Act of 1965 and the influx of Southeast Asian since the 1970s have
contributed to time in case. Among the states, California is one of the six major
immigrant destination states (Lincroft, Resner, Leung, & Bussiere, 2006). In 2007, 12.4
% of 36.5 million Californians were estimated to be Asian, compared to 4.4% nationwide
(U.S. Census Bureau, 2008a).
Theoretical Foundation
Scholars have espoused various theoretical perspectives, particularly the
acculturation theory, to understand the Southeast-Asian population. Acculturation is the
process of individuals adapting to cultural environmental changes that require the contact
of at least two cultural groups (Berry, 1980, 2003; Valencia & Johnson, 2008), which can
26
occur at either the cultural level – as an aspect of the broader cultural change, and/or at
the psychological level – the changes in individuals who participate in cross cultural
contact (Berry, 1980, 1997, 2003). When individuals adapt to a new society, the changes
in their sense of cultural identity can include attitudes, behaviors, and values, as they are
learning the new language, customs, laws, and social norms and behavior.
It has also been known that the level of acculturation has contributed to disparities
in socioeconomic status, educational level, and access to resources among immigrants.
Measuring one’s level of acculturation, therefore, has been of great interests to theorists
throughout acculturation studies. Various measurements of acculturations have included
one’s language and cultural behaviors (Cuéllar, Arnold, & Maldonado, 1995), one’s
length of exposure to the host culture (Ryder, Alden, & Paulhus, 2000), the status,
prestige, and one’s strength of cultural network (Cheung-Blunden & Juang, 2008), and
even one’s sense of psychological attachment and belonging within the dominant culture
(Tropp, Erkut, Coll, & Alarcon, 1999).
Understanding how individuals acculturate has been the subject of much study.
Several distinct theoretical models have been used to guide the acculturation process.
The unidemensional model proposes that changes in cultural identity take place along a
single continuum over the course of time (Laroche, Kim, Hui, & Tomiuk, 1997).
Theorists who hold the unidemensional perspective assume that in order for acculturation
to occur, one must give up traits of the original culture while gaining the traits of the new
culture. Thereby, the process of adapting a new culture must happen simultaneously
while abandoning the attitudes and customs of another culture (Berry, 2003). This
27
framework posits that one cannot maintain a strong ethnic identity once he or she has
become assimilated into the mainstream society.
On the contrary, it has also been hypothesized that acculturation occurs at the
bidimensional level, where the acculturating individuals are still able to maintain their
original cultural values, attitudes, and behavior, despite adapting to another culture
(Valencia & Johnson, 2008; Berry, 2003; Ryder, Alden, & Paulhus, 2000). Theorists
supporting this model presume that there is a distinct relationship between the minority
and dominant cultures along the acculturation process. Each group or individual takes a
different path to acculturation outcomes depending on various factors including the
nature of cultural contact, the attitude of the host culture, the governmental policies,
social ecology, vitality, and individual psychological state (Berry, 2003). Bicultural
models suggest that an individual is able to maintain contact with one culture while
adapting to another, forming a bicultural identity and skills (Berry, 2003; Oetting, 1993).
Meanwhile, orthogonal models further suggest that identification with one culture is
independent of identification with any other culture (Oetting, 1993; Valencia & Johnson,
2008). This model explains that an individual can have any combination of cultural
identifications; he or she may exhibit a single cultural identity, a bicultural identity, a
strong identification with one culture and a modest one with another, or a weak
identification with any culture (Oetting, 1993).
The discussion of which model effectively captures the acculturation process has
been commonly debated in past and current literature (Ryder et al., 2000; Valencia &
Johnson, 2008). Despite the different views, the effectiveness of the bidimensional
28
model seems more supported by the literature. However, there are scholars who agree
that acculturation dimensionality may differ across contexts. These theorists speculate
that the data of the study should determine which acculturation model would be more
appropriate (Cheung-Blunen & Juang, 2008). Overall, a review of the literature indicates
that acculturation is a complex process as it is dependent upon an individual’s values,
experiences, and opportunities.
Acculturation has been established as playing an important role in the
development of cultural identity and adaptation in a social environment. The literature
has indicated there is an association between the degree of acculturation and
psychological adaptation of individuals. Berry (2003) contends that individuals who
pursue and accomplish this acculturation strategy appear to be better adapted
psychologically and socio-culturally than those who have not. Oetting (1993) found that
children with a high cultural identity have a higher sense of competency, capability, and
confident. Another study has concurred with this finding as well. Leong and Chou
(1994) illustrated the role of acculturation in the lives of Asian Americans and found that
there was a significant relationship between Asian Americans’ cultural identities and
career choices. The authors speculate that Asian Americans with a separationist identity
are more likely to experience discrimination, which can lead to lower levels of job
satisfaction, decreased upward mobility, and higher levels of job stress (Leong & Chou,
1994).
It is important to note that there are different rates of acculturation, depending on
one’s distinct experiences. In a study evaluating two groups of Asian Americans
29
(Vietnamese and East-Indians), Kwak and Berry (2001) show that the East-Indian group
had reached a more stable adaptation, while the Vietnamese group was still in a crisis
phase. Kwat and Berry (2001) posit that the different adaptations were attributed to their
immigration processes. In another study, Bemak, Chung, and Wong (2000) compare two
groups of Vietnamese refugees who came to the United States at different times, and their
study results indicate that the more recent immigrant group experiences higher
psychological distress and acculturation difficulties. Therefore, one cannot generalize
about the acculturation process since sub-groups are different from one another, share
different experiences, and have different perspectives.
Cultural Concerns
Arriving relatively recently in the United States, the Southeast Asian population’s
resettlement process was disrupted in several aspects. Whether having immigrated 30
years ago or within the last five or 10 years, the pre- and post- immigration experiences
of Southeast Asian immigrant families included multiple stresses (Hosley et al., 2003;
Lincroft et al., 2006; Pelczarski & Kemp, 2006; Carson & Rosser-Hogan, 1993, Chang,
Rhee, & Berthold, 2008). Unlike many migrants, these refugees were often unprepared
to leave their country of origin, and suffered the traumatic exodus experiences. Language
unfamiliarity, lack of a social system (Coll et al., 2002) poverty, emotional stress, family
violence (Yeh, 2003; Leong & Lee) and lack of financial means (Stewart, Anderson,
Beiser, Mwakarimba, Neufeld, Simich, & Spitzer, 2008) have all been prevalent among
this group. The U.S Census Bureau (2004a) shows that Southeast Asians particularly
among the Hmong population have much higher poverty rates than other Asian groups.
30
This is important to note since studies have documented high rates of poverty among
child maltreatment cases (Brown, Cohen, Johnson, & Salzinger, 1998). The reason for
high rates of poverty can be attributed to language and cultural barriers, inadequate
formal education in their home country, and unfamiliarity with American systems, which
have limited the opportunities for Southeast Asian adults to gain meaningful employment
and upward mobility. Studies have also documented that these social barriers among
Southeast Asian adults not only result in unstable employment but also in high rate of
welfare dependency, high stress level, and low self-esteem (Chang et al., 2008; Rhee &
Chang, 2006). Other studies contend that Southeast Asian families are highly exposed to
violence in the United States, which also creates more traumas in addition to the trauma
experienced in their home country (Ho, 2008; Marshall, Schell, Elliott, Berthold, &
Chun, 2005).
A high proportion of this Asian group suffers from psychological distress, family
conflict, and violence, resulting from not only the hardships endured in the late 1970s,
but also the discrimination experienced since. Researches have asserted that the level of
acculturation is associated with health behaviors among immigrants (Yeh, 2003; Leong &
Lee, 2006). For example, in Yeh’s (2003) findings, acculturation stress was the most
significant factor in general mental health of Asian immigrants. The manifestations of
various psychological problems are generally caused by experiences of cultural conflicts,
which include acculturation stress and interpersonal conflicts (Leong & Lee, 2006). A
preliminary study found that mental illnesses, such as depression and post-traumatic
stress disorder (PTSD), are prevalent among Cambodian adults, and are the likely result
31
of the trauma experienced under the Khmer Rouge regime. These experiences include
violence, sexual abuse, and loss of family members (Blair, 2000; Carlson & RosserHogan, 1993; Marshall et al., 2005). Post-immigration stresses such as poverty,
illiteracy, prolonged welfare dependency, cultural differences, social isolation, the
language barrier, and loss of status also contribute to the occurrence of psychological
problems among Southeast Asian refugees (Blair, 2000; Carson & Rosser-Hogan, 1993),
and alcohol and drugs were common coping mechanisms utilized to alleviate depression
and feelings of inadequacy (Chang et al., 2008; O’Hare & Tran, 1999). Furthermore,
other acculturation stresses such as dealing with a new role, new language, and new
social environment (O’Hare & Tran, 1999) also contribute to child maltreatment
occurrence (Brown et al., 1998; Lincroft et al., 2006; Pelczarski & Kemp, 2006; Ima &
Hohm, 1999).
Forming a social support system is even more difficult when immigrants have
limited information about the new society, language difficulties, and no help from the
community (Stewart et al., 2008). The level of acculturation is also associated with
patterns of help-seeking behavior among immigrants. Yeh (2003)’s findings explain that
Asian Americans who are more acculturated into the society, such as through language
proficiency, can achieve higher academic skills, and, therefore, may be more comfortable
communicating and seeking professional services. Asian Americans who have lived in
the United States for a longer period and are well adjusted, generally Chinese-, Japanese-,
and Korean-Americans, are more likely to seek services when needed than do the more
recent Southeast Asian Americans, such as Vietnamese-, Cambodian-, or Hmong-
32
Americans. It is evidenced by the continuous reliance on traditional medicine and
spiritual healing methods, which are highly valued among Southeast Asian communities
(Chung & Lin, 1994). Along with limited acculturation, the underutilization of mental
health services among Southeast Asian immigrants can also be attributed to the stigma
associated with mental illness, unfamiliarity with community services, and the
individuals’ distrust in mental health professionals, particularly among those who are
ethnically and culturally different from them.
Although psychological distress can contribute to complex family dynamics,
studies have clearly documented the relationship between cultural change and family
conflicts (Kwat & Berry, 2001); Lee, Jung, Su, Tran, & Bahrassa, 2009; Ying & Han,
2007-b, 2008). A study posits that unless their own community and social network
support the culture of one’s family, the acculturation stress can be detrimental to the
harmony of family relationships (Kwat & Berry, 2001). Several studies have
documented the pervasive intergenerational conflicts among Southeast Asian families
(Hosley et al., 2003; Ying & Han, 2008; Ying & Han, 2007, Pelczarski & Kemp, 2006;
Chang et al. 2008). The reason for significant intergenerational conflicts can be
explained by either the gap or differences in the rate of acculturation between parents and
their children. Immigrant parents generally retain the lifestyle and traditions of their
homeland while their children are quicker to adopt the American culture and develop
different attitudes on various issues such as academics, ethnic identity, values, and
lifestyles. This is due in part to the children’s developmental stage and increased
opportunities to interact with the mainstream society (Xiong et al., 2005), as well as
33
influences by peers, school, media, and the larger society as a whole (Lee, Jung, Su, Tran,
& Bahrassa, 2009;Ying & Han, 2007-a & b). As children gradually reject their families’
values and begin to challenge parental authority, parents are inclined to exercise higher
authority over their children. For example, the concern that Hmong children’s rejection
of the traditional customs and values will jeopardize the Hmong community has led
parents to exert greater control over their children (Lee et al., 2009). While the
traditional authoritarian parenting style is prevalent among Southeast Asian families
(Nguyen, 2008), Southeast Asian adolescents prefer a parenting style that reflects the
U.S. cultural norms (Nguyen, 2008; Ying and Han, 2007a). Additionally, the role
reversal between parents and their children due to English skills may have contributed to
the unstable parent-child relationships, making family dynamics increasingly complex
(Chang et al., 2008).
The risk for intergenerational conflicts among Southeast Asian families is
increased by the significant difference between Southeast Asian culture and mainstream
American culture (Ying & Han, 2008). While the mainstream American culture
emphasizes individuals, youth, and the family formed after marriage, Southeast Asian
cultures value the elderly, the family of origin, and the family unit above the individual
(Ying & Han, 2007b). A study shows that when compared to their Anglo-American
counterparts, the Asian groups (East-Indians, Korean, and Vietnamese) agreed on greater
parental authority, greater children’s obligation, and little emphasis on children’s rights
(Kwak & Berry, 2001). The risk for intergenerational conflict is also likely to be
prominent during adolescence, a period during which American youths are expected to
34
forge individualism and independent identity whereas Southeast Asian adolescents are
expected to bear more responsibility and to contribute to their family’s well-being (Xiong
et al., 2005; Ying & Chao, 1996). As a result, Southeast Asian youths feel confused and
trapped by the conflicting home and school cultures, and the inconsistent values and
expectations of their parents and peers (Rhee & Change, 2003), while their parents feel
betrayed and dismayed by this unexpected problem (Kibria, 1993; Ying & Chao, 1996
cited in Ying & Han, 2007-b). The difference in values between the two cultures often
becomes intertwined, causing not only acculturation stress but also interpersonal
conflicts. It often leads to the collapse of parent-child communication, the weakening of
the parent-child bond (Han, 2006) and increasing further intergenerational conflict (Ying
& Han, 2007a), and, ultimately, to the loss of important familial resources and support
(Lee et al., 2009). These predicaments also result in adjustment problems, psychological
distress, and poor academic performance among the children (Lee, et al., 2009).
Parental acculturation, intergenerational relations, and child outcomes are
significantly associated (Ying & Han, 2008). Studies have documented the relationship
between intergenerational conflicts and mental health among Southeast Asian immigrant
adolescents, such as low self-esteem and depression (Han, 2006; Nguyen, 2008; Ying &
Han, 2007a&b) and a low sense of coherence (Han, 2006). It was found that those
adolescents who perceived their fathers as not being acculturated, and using the
traditional authoritarian parenting style, reported lower self-esteem and higher depression
scores (Nguyen, 2008) as well as a lower sense of coherence (Han, 2006). Acculturation
facilitates parental involvement across home-education, school, and social contexts,
35
which help to enhance the quality of the intergenerational relationship, which in turn
promotes the adolescents’ well-being (Ying & Han, 2008). For example, a study found
that parents with limited English skills are less engaged with their children in areas of
their attitudes, school involvement and study, and control over children’s behaviors (Coll
et al., 2002). Unfortunately, among the Southeast Asian families, parental involvement
in the children’s lives is often negatively affected by the post-migration challenges (Ying
& Han, 2008).
Taken together, these studies suggest that several cultural issues are significantly
relevant to the acculturation experiences of Southeast Asians. The reason is that
significant life changes that come with facing the challenges in a new society bring a
certain amount of stress. Mental health disorders and intergenerational conflict are two
of the most common problems documented among Southeast Asian families and dealing
with these issues will often delay the acculturation process in the United States. It should
be noted that these two problems are in tandem to one another. For example,
intergenerational conflict can intensify previous stress experienced by the immigration
process and contribute to the increase in mental health problems. Cultural factors such as
immigration experiences, psychological distress, and family conflicts can significantly
increase the odds of serious violence, mental health disorders, substance abuse, poverty,
and child maltreatment among this group of immigrants.
Factors Contributing to Child Maltreatment
Although Asian and Pacific Islander Americans are relatively underrepresented
among reported cases of child maltreatment, Southeast Asian families have higher child
36
maltreatment rates than other Asian families (Pelczarski & Kemp, 2006). Studies have
speculated that pre- and post-immigration stresses have considerably contributed to child
maltreatment among this group (Chang et al., 2008; Chang & Rhee, 2006; Hosley et al.,
2003; Ima & Hohm, 1991; Lincroft et al., 2006; Pelczarski & Kemp, 2006). One study
concurs that stresses from political persecution and war-related trauma can severely
affect parents’ ability to effectively care for their children (Coll et al., 2002). This
phenomenon was documented among Cambodian refugees who were considerably less
likely than the general population to be involved in their children’s lives (Coll et al.,
2002). High cases of child maltreatment among Southeast Asian families can also be
attributed to the lack of knowledge of American child abuse reporting laws and/or the
difficulty in adjusting to mainstream American child rearing and disciplinary practices
due to the cultural sanctioning of corporal punishment towards Southeast Asian children
(Chang et al., 2008; Lincroft et al., 2006; Pelczarski & Kemp, 2006). In view of the fact
that child rearing practices and disciplines differ across cultures and societies, Southeast
Asians even today are challenged with different philosophies and adjusting to different
child-rearing and disciplinary practices of the new society (Ima & Hohm, 1991).
Poverty, social isolation, lack of social support, and inadequate housing such as
overcrowding and visible hazards, add further stress to this population in their struggle to
resettle in this new country. Intergenerational conflicts, as well as the role reversal
between parents and their children due to English skills, also augment the risk for
maltreatment (Xiong, Eliason, Betzner, & Cleveland, 2005; Pelczarski & Kemp, 2006;
Chang et al., 2008). Such multiple stressors, as well as alcohol and drug use as a coping
37
mechanism, have been documented in relation to the increased risks for child
maltreatment (Brown et al., 1998; Chang et al. 2008; Lincroft et al., 2006; Pelczarski &
Kemp, 2006; Ima & Hohm, 1991).
Asian Americans in the Child Welfare System
Despite the large body of literature regarding the experiences of ethnic minority
families in the pubic child welfare system (Pelczarski & Kemp, 2006), relatively little is
known about Asian families in this setting. This might be due to the fact Asian families
are relatively underrepresented in reported cases of child maltreatment. It has also been
suggested that resistance towards disclosure likely results from the Asian family value of
filial piety, and leads to underreporting of any forms of family violence by Asian
Americans (Pelczarski & Kemp, 2006). Furthermore, the available data on Asian
families are undifferentiated and often put into a global ethnic category (Asian/Pacific
Islander) which contains more than 20 ethnic groups differing in multiple dimensions
(Pelczarski & Kemp, 2006). Consequently, the stereotype that Asian Americans are the
“model minority” has overlooked many problems within the Asian community as
previously mentioned. Although the maltreatment rates of Asian American children may
be small when compared as a whole, the rates for some sub-Asian group are larger. In
Pelczarski’s and Kemp’s (2006) study, Cambodian, Thai, Laotian, and Vietnamese
families were overrepresented in CPS reports when compared with their representation in
Washington state’s Asian/Pacific Islander population. The reason for the
overrepresentation was attributed to their migration experience, which, Pelczarski &
Kemp (2006) speculated, is likely to intersect with other factors such as devastating war
38
experiences, a minimal level of education, low socioeconomic status, and high rates of
poverty, from which they continue to suffer.
Although limited, literature shows that no current system counters the rising
number of Southeast Asian children in the child welfare system. This is because the
current model of child welfare service has emerged from the dominant Anglo culture and
is not geared to meet the needs of various minorities (Lu et al., 2004). However, this is
not as a significant factor as socioeconomic status, education, employment, and mental
health issues. Social workers, therefore, provide the families with what the agency has,
not necessarily what they need (Williams, 1997). Research has also shown that minority
children, including Asian American children, are more likely to stay in foster care and
have less access to expensive services (Hines, Lee, Osterling, & Drabble, 2007; Lu et al.,
2004). Hines et al. (2007) suggest that families who fail to reunify often have serious
social and economic risk factors unaddressed in family reunification services.
Humphreys et al. (1999) concur that the foster care system often fails to provide adequate
resources to help the reunification process. Another study of Asian children and families
in the child welfare system found that Asian children were less likely than Whites and
Latinos to be reunified with their birth families (Hines, et al., 2007). This study suggests
that Asians in the child welfare system may possess numerous barriers and difficulties in
reunification, such as the experience of being a refugee, language barriers, and low
educational attainment (Hines et al., 2007). Another study indicated that Asian children
had a 67.2% rate of unsuccessful reunification (Lu et al., 2004). Literature, therefore,
shows that the current system does not always match the needs with adequate services,
39
hindering social workers from providing culturally appropriate services to ensure the
well-being of clients and successful outcomes.
The need for services catered to minority children is critical given the rapid
growth of the minority population in the child welfare system (Rosenthal & Curiel,
1990). Research has indicated that the implementation of culturally competent services
when working with Asian Americans generates better outcomes (Lu et al., 2004; Lu et
al., 2001). This is because Asian families have different problems, resources, and needs
than the general population (Lu et al., 2004; Tharp, 1991). Researchers have argued that
social workers and other helping professionals need to set aside the assumption that
Asian families are the “model minority” in order to see the reality that many Asian
groups experience the high stress and anxiety of relocation, material deprivation, and
social immobility (Pelczarski & Kemp, 2006). The term “model minority” may be
suitable for some Asian Americans in the United States; however, it is misleading to
generalize this image across all Asian Americans. For example, Pelczarski’s and Kemp’s
(2006) study found that some Asian/Pacific Islander groups experience higher levels of
socio-economic stress and are at higher risk of child welfare involvement than other
groups. As a group, Asian Americans are too diverse to stereotype. Some Asian ethnic
groups, which include various Southeast Asian groups, experience higher levels of
socioeconomic stress and are more at risk of child welfare involvement. For example, in
Hines et al. (2007), the county in which their study of Asian children in the child welfare
system took place has a large Southeast Asian immigrant population and the sub-sample
of Asians in this study contained two-thirds Southeast Asians.
40
Cultural and language barriers are some of the biggest issues that have to be
overcome in order to better serve Southeast Asian families. Although Southeast Asian
refugees have been in this country for almost 30 years, the language barrier is still a great
concern. Over 90% of Cambodians, Hmong, Laotians, and Vietnamese speak a language
other than English at home, and over 50 % of them spoke English less than “very well”
(U.S. Census Bureau, 2004a). Humphreys et al. (1999) found that the majority of
Southeast Asian families needed an interpreter when seeking services, and even then,
many experienced discriminatory services. A more recent case study of a Vietnamese
Head Start interpreter provides an anecdotal update. Nine out of the ten Southeast Asian
families described in the case study depended on this interpreter for services such as
phone calls from English-speaking agencies, doctor conferences, and/or parent-teacher
conferences (Hwa-Froelich & Westby, 2003). Another study also found that hiring
bilingual and bicultural staffs was associated with greater access of mental health
treatment among Asian Americans (Snowden, Masland, Ma, & Ciemens, 2006). In spite
of this finding, there continues to be an inadequate number of bicultural/bilingual
workers and interpretation services in the child welfare system (Lincroft et al., 2006).
Considering the cultural, social, and linguistic barriers that Southeast Asian families face,
much of the literature recommends increasing the number of child welfare workers that
reflect the Asian community, making interpretation services readily available and
expanding culturally and linguistically relevant outreach programs.
41
Current Practice
There has been a consensus that cultural competency in social work organizations
requires staffing, management, and leadership reflecting the diversity of the client
population (Nybell & Gray, 2004). In recent years, child welfare agencies have been
under public criticism for being negligent with high staff turnover, insufficient trainings,
and inadequate response to the families and children entering the system. For example,
in the most recent review of the Sacramento County Child Protective Services Division,
the overall finding concluded that the majority of children and families in the Sacramento
child welfare system are underserved (MGT of America, Inc., 2009). The review noted
that although there are a large number of referrals being investigated every year,
performance issues continue to hinder the county division’s ability to provide effective
and efficient services, therefore, contributing to the lack of opportunities that child
welfare workers have to protect children from abuse and neglect as well as to preserve
their safety and well-being. It was also contended that the current structure and
requirements within the system are set up in a way that social workers cannot perform
their duties; for example, social workers and supervisors struggle to work in a system that
exceedingly places stress on documentation, paper work, and deskwork rather than on
children and fieldwork (MGT of America, Inc., 2009). In addition, it was found that CPS
workers are carrying twice as many caseloads as was recommended by the Child Welfare
League to ensure best practices. Given the increase in caseloads, and the demands on
documentation and procedures, social workers are continuously failing to provide
appropriate services to meet the needs of families and children. These problems
42
ultimately prevent successful reunification of families and preservation of children’s
well-being and safety.
To better serve the growing Southeast Asian population, it has been suggested
that child welfare agencies should create various distinct units to carry out different
responsibilities. The Los Angeles County Department of Children and Families Services,
for instance, have established various specialized units in an attempt to meet the specific
needs of diverse population. The units include Asian Pacific Project, Black Family
Investment Project, American Indian Unit, Latino Family Preservation Project, Deaf
Services Project, Sexual Abuse Treatment Team, Special Immigrant Status Unit, and
Medically Fragile Children. These units are specialized to handle sensitive issues related
to the population (Los Angeles County Department of Children and Family Services,
2008).
The Asian Pacific Program was established in 1989 in Los Angeles County,
which provides countywide services exclusive to Asian and Pacific Islander families.
This program has a capacity to provide services in approximately 12 languages and
dialects, including Cambodian, Cantonese, Mandarin, Hmong, Thai, Japanese, Korean,
Laotian, Tagalog, Tongan, and Vietnamese. The purpose of the program is to
immediately provide culturally and linguistically appropriate child welfare services to
protect children and preserve families (The Coalition of Asian American Children and
Families, 2001). In the program, a social worker is assigned to a case based on a client’s
particular needs, such as language and cultural match, and is responsible for all aspects of
the case from the initial referral until the service termination. The reason for this is to
43
prevent clients from facing multiple social workers. In addition, the role of social
workers’ from this unit includes educating, in the appropriate languages, the Asian
community on child abuse laws and parenting practices. Social workers also provide
education and consultations on staff training, foster care family recruitment, and related
services, both inside and outside of the Department (The Coalition of Asian American
Children and Families, 2001).
An increase in Bi-cultural child welfare workers
Whether ethnic/racial compatibility between professionals and clients helps
achieve cultural competency practice and reduces cross-cultural barriers has been an
ongoing discussion throughout literature. Despite this, there seem to be a broad
consensus that bilingual professionals are increasingly needed as part of the child welfare
workforce. Ethnic/racial matching has been a priority in child welfare agencies. This
was particularly true among Asian American child-welfare workers who carried the
highest caseloads of clients with the same ethnic and racial background (Perry & Limb,
2004). Whether ethnic/racial compatibility actually improves the delivery of services
remains unclear. However, a study contends that higher numbers of ethnic practitioners
increases access among ethnic minorities (Snowden, Masland, Ma, & Ciemens, 2006). In
addition, a burgeoning number of studies provide evidence that the ethnic and/or racial
matching of professionals and clients can not only alleviate cultural differences and
reduce language barriers, but also enable higher rapport, creating more positive working
relationships and effective interventions (Cox & Ephross, 1998; Lu et al. 2001). In
addition, several studies of mental health practices found that ethnic clients who
44
participated in ethnic-specific programs had lower dropout rates and better results than
those who used mainstream services (Sue, 1998; Lu et al. 2001).
Contrarily, Shin, Chow, Camacho-Gonsalves, Levy, Allen, and Leff ‘s ( 2005)
findings showed no significant differences in overall functioning, service retention, and
the total number of sessions attended between ethnically/racially matched clientsclinicians and non matched clients-clinicians. Thus, they suggested that ethnic/racial
matching of clients and workers might be more relevant if language is a barrier to service
delivery. Particularly given their limited English skills and lesser degree of acculturation,
the linguistic and cultural competence of child protective workers is critical in working
with Southeast Asian families (Cox & Ephross, 1998; Lu et al., 2001; Sue, 1998). This
can be evident in the findings that Asian Americans, particularly, stayed in treatment
longer and had better treatment outcomes when their clinicians had similar ethnic and
linguistic backgrounds (Sue, 1998; Lu et al. 2001). Because of the special linguistic needs
and acculturation issues, the presence of bilingual and bicultural professionals is needed
to ensure the delivery of cultural competency practice to Southeast Asian clients.
As a response, the child welfare agencies, including Sacramento County’s, have
been encouraged to diversify their workforces to meet the needs of these families, and
employ special skills workers who are bilingual and bicultural in various Southeast Asian
cultures including Vietnamese, Cambodian, Hmong, and Mien.
Interpretation Services
The number of special skills workers, however, is still in short supply in many
child welfare agencies. The reason is that it is too difficult to locate social workers who
45
speak each language needed in our increasingly diversified society within each bureau of
CPS. It is, therefore, critical that child welfare agencies make interpretation services
available. Although it is ideal to have language-concordant providers, recent studies in
the health care arena have found the use of interpreters enhanced the satisfaction of Asian
patients with the health care system (Green, Ngo-Mefzger, Legedza, Massagli, Phillips,
& Iezzoni, 2005; Morales, Elliott, Weech-Maldonado, & Hays, 2006; Ngo-Metzger et al.,
2007). Because interpreters are highly important in child welfare agencies, it is critical
that they receive adequate training. Studies have documented the limitations and
difficulties of using interpreters. For example, different expressions that are not easily
translatable can put clients at a disadvantage. Trying to communicate through untrained
interpreters is also unreliable and may even be detrimental to the needs of clients, as well
as to the professionals involved (Chand, 2005; Green et al., 2005; Ngo-Metzger, Sorkin,
Phillips, Greenfield, Massagii, Ciarridge, & Kaplan, 2007). These untrained interpreters
may lack the linguistic skills to accurately translate from one language into the other, the
technical knowledge that might be needed to provide an accurate interpretation, and the
cultural knowledge about the family’s background. Not to mention, there is also the risk
of interpreters including their own opinions and quoting inaccurate translations or
information. Studies have documented that interpreters often are held to different
expectations by the client and the agency, and it is difficult for them to remain neutral
during cultural conflicts between the client and the agency if they are embedded with the
client’s culture (Chand, 2005; Hwa-Froelich & Westby, 2003). Thus, the quality of
interpreter services is important, and the training for the interpreter is critical.
46
Hwa-Froelich and Westby (2003) suggest that trainings for interpreters should
include information on different communication styles. Interpreters must be aware of
their cultural communication style as well as that of providers, and understand how their
style will be interpreted. In addition, it is crucial for them to understand their role as
interpreters, and so it is recommended that they be trained in procedures of assessment if
they are to assist with assessments or intervention. Equally important is training for
providers on working with interpreters (Chand, 2005; Hwa-Froelich & Westby, 2003;
Green et al., 2005; Ngo-Metzger et. al., 2007). The recommended training includes the
continuum of interpreter roles, appropriate roles for interpreters, culturally diverse
communication styles, and intercultural conflict (Hwa-Froelich & Westby, 2003). By
making interpretation services available, appropriately trained interpreters can be a
valuable asset in helping provide child welfare workers cultural information about their
clients and accurate language interpretation.
Increase the Quality of Trainings
While the above findings suggest racial and linguistic matching is important in
cross-cultural practice, professional competency is more important. Although workerclient racial/ethnic correspondence was preferred among ethnic families, professional
competency was found to be their top preference (Cox & Ephross, 1998). A study
concurs that building rapport is difficult if workers display no understanding of the
clients’ situation even when the social workers are racially and linguistically compatible
with their clients, (Yueng & Kam, 2008). The reason for this is that clients who feel the
worker understands their problems will be more likely to share and seek help (Yueng &
47
Kam, 2008). It has also been indicated that even when the worker shares similar
ethnic/racial backgrounds with their clients, the quality of services they provide depends
on their cultural competency and experiences (Shin et al., 2005; Cox & Ephross, 1998).
Client-worker racial/ethnic matching should be one factor to consider, but even more
important are issues of acculturation, gender, and/ or education, as well as cultural
competency (Shin et al. 2005).
Child welfare workers who not only lack the language skills of the families, but
also lack the cultural knowledge, limit their capacity to conduct child protective
investigations, build effective rapport, and engage families in services. A study indicated
that Asian Americans had very low interaction with their workers but this may be due to
the practitioners’ cultural insensitivity and language differences, not necessarily the
racial/ethnic disparity between the social workers and their clients (Saha et al. 2003). In
an effort to build a bridge of understanding between child welfare workers and their
Southeast Asian clients, it is important that cultural competency trainings specific to the
culture, values, and problems within this particular community be required and available
for all child welfare workers. Within several California child welfare agencies, including
Sacramento County’s, cultural competency trainings are unspecific to Southeast Asian
Americans, as they are generalized to all “ethnic minorities.” Specific trainings exist for
some ethnicities. For example, current grants have been awarded to assist State child
welfare agencies to provide training projects for Hispanic- and Native American children
and families, but not for Southeast Asians (Child Welfare League of America, 2002).
48
Outreach Programs
A review of past literature on the topic of Southeast Asian families reveals the
prevalence of poor economic status, family violence, and mental health disorders within
the Southeast Asian community. Considering the multiple needs of Southeast Asian
families, combined with the lack of available resources in the community, it is essential
to effectively link Southeast Asian families to various community and government
resources. Southeast Asian families’ needs include mental health services, English
classes, parenting classes, child care, public housing assistance, and job training
initiatives, among others. These salient needs, if left unaddressed, can lead to more
psychological distress and family violence. These interventions, therefore, can empower
families as they provide support, build on family members' competencies, and enhance
their cultural strengths rather than focusing on families' deficits (Green, McAllister, &
Tarte, 2004). Johnson, Takesue, and Chen (2007) explain that early resolution to these
problems not only support the individual’s cultural needs, but may prevent the need for
treatment for some individuals or increase those individuals’ help-seeking behavior.
Expanding community programs can also create a better system to connect
Southeast Asian families to resources that will increase fundamental knowledge, enhance
help seeking skills, and raise communication skills, which altogether will increase
resources that are culturally and linguistically appropriate to this population. Outreach
programs for this at-risk population should include education regarding child protective
services and child welfare legislation, which will expand awareness of alternative noncorporal punishment techniques and promote a healthier child rearing practice.
49
Expanding outreach programs within Southeast Asian community can help bridge
cultural gaps between this community and child welfare agencies. In a case example of a
strength-based community outreach program for a Cambodian community, it was found
that more than 50% of the participants from the educational workshops and peer support
group reported positive behavioral changes as a result of what they have learned in the
programs, and 100% report telling others about what they have learned (Grigg-Saito et
al., 2008). In another study of the benefit of discussion groups, Johnson, Takesue, and
Chen (2007) argue that discussion groups are valuable for ethnic minorities because they
provide support and help decrease the psychological distress caused by cultural conflict.
Reaching and engaging Southeast Asian families, particularly those involved in
CPS, can be quite difficult. A study of Asian American refugees found that ignorance of
services, language difficulties, social isolation, inadequate information, perceived racism,
and staff attitudes were all obstacles in accessing formal support services (Stewart et al.,
2008). Chui & Ho (2006) found in their study that resistance is also common in social
work outreach programs. The authors also contend that social workers’ patience and
sensitivity, however, can alleviate resistance and build rapport with clients. Programs
utilizing a strengths-based foundation also led to families feeling more respected and
valued and therefore possibly increasing their participation (Green, McAllister, & Tarte,
2004). The key aspects of strengths-based practice, as described by Green, McAllister,
and Tarte (2004) are the extent to which staff build on the family's strengths and skills,
are culturally sensitive and responsive to the family, are knowledgeable and sensitive to
the family needs, and can facilitate parents’ relationships with other parents and
50
community members. Grigg-Saito, Och, Liang, Toof, and Silka (2008) also argue that
intervention approaches must include the Southeast Asian and the mainstream
community norms, as well as the Southeast Asian community’s perception of their
situation and how it will be improved. Outreach strategies and activities are also integral
to the engaging of community participants who may be socially isolated from their
community due to a language barrier or ignorance of available services. Some of the
successful approaches that Grigg-Saito et al. (2008) identify in one Cambodian
community include going door to door to explain the outreach programs, collaborating
with the community’s local businesses (such as the Cambodian markets), churches,
temples, and leaders in charge of cultural events, as well as the community’s local
providers such as nurses and physicians.
Sacramento County has been making an effort to improve its cultural competency
practice by increasing the number of Special Skills workers, offering a training for
cultural competency practice, providing interpreters, and contracting culturally and
linguistically relevant services. Sacramento County has encouraged diversification within
its workforce to meet the needs of minority families, and has employed special skills
workers who are bilingual and bicultural. Sacramento County currently employs child
welfare workers who are of Southeast Asian background including Vietnamese,
Cambodian, Hmong, and Mien, and some of them are employed as Special Skills
workers. However, the numbers of skilled workers are still in short supply; thus, nonSoutheast Asian workers often serve Southeast Asian clients with the use of interpreters.
Currently, Sacramento County utilizes interpreters from four different contracted
51
vendors. Cultural competency training, called Cultural Humility, is offered through the
Northern California Children & Family Services Training Academy on the University of
California, Davis campus, but this training mandatory for new child welfare worker and
it is unspecific to Southeast Asian clients. Sacramento County developed collaborative
relationships with Southeast Asian community service providers such as My Sister’s
House, Asian Pacific Community Counseling, Southeast Asian Assistance Center, and
offer a few culturally and linguistically relevant services, including mental health
treatment services, counseling, and an alcohol and other drug (AOD) prevention program
for its Southeast Asian clients.
The review of literature indicates that Southeast Asian families face multiple
stresses and barriers that hinder their adjustment to their new society, and increase family
conflicts. Thus, it is critical that social workers conduct culturally competent practice
with cultural awareness, knowledge, and skills to effectively serve this special
population. It is equally critical that child welfare agencies provide appropriate support
for the social workers to develop and practice the culturally competency skills. Another
critical component is empowering Southeast Asian families through culturally and
linguistically appropriate social services and outreach programs. As Sacramento County
still has room for further improvement in its cultural competency work with Southeast
Asian families, this study examined the perception of social workers on how to further
improve cultural competency at individual and agency levels. The study intended to find:
1) what supports and resources are needed to further improve the cultural competency
among social workers; 2) what institutional factors would further improve service
52
delivery to Southeast Asian families in the child welfare system; and 3), what services
and outreach programs are needed to empower Southeast Asian families and increase
their coping skills.
53
Chapter 3
METHODOLOGY
Introductions
The study investigates what the relevant cultural considerations are when working
with Southeast Asian families in child welfare practice by exploring the current child
welfare practice with Southeast Asian clients from Sacramento County Child Protective
Services (CPS) workers’ perspective. The purpose of the study is to present various
cultural competency practices, with the objective of providing recommendations to the
agency as to how to improve their practice with Southeast Asian clients. These
recommendations will include whether education and trainings in CPS should be added
or altered, whether the agency’s institutional system should be altered, and what services
and outreach program should be expanded.
Study Design
To study the cultural considerations of Southeast Asian Americans, this study
utilized a descriptive research design gain in-depth information about those practice and
how they can be improve. The study was conducted through the administration of a
survey questionnaire designed to measure understanding of Southeast Asian cultures,
challenges in working with this population, and workers’ recommendations in how to
solve this problem and/or work more effective. Multiple-choice questions and Likerttype statements were used to meet the objectives. Once the survey results are obtained,
the information was incorporated into the study. Both qualitative and quantitative
methods were pursued, with the use of both open- and closed-ended questions, as
54
researchers have recognized the benefits of using these combined approaches. The use of
quantitative and qualitative approaches enhanced the research’s hypothesis by allowing
subjects to elaborate on their thoughts and allowing us to analyze the data with the same
frame of references.
Sampling Procedures
A sample of frontline social workers from Family Maintenance (FM), Informal
Supervision (IS), Family Reunification (FR), and Emergency Response (ER) were asked
to participate. The researchers continued this sampling of social workers until they
yielded enough participants (36) from which meaningful comparisons can be made. The
criteria for the inclusion of this sample were these frontline social workers currently
employed at Sacramento County CPS who hold a BSW, MSW, or other degrees that
qualified them to be a Human Service Social Workers in the County of Sacramento CPS
The researchers identified the 36 participants among the three bureaus using
purposive, convenience, and snowball sampling methods to fulfill the sampling
objectives. The selection of the subjects was completed through purposive sampling due
to the specific predefined group the study sought. Convenience sampling was used, as
the populations surveyed were more accessible to us. In addition, snowball sampling was
used because researchers did not have sufficient access to enough people with the
characteristics the study sought. Royse (2008) warned that these non-probability
sampling methods decreased the likelihood of the samples resembling the “true”
population. Using these methods may yield samples that are unrepresentative of the
general population and, therefore, reduced the reliability of the study. The advantages of
55
using these methods, however, were that it was affordable, fast, and easy.
Data Collection Procedures
Procedures for this study were conducted in full compliance with the Sacramento
County Division of CPS’s protocol, and the Human Subject Review Committee at
California State University, Sacramento (CSUS). The study’s data collection occurred in
the months of October and November 2009, shortly after consent was obtained. Workers
among the various CPS bureaus were administered the Cultural Competency with
Southeast Asians Survey (CCSAS) questionnaire and were asked to return the
questionnaire within three weeks. The study was administered in the four CPS units: IS,
FR, and ER for convenience purposes. The candidates who agreed to participate in the
study completed the survey and returned it to the researchers. All candidates were
screened by the researchers to ensure that the criteria for the study were met.
Instruments
This study employed a survey instrument. Relevant information, including the
CalSWEC cultural competency as suggested in Child abuse: Characteristics and patterns
among Cambodian, Chinese, Korean, and Vietnamese American families (2006), and
Culturally Competent Practice: A framework for understanding diverse groups and
justice issues by Lum (2003) were implemented as guidance to create the instrument.
The survey consisted of 24 questions divided into five parts. Those four parts are made
of the following: 1) workers’ demographics, 2) workers’ successful comprehension, 3)
worker’s perspectives on how the agency helps them practice with Southeast Asian
clients, and 4) workers’ familiarity with programs and community services that would be
56
helpful to these clients. The final section of the questionnaire assessed workers’
recommendations as to how to improve their own cultural competency practices as well
as that of the agency (see Appendix). Past research has provided evidence of the
importance of ethnic and cultural compatibility between practitioners and their clients.
Thus, analyzing ethnic backgrounds of social workers was important in this study.
Independent variables including ethnic background, level of experience and level
of education were used to uncover whether they make a difference in subjects’ survey
responses (eg. professional choices and decisions). For instance, differences in
understanding of Southeast Asian cultures, challenges in working with this population,
and workers’ recommendations in how to solve this problem and/or work more effective
were compared between social workers with a Southeast Asian background and Social
workers with a non-Southeast Asian background, social workers who are “special-skilled
workers” and social workers who are not, social workers who received cultural
competency training and social workers who did not, as well as social workers with
limited agency work experience versus agency veterans. For each of the items,
participants were asked to rate the statements that best reflected their opinion (for
example: very important, important, somewhat important, or not important)
Pilot testing the instrument with five Title IV-E social work students at CSUS has
assured content, and face, validity of the instrument. The researchers modified the survey
questionnaire according to the pilot results to increase the degree of validity of the
instrument.
57
Data Analysis Approaches
The screened data was processed and manipulated through the Statistical Package
for Social Sciences (SPSS). Descriptive statistics, inferential statistic, content analysis,
and statistical analysis were all employed to analyze the data. Descriptive statistics were
used to capture the demographic characteristics of the study population (e.g. years of
experience at CPS). Tables and charts were utilized to provide a graphical summary of
this quantitative analysis.
Protection of Human Subjects
All participants were treated in accordance with the Sacramento County
Institutional Review Board (IRB) agency’s protocol, and the Human Subject Review
Committee at California State University, Sacramento (CSUS). The protocol for the
human subjects research was submitted and approved by both the CSUS Human Subject
Review Committee, dated September 29, 2009, approval number 0910004, and the
Sacramento County IRB, dated September 11, 2009 as a minimal risk project prior to
undertaking the study.
Along with the survey questionnaire, each participant was supplied an informed
consent form describing their rights as a participant, as well as the survey’s purpose,
procedures, risks, benefits, and confidentiality concerns (See Appendix). The letter
explicitly informs the candidates that participation in the study is voluntary, and can be
terminated at anytime during the study without explanation or consequences. The form
also indicates that willing CPS workers will be confidential and anonymous.
Confidentiality was ensured by prohibiting subjects to identify themselves on the survey.
58
The participants were also informed that survey data will be kept in a secure location, and
will be destroyed shortly after the research’s completion.
Participants were informed that responses collected from them would be used for
the master’s thesis and possibly used as a resource for child welfare agencies. In
addition, the letter informed participants that the study is anticipated to carry minimum
risk of causing subjects emotional discomfort. Participants were, however, encouraged to
stop the survey if they develop fatigue or any emotional distress. Upon acknowledging
all the terms of the study, the candidates who agreed to participate in this study were
asked to complete the survey and return it to the appropriate boxes provided to reduce
inconveniences.
Summary
This chapter detailed the design and methodology used in the research study.
Using both qualitative and quantitative data generated, the research study investigated
Sacramento County CPS workers’ understanding of Southeast Asian cultures, challenges
in working with this population, and workers’ recommendations as to improve practice.
In sum, the methods and measures of the research yielded rich quantitative and
qualitative data that can inform future studies of cultural practice with Southeast Asian
families.
59
Chapter 4
FINDINGS
Introduction
The purpose of this chapter is to present the data generated by the questionnaire in
order to identify and analyze the Sacramento County Child Protective Services (CPS)
workers’ perceptions of current child welfare practices with Southeast Asian clients.
Several common themes, as well as differences, were examined between Southeast Asian
and non-Southeast Asian workers, as well as Special-Skilled and non-Special Skilled
workers. Descriptive statistics were used to examine other relevant variables, including
level of education, years of experience, and level of training. This chapter explores the
following components: participants’ demographics; cultural competency of child welfare
workers including familiarity, cultural awareness, and challenges in working with the
Southeast Asian population; community resources and support by the agency including
training and interpretation services; and recommendations on effective practice with
Southeast Asian clients. Thirty-seven of fifty questionnaires were returned to the
researchers, of which one was excluded from the study because of the respondent’s status
as an intern. Thus, a total of 36 questionnaires were included in this study.
Demographics
The 36 participants in the study represented approximately 10% of all Sacramento
County CPS workers (MGT of America, Inc., 2009). The majority of the respondents are
either Caucasian (n=11), African American (n=10), or Southeast Asian (n=8) (see Table
4.1). Most had either a MSW (75%, n=27) or MA/MS (16.7%, n=6), while just three of
60
them (8.3%) had attained only a bachelor’s degree. Close to half of them (47.2%, n=17)
were multilingual, and their language abilities included Thai, Laotian, Hmong,
Vietnamese, Cambodian, Chinese, Spanish, Russian, and French. A total of 15
respondents (41.7%) were Special Skilled workers for the Sacramento County Child
CPS, and four of them were certified for Southeast Asian languages (see Table 4.2).
Their experience as a Human Service Social Worker ranged from one to 20 years, with an
average of 7.8 years. Six out of the eight Southeast Asian study participants reported as
having more than seven years of experience.
Table 4. 1
Ethnicity of the Study Participants
Ethnicity
Frequency
Percent
Caucasian (non-Hispanic)
11
30.6
African American
10
27.8
Southeast Asian
8
22.2
Other Asians
1
2.8
Hispanic
4
11.1
Other
1
2.8
Multi-racial
1
2.8
Total
36
61
Table 4. 2
Special Skilled and Non-Special Skilled Workers
Frequency
Frequency
Frequency
Southeast Asian
4
11.1
Other
11
30.6
Non-special skilled
21
58.3
Total
36
The study participants were asked about the frequency of their direct work with
the Southeast Asian population. Half of the respondents (n=18) indicated that they
“rarely” work with the population, and 33% (n=12) of them indicated that they work with
them “occasionally”. Only 14% (n=5) of the participants indicated that they work with
this population “frequently”, and three of these five participants were Southeast Asian.
This data shows that the respondents in this study do not have much experience in direct
child welfare practices with the Southeast Asian population. It is suggestive that many of
their perceptions and opinions regarding the Southeast Asian client population and the
current practice with this population might not be based on their own experience but on
second-hand knowledge through education and training.
Cultural Competency of Child Welfare Workers
Cultural Competency Components. The study survey asked the respondents to
rank factors of cultural competency in the order of most importance. The findings
revealed that “awareness of one’s own cultural background and possible biases” was
62
ranked the highest in importance, followed by “the knowledge of Southeast Asian culture
and their cultural issues” and “awareness of clients’ cultural background”. The data also
shows that a greater number of the Southeast Asian workers rated “awareness of possible
biases”, “awareness of clients’ cultural background”, “knowledge”, and “sensitive
assessment” as “very important.” “Ethnographic interviews” and “flexibility” were
ranked lower as more of the respondents gave them a score of five or six. The nonSoutheast Asian respondents also ranked “awareness of possible biases” as the most
important component, followed by “awareness of clients’ cultural background”,
“sensitive assessment”, and “knowledge”. Within this group, “ethnographic interviews”
and “flexibility” were at the bottom. The comparisons between Special Skilled and NonSpecial Skilled workers showed similar patterns to those between Southeast Asian and
non-Southeast Asian. This finding suggests that awareness of one’s own cultural
background and possible biases is universally considered as the most important factor,
while ethnographic interviews and flexibility are commonly considered as less important.
Southeast Asian and Special Skilled respondents perceive awareness of clients’ cultural
background, knowledge of cultural issues, and sensitive assessment to be as important as
awareness of their own cultural background and possible biases while non-Southeast
Asian and non-Special Skilled respondents perceive these factors to have varying degrees
of importance.
Familiarity. When assessing familiarity with Southeast Asian culture, close to
half of all respondents (44.5%) reported limited familiarity levels. Four respondents
(11.8%) reported that they are not familiar at all while fourteen respondents (41.2%)
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reported to be either “very familiar” or “familiar” with the culture. The majority of nonSoutheast Asian respondents reported that they are “somewhat familiar” or “not familiar”
while all of the Southeast Asian respondents indicated they are either “very familiar” or
“familiar” with the Southeast Asian culture (see Table 4.3). As the researchers have
expected, cultural backgrounds appeared to make some difference in levels of familiarity.
A burgeoning number of studies have documented the benefits of ethnic and/or racial
matching of professionals and clients – benefits include a reduction of language barriers
and higher rapport (Cox & Ephross, 1998; Lu et al. 2001). This may be related to the fact
that professionals generally have a higher knowledge of their own culture, and, therefore,
can create a more positive relationship with the clients with the same or similar cultural
background.
Table 4. 3
Familiarity: Southeast Asian v. Non-Southeast Asian Workers
Familiarity
Southeast Asian workers
Non-Southeast Asian workers
Very familiar
6 (75%)
1 (3.8%)
Familiar
2 (25%)
5 (19.2%)
Somewhat familiar
16 (61.5%)
Not familiar at all
4 (15.4%)
The years of experience, initially, seemed to make a difference in the familiarity
with Southeast Asian culture as 62.5% (n=10) of these respondents with more than seven
years of experience reported to have cultural familiarity compared to only four out of 18
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workers with less experience who reported to have familiarity. However, it was found
later that among the ten experienced respondents who reported to be familiar with
Southeast Asian culture, six were Southeast Asian. This may explain the higher
familiarity found among the respondents with more experience. This overlap also could
explain the similarity in responses between Southeast Asian participants and the
participants with more than seven years of experience.
Awareness of Cultural Factors. Cultural factors that participants felt were
important to be aware of in their practice with Southeast Asian clients were also
examined in the current study. Participants were asked to rate each factor as “very
important,” “important,” “somewhat important,” or “not important”. The cultural factors
listed in the questioners were following: cultural and linguistic barriers, migration
experience, discrimination, familiarity with American social system, adherence to
traditional values, traditional parenting practice, acculturation levels within the family,
intergenerational conflicts, help seeking behavior, traditional healing practice, the impact
of extended family, and involvement in ethnic community. The majority of the factors
listed, including different acculturation levels within the family, intergenerational
conflict, the impact of extended family members, and parenting practices, were indicated
as “very important” or “important” by a large number of the general respondents.
“Culture and linguistic barriers” was rated as “very important” in the majority of
participants’ response (75%). A comparison between the Southeast Asian and nonSoutheast Asian respondents found that a larger percentage of non-Southeast Asian rated
cultural and linguistic barriers as very important (see Table 4.4). This data indicates
65
cultural and linguistic barriers are critical factors to be aware of in practice with
Southeast Asian clients, and that the cultural and language barriers might be experienced
by the non-Southeast Asian respondents themselves when working with Southeast Asian
clients
“The use of traditional healing practices” and “client’s migration experience”
were rated as slightly less important compared to the other factors. Although the reliance
on traditional medicine is highly valued among Southeast Asian families, only 33% of
respondents indicated that the use of traditional healing practices is very important to take
into consideration in practice with Southeast Asian families. Part of this reason may be
because Southeast Asian folk healing medicines, such as coining and cupping, have been
established as alternative medicine in mainstream American culture. Contrary to the
literature, the current data suggests that clients’ migration experience is perceived to be
less important. This could be due to the majority of the Southeast Asian population in
Sacramento County having been here for more than 20 years, or it could merely be due to
lack of awareness of this issue among the participants. The latter is suggested by the fact
that ten of the respondents who had more than seven years of experience, compared to
only four of the respondents with less than eight years of experience, reported clients’
migration experience as not an important issue.
The importance of cultural factors was perceived quite differently between the
Southeast Asian and non-Southeast Asian groups. The results revealed that a larger
percentage of the Southeast Asian respondents indicated “intergenerational conflict” and
“traditional SEA parenting practice” as important factors (see Table 4.4). This finding
66
suggests that the Southeast Asian respondents may be more aware of the significance of
intergenerational conflict and traditional cultural parenting practices among this
community through their direct experience with their own parents and families.
Table 4. 4
Important Factors in Practice: SEA v. Non-SEA
Factor perceived as “Very Important
Intergenerational conflicts
Southeast Asian
Non-Southeast Asian
6 (75.0%)
11 (39.3%)
5 (62.5%)
10 (35.7%)
2 (25.0%)
10 (35.7%)
5 (62.5%)
22 (78.6%)
Traditional SEA parenting
practice
Discrimination in American
society
Cultural and linguistic barriers
The study assessed which cultural practice and beliefs respondents felt were
difficult to understand and accept. The majority (80%) of the general participants
indicated some cultural practices that are difficult to understand and accept. However,
the differences between those who indicated they have difficulty and those who did not
for each practice were not significant. For example, 45.7% of the general respondents
indicated “family obligation and sacrifice,” as well as “saving face”, as cultural practices
that are difficult to understand, while 54.3% indicated these practices are not difficult to
understand (see table 4.5)
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“Tolerance of corporal punishment” was indicated by more than half of the
general respondents as a cultural practice that is difficult to understand and accept (see
table 4.5). This might be because discipline methods in Southeast Asian families are
generally perceived to be more severe by western families, and differences in childrearing practice and corporal punishment are suggested in the literature to contribute to
high cases of child maltreatment among Southeast Asian (Ima & Hohm, 1991). Thus,
most child welfare workers might be less inclined to accept these discipline procedures.
Table 4. 5
The Cultural Practice Hard to Accept
Cultural Practice
Yes
No
Tolerance of corporal punishment
20 (57.1%)
15 (42.9%)
Family obligation and sacrifice
16 (45.7%)
19 (54.3%)
Saving face
16 (45.7%)
19 (54.3%)
The use of cultural healing practices
12 (34.3%)
23 (65.7%)
When comparing Southeast Asian to non-Southeast Asian participants, a higher
percentage of the Southeast Asian participants indicated having a hard time accepting all
the listed cultural practices. It is especially so for “family obligation” and “saving face”
(see Table 4.6), which are documented to be associated with family violence and mental
health issues among this population. The literature discusses “saving face” as a concept
that discourages outside intervention against family violence for fear of bringing shame
to the family. Differences in family values held by immigrants and their adolescent
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children are associated with high rates of depression and low self-esteem among the
adolescents. However, these two factors are subtle cultural practices that are difficult to
judge, unlike corporal punishment, which is an easily observable behavior. Thus, the
non-Southeast Asians (51.9%) respondents may not have a clear understanding of these
issues, and, therefore, may indicate them as controversial practices. The Southeast Asian
workers might be more aware of these issues through their personal experiences; yet, they
might not be willing to accept these as an excuse for family violence and mental health
issues among this population.
Table 4. 6
The Cultural Practice Hard to Accept: SEA v. Non-SEA
Cultural Practice
Southeast Asian
Non-Southeast Asian
Family obligation and sacrifice
7 (87.5%)
9 (33.3%)
Saving face
6 (75.0%)
10 (37.0%)
Tolerance of corporal punishment
6 (75.0%)
14 (51.9%)
Challenges in the Practice. The challenges of participants faced in their work
with Southeast Asian clients were examined. “Miscommunication because of language
barrier” was the most common challenge that the general respondents indicated
experiencing in direct practice with Southeast Asian clients, followed by the “use of
translators” and “miscommunication because of cultural barriers” (see Table 4.7).
However, differences emerged when examining the data between the Southeast Asians
and the non-Southeast Asians. Among the non-Southeast Asian respondents, “use of
69
translator’ was indicated as the most common challenges, followed by ‘language barrier”
and “engaging”. While “use of translator” was the second cited challenge among all
participants, it was found to be an issue only for the non-Southeast Asians. . These study
findings suggest that communication with Southeast Asian clients is a significant
challenge that child welfare workers face, and language barriers and difficulty in using
translators may be contributing factors for the communication issues. The study data
implies that Southeast Asian workers may have fewer obstacles in delivering services to
the Southeast Asian families as they already possess the language ability to communicate
with the families without using a translator. A lack of sufficient numbers of bilingual
workers would result in non-Southeast Asian workers serving the Southeast Asian
population with the use of interpreters. Yet this study indicates many non-Southeast
Asian workers experience challenges when using interpreters. Thus, the lack of bilingual
workers becomes problematic to meet the needs of the Southeast Asian families entering
the child welfare system.
Table 4.7
The Challenges in Working with SEA Clients
Factor
Strongly Agree
Language barrier
20 (58.8%)
Using translator
16 (48.5%)
Cultural barrier
13 (38.2%)
Engaging the family in services
11 (32.4%)
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Furthermore, the challenges were also recognized quite differently between
Special Skilled respondents and non-Special Skilled respondents. A relatively larger
percentage of the non-Special Skilled respondents indicated that using translators,
making assessments, and building rapport with clients as challenges in their practice
compared to Special Skilled workers (see Table 4.8). The data suggests that the child
welfare workers with Special Skilled status may have a different skill set that allows for
better delivery of services to cross-cultural clients than non-Special Skilled workers do.
Table 4.8
The Challenges: Special Skilled v. Non-Special Skilled
Factors
Special Skilled
Non-Special Skilled
Using translator
28.6%
63.2%
Making assessments
18.2%
41.2%
Building rapport
14.3%
20%
Community Resources and Support by the Agency
Exploration of resources was also included in the current study. Specifically the
resources and support provided by the Sacramento County CPS and the community
resources currently available to the Southeast Asian client population. You can simplify
and say this (or put it in your executive summary) – As a whole respondents felt that
Sacramento County provides translation (97%) and community resources (75%) but is
lacking in consultation (78%), flexibility in practice (72%), and information on Southeast
Asian client concerns (75%).When the Southeast Asian group and the non-Southeast
Asian group are compared, the data shows that a larger percentage of non-Southeast
71
Asians (75.0%) indicated this lack of provided information than the Southeast Asian
respondents.
Trainings. Studies have shown that adequately trained workers are critical in
providing effective and efficient services to cross-cultural client. As such Sacramento
County offers cultural competency training to its child welfare workers through the
Northern California Children & Family Services Training Academy. This study explored
the current cultural competency training at Sacramento County CPS by asking the
participants about their experience and opinion regarding the training. A total of 25
(69.4%) respondents reported having in-service cultural competency training while 11
(30.6%) of the respondents reported never receiving cultural competency training. Ten of
the respondents who attended training received the training within the last year, and six
of them received the training more than five years ago. These numbers show that a
portion of the respondents are not trained for cultural competency at all, and among those
trained, training was not recent. These findings are rather disappointing, considering the
importance of cultural competency training in child welfare practice has been strongly
argued for in the literature and cultural competency training is supposed to be mandatory
for new child welfare workers in Sacramento County.
The majority of the training participants reported that the cultural competency
training had some benefit to their practice with Southeast Asian clients: 30.8% of them
reported the training was “very beneficial”, 26.9% indicated “beneficial”, and 38.5%
answered “somewhat beneficial”. Additionally, the majority (85%) of the training
participants reported the training helped improve their practice with Southeast Asian
72
clients. However, more than half of the participants reported no changes in the areas of
“accessing resources for myself” (81.5%), “accessing resources for SEA clients”
(55.6%), “engaging the family in services” (77.8%), and “building higher rapport”
(77.8%). “Higher understanding of the culture” was the only area in which the
respondents reported to have improved their practice (70.4%).
Respondents who received cultural competency training and those who did not
were compared in terms of familiarity with Southeast Asian culture, perceptions of the
importance of cultural issues.
Many of the trained participants indicated that they have
acquired a higher understanding of Southeast Asian culture. However, the data did not
show significant difference in familiarity with Southeast Asian culture between those
who have received training and those who have not. More than half of those who
received training (58%) as well as those who did not receive training (60%) reported that
their familiarity is limited. This finding can be explained by the fact that the cultural
competency training offered by the agency may not be specific to Southeast Asian
clients. However, there was a difference in frequency of working with Southeast Asian
clients between those who received the training and those who did not. The frequency
was higher among those who received training than among those who did not. More than
a half (60%) of the training participants reported that they work with Southeast Asian
clients either occasionally or frequently whereas the majority of those who have not
received training (81.8%) reported to have rarely or never worked with Southeast Asian
clients. This might be because those who have worked with or have interest in working
with Southeast Asian clients have higher motivation to attend training than those who
73
have not worked with Southeast Asian clients. However, the training may be too general
in promoting cultural diversity but not providing specific contents on working with
Southeast Asian clients. As a result, they would have better understanding but not
familiarity.
When comparing awareness of cultural factors among respondents who have
received cultural competency training and those who have not, the data revealed that a
larger number of respondents with the training indicated all the cultural factors listed are
very important to be aware of while working with Southeast Asian clients compared to
those without the training (see Table 4.9), This suggests that those who have received
cultural competency training might have higher cultural awareness. In other words,
cultural competency training might help increase cultural awareness among child welfare
workers.
Table 4.9
Important Factors: Trained v. Untrained
Factors
Trained
Untrained
Traditional parenting practice
14 (56.0%)
1 (9.1%)
Different acculturation levels within the family
11 (44.0%)
1 (9.1%)
Help seeking behavior
13 (52.0%)
2 (18.2%)
In comparing challenges in practice with Southeast Asian, the data revealed that
both groups, trained and untrained, have similar challenges (see Table 4.10). In fact, a
higher percentages of respondents with training reported almost all the factors listed,
74
including “language barriers”, “use of translator”, “engaging”, and “cultural barriers” to
be challenges in their practice with Southeast Asian clients, compared to those without
the training (see Table 4.10).
Table 4.10
Challenges: Trained v. Untrained
Challenges
Trained
Untrained
Language Barriers
16 (66.7%)
4 (40.0%)
Using Translator
12 (50.0%)
4 (44.4%)
Engaging
10 (41.7%)
1 (10.0%)
Cultural Barriers
10 (41.7%)
3 (30.0%)
Assessment
8 (38.1%)
1 (14.3%)
Building Rapport
6 (25.0%)
The study findings suggest that the current cultural competency trainings offered
in Sacramento County CPS has some areas for improvement.
Even though the training
might increase cultural awareness and ideology of cultural competency practice among
workers, it does not seem to improve workers’ skills to communicate with Southeast
Asian clients, engage them into services, and make an assessment. Moreover, the current
cultural training is not specific to this population; the study participants indicated that
they do not acquire information regarding this particular population or resources
available for them from the training. This lack of positive impact on knowledge and skill
levels is a concern as skills to serve cross-cultural clients, as well as knowledge regarding
75
specific cultures and their issues, are also critical in meeting the needs of the Southeast
Asian clients.
The study participants were asked areas of interest that they would like to further
explore in cultural competency training. A large number of the respondents indicated an
interest in exploring “communication style” (72.2%) and “culturally sensitive
assessment” (69.4%) in training for their practice with Southeast Asian clients. A strong
interest in learning a better communication style by the participants reflects their report of
communication with Southeast Asian clients as the biggest barrier. This data may also
indicate that the workers recognize that, as the literature documents, it is important to
understand communication style relevant to the culture in order to build a cross-cultural
relationship.
The majority of the respondents indicated that they wish to further learn about
“traditional Southeast Asian parenting practice” (75%), “traditional Southeast Asian
values” (66%), “intergenerational conflicts” (63%), and “acculturation difficulties”
(61%). A large number of the respondents indicated they were not interested in further
exploring “traditional healing practice” (72.2%) and “pre-immigration experience”
(69.4%). This data suggests, again, that traditional healing practices as well as migration
experiences are not considered as important as other issues and this may be because these
subjects are already well understood in the mainstream society.
Translator. As the Sacramento County CPS was reported to provide translating
services, only 26% of respondents indicated that increasing the number of translators is
very significant in improving service delivery to the Southeast Asian population. This
76
finding implies that relatively sufficient numbers of translators are available for the
workers to access. When comparing Southeast Asian to non-Southeast Asian
participants, increasing the translators was rated slightly higher among the non-Southeast
Asian. While 31% of the non- Southeast Asians felt that increasing the number of
translators is important to improve service delivery, only 12% of the Southeast Asian
respondents indicated this is important.
The comparisons between Special Skilled and non-Special Skilled workers show
outcomes similar to those between Southeast Asians and non-Southeast Asians. While
37% of the non- Special Skilled workers reported that increasing the number of
translators is important to improve service delivery, only 13% of the Special Skilled
workers indicated this is important This can be explained by the fact that non-Southeast
Asian and non-Special Skilled workers need translation services due to language and
cultural barriers, while Southeast Asian and Special Skilled workers have language
ability and other communication skills to deliver services to meet the families’ needs.
Although availability of interpreter services appears to be relatively sufficient,
large numbers of participants indicated the use of translators as a challenge. This suggests
that the concern is not on availability but the effectiveness and quality of the translation
services. Moreover, while large number of the participants indicated difficulty in using
translators (strongly agree, n=16; agree, n=8), only 13 respondents showed an interest in
being trained in “use of translator”. This suggests that child welfare workers might
perceive the reason for their difficulty in using translators is not with them, but the
problems are with the translators. Similarly, more than half of non-Special Skilled
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respondents (53%), who have more opportunities to use translators compared to Special
Skilled workers, indicated that training translators is very significant in improving the
service delivery even though less Special Skilled workers (23%) indicated this. This
study finding suggests that Sacramento County offers sufficient numbers of translators
for child welfare workers to deliver services to their Southeast Asian clients, yet the
competency of the translators to support service delivery to the Southeast Asian clients in
the field of child welfare might be limited.
Community Resources. Although the participants reported that Sacramento
County CPS provides general community resources, when they were asked about their
knowledge of the availability of culturally and linguistically appropriate resources for
Southeast Asian clients, only a small percentage of participants reported that mental
health, parent support group, family counseling, and alcohol and other drug (AOD)
counseling are available most of time (see Table 4.11). It was only anger management
class that at least half of the respondents indicated to be available most of the time. The
literature has noted the general lack of adequate resources that are made available to
Southeast Asian families involved in the child welfare system, even though they are far
more disadvantaged than the general population, as they offer numerous barriers and
difficulties. The data from this study supports the literature. The results suggest that
linguistically and culturally relevant resources available and accessible to Southeast
Asian clients are still insufficient in Sacramento County. One respondent clearly
commented that child welfare workers are struggling to locate appropriate resources, and
due to Sacramento County’s recent budget constraint, the already limited resources for
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Southeast Asian families, as well as the opportunity to receive these services, are
expected to be further reduced.
Table 4.11
Resources Available in the Community
Resources
Most of the time
Sometimes
Rarely
Unsure
Anger Management class
17 (51.5%)
5 (5.2%)
11 (33.3%)
Parenting classes
14 (40.0%)
8 (22.9%)
10 (17.2%)
7 (20.0%)
Mental health services
10 (28.6%)
10 (28.6%)
6 (28.6%)
5 (14.3%)
Parent support group
10 (28.6%)
9 (25.7%)
8 (22.9%)
8 (22.9%)
Family counseling
8 (22.9%)
13 (37.1%)
8 (22.9%)
6 (17.1%)
AOD counseling
6 (17.1%)
12 (34.3%)
9 (25.7%)
8 (22.9%)
This study also indicates the limited knowledge of community resources for
Southeast Asian clients among the respondents. The survey question regarding the
availability of community resources included “unsure” as a response option, and about
17% to 23% of respondents reported marked this option when asked about the
availability of resources within the community, depending upon the resource.
Unsurprisingly, the data also indicates an association between the knowledge of
availability of community resources for Southeast Asian clients and respondents’
ethnicity and familiarity. About 30% of the non-Southeast Asian participants, and
participants who reported to be not familiar with Southeast Asian culture, indicated that
they are “unsure” of the availability for each of the resources listed, while none of the
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participants of Southeast Asian background, or with familiarity with the culture, reported
“unsure” for any of the resources.
This finding suggests that the struggle among the non-Southeast Asians and
workers unfamiliar with Southeast Asian to locate appropriate resources for Southeast
Asian clients might be due to their limited knowledge of available resources. The failure
to provide information regarding resources for Southeast Asian clients in cultural
competency training, discussed earlier, might be contributing to the limited knowledge of
available resources.
Recommendations for Effective Practice with Southeast Asian clients
Respondents were asked for their recommendations on how to improve services
for Southeast Asian clients. The data revealed that “increasing community resources”
was the most common component the respondents indicated to be very significant in
improving service delivery to the Southeast Asian clients. Increasing bilingual and
bicultural workers and training translators were the next two recommendations from
respondents. (see Table 4.12). Interestingly, all Southeast Asian workers indicated that
increasing community resources will be “very significant” to improve service delivery to
Southeast Asian clients. Increasing the number of translators, and training for translators,
were rated slightly higher among non-Southeast Asian and non-Special Skilled
participants. These findings might reflect that there is a greater need of non-Southeast
Asian and non-Special Skilled workers to overcome the language barriers. Until this
need is met, they cannot be as concerned of what else is needed to help Southeast Asian
clients.
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Researchers have noted the lack of adequate resources that are made available to
families involved in the child welfare system. Southeast Asian families are far more
disadvantaged, as they present numerous barriers and difficulties, such as the experience
of being a refugee, language barriers, and low educational attainment. This data supports
the literature. The results suggest that the Sacramento County CPS lacks cultural and
linguistic resources for Southeast Asian families. The data also suggests that increasing
the number of bilingual and bicultural workers would be beneficial to services delivery.
Considering the cultural, social, and linguistic barriers that Southeast Asian families face,
studies have suggested that hiring bilingual and bicultural staff that reflects the Asian
community would encourage families to access services (Lincroft et al., 2006).
Table 4.12
Ranked Significant Factors
Significant Factors
1. Increase community resources
2. Increase bilingual/bicultural workers
3. Trainings for translators
4. Increase cultural competency training
5. Increase translators
6. A specialized unit
Linguistic and Cultural Matching. As cultural and language barriers are
significant factors that prevent Southeast Asians from receiving appropriate services from
81
child welfare agencies, the respondents were asked what they think will decrease the
barriers. Linguistic matching, effective use of translators, and demonstrating sensitivity
to clients’ cultural practice were indicated to be “very significant” in helping minimize
cultural barriers by a large number of the respondents. Racial/ethnic matching, as well as
cultural matching of clients and workers, was not indicated to be as important in
respondents’ choice (see Table 4.13).
Table 4.13
Factors to Minimize Cultural Barriers
Factors
Very Significant
The linguistic matching
20 (57.1%)
Effective use of a translator
19 (59.4%)
Sensitivity to cultural practice
18 (52.9%)
The racial/ethnic matching
14 (40.0%)
The cultural matching
11 (32.4%)
This data suggests that racial and ethnic matching between the workers and their
clients may not necessarily help minimize cultural barriers, but what is important is that
the worker’ cultural sensitivity towards the clients’ culture and their ability to
communicate well with the clients. The literature has discussed the possibility of low
interaction between practitioners and Asian American clients due to the practitioners’
cultural insensitivity and language differences (Saha et al. 2003). Cultural matching and
racial/ethnic matching were rated slightly higher among participants with Special Skilled
82
status and participants with limited experience. A larger percentage of Southeast Asian
participants (50%) reported cultural matching to be very significant compared to their
counterparts (25%).
Macro. Participants were asked to rate the significance of child welfare related
factors that they believe that would help ameliorate issues many Southeast Asian families
face. The data revealed that “increasing the collaboration between CPS and ethnic
communities” (71%) and “decreasing the stigma of mental health among Southeast
Asians” (69%) were the top two factors that the majority indicated to be “very
significant”, followed by “increasing communication skills of the families,” (58.3%) and
“educating families about the American social system,” (52.8%) (see Table 4.14).
Table 4.14
Factors to Ameliorate Issues of SEA Families
Factors
Very Significant
Increase the collaboration between CPS and ethnic communities
25 (71.4%)
Decrease stigma of mental health among SEA
24 (68.6%)
Increase communication skills of the families
21 (60.0%)
The significance of child welfare related factors to ameliorate issues among the
Southeast Asian client population was recognized differently between the Southeast
Asian respondents and the non-Southeast Asian respondents. A higher percentage of the
Southeast Asians indicated all of the factors listed with the exception of “decrease stigma
of mental health” as very significant to ameliorate cultural issues that many of the
83
Southeast Asian client population face. This was particularly true concerning educating
parents regarding the American social system, and educating parents about other
mainstream cultural values. For example, 75% of the Southeast Asian respondents
indicated educating parents regarding the American social system as very significant and
88% indicated educating parents regarding mainstream cultural values as very important.
However, when analyzing the non-Southeast Asian group, less than half of the nonSoutheast Asian respondents indicated this to be very significant.
Contrary, a larger number of the non-Southeast Asians (75%) indicated
decreasing a stigma of mental health very significant compared to 50% of the Southeast
Asians indicating decreasing the stigma very significant. This might be because high
occurrence of mental health problem among Southeast Asian families, as well as a stigma
of mental health in the community, is well documented.
This study suggests that increasing the collaboration between CPS and ethnic
community is universally considered to be very significant to support the Southeast Asian
client population. The non-Southeast Asian workers consider decreasing the stigma of
mental health within the Southeast Asian community is the most significant factor to
ameliorate problems among Southeast Asian families while the Southeast Asians
perceive other factors to be more significant. These study findings suggest that the
Southeast Asian respondents believe that educating parents is critical in empowering the
families in order for them to navigate through American society as well as the child
welfare system.
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Resources Needed in the Southeast Asian Community. The study explored what
resources are needed within the Southeast Asian community. Domestic violence
services, family therapy, and mental health outreach programs were rated high in
significance by the general respondents, followed by educational programs regarding
Child Protective Services/ Child Welfare System (CPS/CWS) and other social systems,
educational support, and community programs (see Table 4.15).
Table 4.15
Resources Needed for SEA Families
Factors
Very Significant
Domestic Violence services
23 (67.6%)
Mental Health outreach program
18 (52.9%)
Family therapy
19 (54.3%)
Education program regarding CPS/CWS/other social system
17 (48.6%)
All of the Southeast Asian respondents reported the need for domestic violence
services among the Southeast Asian community as a factor to decrease issues Southeast
Asian families face (see Table 4.16).
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Table 4.16
Resources Needed: SEA v. Non-SEA
Factors
Southeast Asian
Non-Southeast Asian
Domestic Violence
8 (100.0%)
15 (57.7%)
6 (75.0%)
11 (40.7%)
Cultural program for youth
6 (75.0%)
8 (29.6%)
Child care
6 (75.0%)
8 (29.6%)
Education program regarding CPS/CWS/other
social system
Summary
The findings of this study indicate that culturally competent practice with the
Southeast Asian population in the Sacramento child welfare system is still limited. The
limitation exists within all three of the micro, meso, and macro levels: individual
workers’ cultural awareness, knowledge regarding Southeast Asian population, and skills
for engagement, assessment, and intervention; training, resources, and support provided
by the child welfare agency; and community resources to serve Southeast Asian families.
Cultural Competency of Child Welfare Workers. The study found that cultural
awareness is acknowledged by child welfare workers to be critical in providing services
to Southeast Asian clients. Accordingly, the majority of the study participants indicated
that it is important to take the cultural factors into consideration in their practice. The
cultural factors include Southeast Asian clients’ limited cultural and linguistic skills,
unfamiliarity with the American social system, cultural parenting practice, limited
acculturation, and intergenerational conflict. However, the findings showed that the
86
majority of the non-Southeast Asian workers have limited knowledge of the Southeast
Asian population and availability of culturally and linguistically relevant resources as
well as limited direct working experience with this population compared to social
workers of Southeast Asian backgrounds.
Furthermore, the study suggests that current child welfare workers posses limited
skills to work with Southeast Asian clients. The finding showed workers struggle in
communicating with the clients due to language barriers, use of translators, and engaging
the clients in services. Although the study showed a majority of the respondents
encounter similar challenges in their direct practice with Southeast Asian clients,
Southeast Asian and Special Skilled workers appeared to have less challenges and the
significance of linguistic matching in the service delivery to this population was
highlighted. These findings indicate the skills and abilities of bilingual, bicultural
workers are critically important to better serve immigrant populations.
Training. Although cultural and linguistic matching is important in cross-cultural
practice, cultural competency is more important. Cultural competency occurs when
workers are adequately trained. The majority of workers reported that the training they
have received was beneficial, and the findings suggest the current trainings may increase
cultural awareness. However, this study found limitations in the effectiveness of cultural
competency training provided by the Sacramento Child Welfare Agency. Many workers
who have received cultural competency training reported no change in their practices
with Southeast Asian clients, and the findings indicate the training did not improve their
familiarities with Southeast Asian culture or ease their challenges in their practice with
87
Southeast Asian clients. This might be because information regarding Southeast Asian
issues and resources available to Southeast Asian clients are not provided in the training.
Additionally, the study found that even though cultural competency training is mandatory
for new child welfare workers, there are some workers who have never participated in
any cross-cultural training.
The study findings found communication as one of the biggest obstacles in
working with Southeast Asian clients. Accordingly, the study participants showed an
interest in learning communication styles in training. In addition, the study shows that
large numbers of child welfare workers experience difficulty in using translators, and feel
interpreters should be trained to improve the service delivery to Southeast Asian clients.
Consultation and Support. Although peer and supervisory consultations are
available in the Sacramento County CPS, this study found that access to information
regarding Southeast Asian culture and issues among this population is limited. This
might be because knowledge of, and familiarity with, Southeast Asian culture among
their peers as well as supervisors and program managers are also limited. Thus, upper
management is unable to provide appropriate advice to service workers regarding this
population. However, the study participants showed little interest in creating a
specialized unit in the agency to serve Southeast Asian clients even though it would allow
workers to receive consultation regarding cultural matters of this specific cultural group.
This lack of interest might be because the number of Southeast Asian child welfare
clients in Sacramento County is still relatively small compared to counties such as Los
Angeles and San Mateo where this is a larger population of SEA.
88
Community Resources. Considering the multiple difficulties facing Southeast
Asian families, availability and accessibility of services and resources in the community
is critical to effectively intervene with this population. However, the study indicated
appropriate community resources that are available for child welfare workers to refer to
Southeast Asian clients are limited. This shortage of appropriate community resources
poses an immense problem for the child welfare agency, as child welfare workers are
unable to ensure that their Southeast Asian clients are receiving appropriate services.
Increasing community resources, as well as increasing the collaboration between the
child welfare agency and ethnic communities, would help improve the service delivery to
this population and to ameliorate difficulties and problems that are prevalent among this
population.
The study indicated that family therapy and mental health outreach programs
were greatly needed in the Southeast Asian community, and decreasing the stigma of
mental health among the Southeast Asian community is indicated as a significant factor
to decrease the risk of family violence among this population. These findings were
expected by the researchers since intergenerational conflict and mental health disorders,
as well as stigma of receiving professional help, are the most common problems
documented among Southeast Asian families. However, the findings indicated domestic
violence intervention services as the most needed of services among this population.
Moreover, the collaboration of child welfare agencies and ethnic communities, and
educational programs regarding the child welfare system and other social systems, are
89
also indicated by the respondents to be highly needed to assist the Southeast Asian
community.
90
Chapter 5
CONCLUSION
Summary
Culturally competent practice in child welfare services is an essential component
to the quality of services that social workers and child welfare agencies can provide to
cross-cultural clients. It is especially true of the services for Southeast Asian clients as
the rapid growth of this population presents a challenge to child welfare workers
delivering services to this population. Culturally competent practice should be
incorporated at the micro, meso, and macro levels in order to exercise effective service
delivery. This study was conducted in order to explore various components of culturally
competent practice at the micro, meso, and macro levels that are particularly pertinent to
the needs of the Southeast Asian client population. This study explored three areas: 1)
cultural awareness, knowledge acquisition, and skill development among child welfare
workers; 2) training, resources, and support provided by the child welfare agency for the
workers to provide culturally competent services to Southeast Asian clients; and 3)
linguistically and culturally relevant community services and resources to which the
social workers are able to refer Southeast Asian clients. Based on current literatures, this
study explored the perceptions of Sacramento County child welfare workers. This study
identified both current practices with the Southeast Asian population and what is needed
to effectively serve this particular population.
Given the number of child welfare workers currently employed at Sacramento
County Child Protective Services (CPS), the sample size of 36 utilized in this study is
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relatively small. This study is, therefore, limited to Sacramento County, as the small
sample ineffectively represents other counties’ child welfare workers. Additionally, the
small sample limits the comparison between the Southeast Asian workers and the nonSoutheast Asian workers, as well as the comparison between the Special Skilled workers
and the non-Special Skilled workers. Furthermore, a majority of the study subjects had
limited direct working experience with Southeast Asian clients; thus, this study focuses
more on their perceptions and beliefs rather than their actual experience and knowledge
in the field. The instrument employed in this study is a self-assessment survey
questionnaire, which is another inherent limitation even if the responses are anonymous.
Child welfare workers may not report all of their challenges or may report more
knowledge than they have for fear of being perceived as culturally incompetent.
Conclusion and Recommendations
The findings of this study indicate that culturally competent practice with the
Southeast Asian population in the Sacramento child welfare system is still limited, and
this limitation exists within all three of the micro (individual child welfare workers),
meso (the child welfare agency), and macro (community) levels. This lack of
competency in cross-cultural situations can prevent effective service delivery, and it can
be harmful to clients as well as to the morale among child welfare workers. This study,
therefore, suggests that the Sacramento Child Welfare Services Agency needs to
reevaluate its training, program, and institutional system to address their limited cultural
competency and to enhance service delivery to Southeast Asian families.
92
Cultural Competency at a Micro Level. Cultural awareness, knowledge
acquisition, and skill development are components of cultural competency that can
enhance social workers’ effectiveness in providing services to cross-cultural clients. The
study found that child welfare workers perceive cultural awareness as the most important
component in providing services to Southeast Asian clients, and indicated they were
aware of cultural issues among the clients. Yet the findings show that these workers have
a limited knowledge of the Southeast Asian population as well as a limited knowledge of
the availability of linguistically and culturally relevant resources for this population.
Limited skills among the workers were also suggested as the participants reported
difficulty in communicating with the Southeast Asian clients, using translators, engaging
the clients, and making an assessment. It seems that child welfare workers value and
recognize cultural awareness, but are not equipped with adequate knowledge and skills to
work with Southeast Asian clients. This emphasis on cultural awareness rather than on
cultural knowledge and skills appears to be reflected in the cultural competency training
provided by the agency.
Culturally Specific Training and Skill Development. Professional competency
occurs when workers are adequately trained. Thus, training is critical in enhancing
cultural competency skills among child welfare workers. However, even though the
study findings suggest that current trainings may increase workers’ cultural awareness, it
does not seem to improve their knowledge of the Southeast Asian culture or ease their
challenges in practice with Southeast Asian clients. Therefore, these researchers
recommend the focus of cultural competency training be shifted more towards knowledge
93
acquisition and skill development. This training should be more culturally specific, and
should provide information regarding Southeast Asian culture, issues among this
population, and the availability of culturally and linguistically relevant resources.
Information on traditional parenting practices, traditional values, acculturation
difficulties, and intergenerational conflicts, as well as resources available and accessible
to Southeast Asian families should be included in the training. In addition, skill
development is equally important to improve workers’ competency to communicate,
engage, assess, and intervene with Southeast Asian clients. Communication especially
needs to be addressed, as it was indicated as the biggest challenge in practice with
Southeast Asian clients.
Employ Bicultural Child Welfare Workers. There seems to be a broad consensus
throughout the literature as well as in this study that bilingual and bicultural professionals
are increasingly needed as part of the child welfare workforce. As the language barrier is
a major issue within this population, and difficulties in using translators are well
documented, the value of Southeast Asian workers’ language ability and cultural
knowledge should be highly prized. Special Skilled workers seem to have not only
language ability and cultural knowledge, in addition to general social work skills, but also
other skills, such as an engagement skill and an assessment skill, to better serve crosscultural clients. Thus, it is essential for the child welfare agency to recruit bilingual and
bi-cultural workers in the child welfare workface as Special Skilled workers in order to
better serve the Southeast Asian population.
94
Training for Translators. Aside from ensuring the availability of translation
services, the child welfare agency must ensure that their interpreters are competent in
their work. Large numbers of child welfare workers expressed difficulty in using
translators, and feel interpreters should be better trained to improve service delivery to
Southeast Asian clients. This study was unable to identify in what area translators should
be trained; however, training in procedures of assessment for translators who assist with
assessments or interventions is recommended in the literature (Hwa-Froelich and Westby,
2003). Due to the nature of this work, it is essential for interpreters to receive adequate
training specifically on working with child welfare clients. Without appropriate training
interpreters can be unreliable, and, as a result, can be detrimental to the client.
Consultation and Support. When child welfare workers are unsure of how to
handle a situation or make a decision, or need information that will better equip them for
practice, it is important for them to receive support to ensure that their service delivery is
appropriate. However, in the Sacramento County CPS access to information regarding
Southeast Asian culture and issues among this population, as well as consultation
regarding cultural matters are limited. Therefore, the researchers recommend the
Sacramento County CPS develop a system to provide its workers with easy access to
information and consultation regarding cultural practice, values, or issues of Southeast
Asians as well as other ethnic groups. When child welfare workers feel supported,
guided, and they have the tools that they need, they are more likely to develop higher
morale and feel more confident in serving their clients.
95
Expanding Community Resources. Even though Southeast Asian families face
various difficulties, culturally and linguistically appropriate services and resources
available to them are limited. Increasing community resources, as well as increasing the
collaboration between the child welfare agency and ethnic communities, is highly
suggested to improve the service delivery and to ameliorate these difficulties. Resources
that are greatly needed among this population include domestic violence services, family
therapy, and mental health outreach programs. Additionally, educational programs
regarding the child welfare system and other social systems are highly needed to develop
the collaboration between the child welfare agency and the ethnic community and to
reach out to Southeast Asian families in need.
Implications for Social Work Practice and Future Studies
This exploratory study has examined Sacramento County child welfare workers’
perceptions of current practice with the Southeast Asian population, and their
recommendations on how to improve service delivery to this population and to ameliorate
problems prevalent among this population. However, this study did not explore child
welfare practice and the needs of this population from the viewpoint of Southeast Asian
clients themselves. Their perceptions of current practice, and of how to improve the
service delivery, might be different from those of child welfare workers. Thus, future
studies are recommended to produce more conclusive results, which might validate the
recommendations for improvement suggested in this study. To achieve this, future
studies must include a large sample of Southeast Asian families who have been involved
in the child welfare system.
96
Bringing awareness of the importance of culturally competent practice with
Southeast Asian families engaged with child welfare agencies may bring systematic
changes in the quality of services this group receives, as well as in the delivery of
services child welfare workers can provide. Therefore, this study is intended to provide
the Sacramento County Department of Heath and Human Service Child Protective
Services recommendations as to how to improve the delivery of services to Southeast
Asian clients on the macro and meso levels, based on both the literature findings and the
perceptions of current Sacramento County child welfare workers. Cultural competency
practice, although one of the most discussed concepts in the school of social work, is still
unfortunately disregarded in the child welfare field. This may be because child welfare
agencies are affected by the large number of referrals, high caseloads, and frequent staff
turnover. However, the infusion of cultural competency practice into child welfare
practice should be a high priority, particularly in the Sacramento County CPS, given the
diversity of the client population involved in the child welfare system, and the ethnic
disparity in services.
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APPENDICES
98
APPENDIX A
LETTER OF CONSENT FORM
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY
TITLE: Cultural Competent Practice with Southeast Asians in Child Welfare System
INVESTIGATOR: Ana Nguyen and Yoriko Stenhouse, MSW candidates at California State
University, Sacramento (CSUS).
PURPOSE:
This study is being carried out in partial fulfillment of the requirements for a Master’s
Degree in Social Work for the researchers. The study investigates relevant cultural considerations
when working with Southeast Asian (SEA) families in child welfare system and social workers’
perception on current cultural practice with the SEA families at individual and agency levels. In
addition, the study explores the importance of the cultural understanding of Southeast-Asian
Americans. The researchers intend to recruit 40 social workers from Family Maintenance/
Informal Supervision and Emergency Response for this study.
PROCEDURE:
Should you agree to participate in this study, you will be asked to complete a survey that
will take approximately 15 minutes of your time. The survey is composed of yes/no and multiple
choice questions and statements that you will be asked to rate on a Likert-type scale. The survey
has a total of 24 questions that cover such areas as demographics, your training and experience
with Southeast Asian clients, and the availability and accessibility of cultural aware resources for
these clients.
Upon completion, you will be asked to return the survey and this informed consent form
into the boxes provided.
RISKS:
The researchers believe that there is minimal risk to you by participating in this research
study. You are, however, encouraged to stop the survey if you experience excessive discomfort
while completing it, and you may contact EAP program at 1-800-227-1060 for assistance.
BENEFITS:
There is no direct benefit to you by participating in this study. However, the findings of this
study may result in recommendations to CPS on how to improve social worker education and
training for working with Southeast-Asian clients.
CONFIDENTIALITY:
Confidentiality will be maintained to the extent possible. Informed consents and surveys
will be kept separate so that even the researchers will not know which survey you completed.
Survey data will be kept in a secure, locked, location that is only accessible by the researchers.
All research data will be destroyed after the completion of the research project (no later than June
2010). No individually identifying data will be collected or included in any papers or publications
that result from this study. Complete confidentiality cannot be guaranteed because research
99
records may be subpoenaed by the federal DHHS for the purpose of ensuring the protection of
participants in research.
ALTERNATIVES/RIGHT TO REFUSE OR WITHDRAW:
Participation is voluntary, and you are able to discontinue your participation or drop from
the study at any time without explanation. You may decline to participate now or at any time in
the future without any risks or consequences to job performance, current or future employment
with DHHS.
QUESTIONS:
If you have any questions or comment in regard to this study, please feel free to contact Ana
Nguyen at ananga87@hotmail.com or Yoriko Stenhouse at ageha17j@hotmail.com.
Research Study Participant’s Bill of Right
1) To be told what the study is trying to find out
2) To be told what will happen to you and whether any of the procedures, drugs or
devices is different from what would be used in standard practice.
3) To be told about the frequent and/or important risks, side effects or discomforts
of the things that will happen to you for research purposes.
4) To be told if you can expect any benefit from participating and, if so, what the
benefit might be.
5) To be told the other choices you have and how they may be better or worse than
being in the study.
6) To be allowed to ask questions concerning the study, both before agreeing to be
involved and during the course of the study.
7) To be told what sort of medical treatment is available if any complications arise.
8) To refuse to participate or to change your mind about participating after the study
is started. This decision will not affect your right to receive the care you would
receive if you were not in the study.
9) To receive a copy of the signed and dated consent form
10) To be free of pressure when considering whether to be in the study.
CONSENT: I have read and understand this consent form and the Bill of Rights for Experimental
Subjects. I have had a chance to ask questions about this research study. I also understand that
when I sign my name below, I am agreeing to volunteer for this research study. I have signed this
informed consent prior to any and all study-related procedures being performed. I have received
my own copy of this form.
___________________________
Signature of Participant
Date
____________________________________
Participant’s Name (Please print)
Please return this informed consent form into the box marked “Informed Consent”.
100
APPENDIX B
SURVEY QUESTIONNAIRE
Please do not put your name on this survey.
Cultural Competence with Southeast Asian (SEA) Americans Survey (CCSAS)
Please select the box after each question that best reflects your opinion. Thank you for
your participation.
1) What ethnic group do you most identify with?
Caucasian (non-Hispanic)
□
Hispanic
□
African American
□
Native American
□
Asian/Pacific Islander
□
Other
□
(If you are Asian/Pacific Islander, please specify: SEA □ non-SEA □ )
2) List the language (s) that you speak other than English
3) What is your highest level of education?
BSW □ BA/BS (specify your major)_________________
MSW □ Other (specify) __________________________
4) How long have you been a human service provider in child welfare?
_____________year(s)
5) Are you or have you been a Special Skilled Worker for Child Protective Services
(CPS)?
Yes □ No □
If yes, specify cultural group___________________
6) How often do you work with SEA clientele on the average?
Frequently □
Occasionally □
Rarely □
7) How would you rate your own familiarity with SEA culture?
Very familiar □ Familiar □ Somewhat familiar □
Never □
Not familiar at all □
8) How important are the following factors in your practice with SEA clients?
(VI=Very Important, I = Important, SI = Somewhat Important, NI = Not Important)
VI I
Cultural and linguistic barriers -------------------------------------- □ □
Clients’ migration experience --------------------------------------- □ □
Clients’ experience of discrimination in American society ----- □ □
SI NI
□ □
□ □
□ □
101
Clients’ familiarity with American social system ---------------Adhesion to traditional SEA value --------------------------------Traditional SEA parenting practice -------------------------------Different acculturation levels within the family------------------Intergenerational conflicts ------------------------------------------Help seeking behavior of the clients ------------------------------Use of traditional healing practices such as coining-------------The impact of the extended family members---------------------Clients’ involvement in ethnic community-------------------------
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
9) Rank these components in the order in which you feel important. (1 to be most
important)
Aware of your own cultural background and possible biases ------ [
]
Awareness of clients’ cultural background---------------------------- [
]
The knowledge of SEA culture and their cultural issues ----------- [
]
Culturally sensitive assessment ----------------------------------------- [
]
Ethnographic interview technique-------------------------------------- [
]
Flexibility ------------------------------------------------------------------ [
]
Other (specify) _______________________________________ [
]
[
]
10) The followings are the challenges in my work with SEA clients.
(SA = Strongly Agree, A = Agree, D = Disagree, SD = Strongly Disagree)
SA A D SD
Miscommunication because of cultural barrier -------- □ □ □ □
Miscommunication because of language barrier -------- □ □ □ □
Building rapport --------------------------------------------- □ □ □ □
Engaging the family in services --------------------------- □ □ □ □
Using translator --------------------------------------------- □ □ □ □
Making assessments ---------------------------------------- □ □ □ □
Other (explain) __________________________________________________
11) In your work with SEA clients, what are some of their cultural practice and beliefs
that you and your fellow CPS workers have to work harder to understand and
accept? Please check all that apply.
Family obligation and sacrifice --------------------------------------------- □
Saving face -------------------------------------------------------------------- □
The use of cultural healing practices such as coining and cupping ---- □
Tolerance of corporal punishment ------------------------------------------ □
Nothing ------------------------------------------------------------------------- □
Other (explain) __________________________________________________
102
12) What aspect of SEA cultures & cultural issues do you want to further explore?
Please check all that apply.
Pre-immigration experience ------------------------------------------------- □
Acculturation difficulties ----------------------------------------------------- □
Traditional SEA value -------------------------------------------------------- □
Traditional SEA parenting practice ----------------------------------------- □
Intergenerational conflicts --------------------------------------------------- □
Traditional healing practices ------------------------------------------------ □
Other (explain) __________________________________________________
13) Have you ever participated in any in-service training for cultural competency.
Yes □ No □
If yes, please answer the questions 14 to 17. If no, please skip to the questions 18.
14) How recent was the training?
___________________________
15) What are the formats of the training?
Half day workshop -----------------------------------------------------------A whole day workshop ------------------------------------------------------Informal peer to peer training-----------------------------------------------Online class -------------------------------------------------------------------Other (specify
_________________________________________________
□
□
□
□
□
16) How would you rate that training?
Very beneficial
□
Beneficial
□
Somewhat beneficial □
Not beneficial at all □
17) In what areas did the training improve your practice with SEA on child welfare
related issues?
No change ---------------------------------------------------------------------- □
Accessing resources for myself --------------------------------------------- □
Accessing resources for SEA clients --------------------------------------- □
Engaging SEA family in service--------------------------------------------- □
Building higher rapport ------------------------------------------------------ □
Higher understanding their culture ----------------------------------------- □
Other
(specify)_______________________________________________
103
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