Mental Health Targeted Case Management Training Lesson 13 Cultural Competence Reference Issues & Ethics in the Helping Profession; sixth Edition Gerald Corey, Marianne Corey & Patrick Callanan - 2003 A. Multicultural Perspectives and Diversity Issues 1. Cultural diversity. A fact-of-life in today’s world and counselors can no longer afford to ignore the issues involved in counseling culturally diverse populations. 2. Multicultural counseling. Attempts to clarify the role of sociocultural forces in the origin, expression and resolution of problems. 3. Culture influences. Every aspect, of our lives, for it influences our view of social and psychological reality. Multicultural counseling is based on a number of premises: a. All cultures represent meaningful ways of coping with the problems a particular group faces. b. All counseling can be regarded as multicultural if culture is defined broadly to include not only race, ethnicity, and nationally but also gender, age, social, class, sexual orientation, and disability. c. People seek counseling largely because of problems that emerge out of sociocultural conditions. d. Traditional counseling is a particular form of intervention developed in the West to cope with psychological distress. e. All cultures have developed formal or informal ways of dealing with human problems. 4. Problems of cultural tunnel vision! Many case managers come to training with monoculture tunnel vision. They have had limited cultural experiences and in may cases they unwittingly impose their values on unsuspecting clients, assuming that everyone shares these values. 5. The culturally encapsulated case manager. Exhibits monoculture tunnel vision, which is characterized by the following traits: a. Defines reality according to one set of cultural assumptions. b. Shows insensitivity to cultural variations among individuals. c. Accepts unreasoned assumptions without proof or ignores proof because that might disconfirm one’s assumptions. d. Fails to evaluate other viewpoints and makes little attempt to accommodate the behavior of others. e. Is trapped in one way of thinking that resists adaptation and rejects alternatives. Mental Health Targeted Case Management Training 6. Multicultural Perspective. A good place for you to begin to develop a multicultural perspective is by becoming more aware of your own culturally learned assumptions. 7. Learning to deal with cultural pluralism: Multiculturalism is an attitude to be embraced rather than something to be tolerated. To operate monoculturally and monolingually, as if all our clients were the same, is not in accord with reality, and it can result in unethical and ineffective practice. 8. Becoming multiculturally competent: This is best conceptualized as a lifelong development process that requires continual education and training. Part of multicultural competence entails recognizing our limitations and is manifested in our willingness to perform the following: a. Seek consultation. b. Seek continuing education. c. Make referrals to a professional who is competent to work with a particular client population. 9. Cultural values and assumptions: Many case management practices are biased against racial and ethnic minorities and women, and often reflect racism, sexism, and other forms of prejudice. A way to avoid these biases is to understand their clients’ cultural context. (e.g., understanding the minorities one services, asking questions, visiting community minority centers, etc). 10. Challenging case manager’s stereotypical beliefs: Case managers may think they are not biased, yet many hold stereotypical beliefs that could well affect their practice. (e.g., Failure to change stems from a lack of motivation! People have choices and it is up to them to change their lives!). 11. Case Managers: Case managers who work with ethnic and racial minority clients without an awareness of their own stereotypical beliefs are likely to cause harm to their clients. 12. Examining some common assumptions: Unexamined assumptions can be harmful to clients, especially assumptions based on cultural biases. What is good for one is not good for all Let’s look at a few of these commonly held beliefs: a. Case managers often assume that clients will be ready to talk about their intimate personal issues, or that self-disclosure is essential for the case management process to work. b. Our American value “cutting to the chase” and getting to the “bottom line,” can hinder client services. In many cultures, a dance or certain rituals may precede intimate disclosure. Many case Mental Health Targeted Case Management Training c. d. e. f. managers may have a tendency to view these behaviors as either resistance or a waste of time. Case managers need to understand that there are many different ways for clients to make themselves known besides talking about private aspects of their lives. Many case managers assume that being assertive is better than being nonassertive. Some case managers assume that clients are better off if they can behave in assertive ways, such as telling people directly what they think and what they want. Your role as case managers is to teach clients the skills to take an active stance toward life. Case mangers may focus on what is good for the client without regard for the impact of the individual’s change on the significant people in that person’s life or the impact of those significant people on the client. Many cultural expressions are subject to misinterpretation, including appropriate personal space, eye contact, handshaking, dress, formality of greeting, perspective on time, and so forth. Western case management approaches tend to prize directness, yet in some cultures directness is perceived as a sign of rudeness and should be avoided. 13. Addressing sexual orientation: The concept of human diversity encompasses much more than racial and ethnic factors. It also encompasses all forms of oppression, discrimination, and prejudice, including those directed toward age, gender, and sexual orientation. In order for case managers to develop effective case management, they must change their attitudes toward sexual orientation. Unless a case manager becomes conscious of their own faulty assumptions and homophobia, they may project their misconceptions and their fears onto their clients. You might implement some of these understandings: a. Case managers must understand that homosexuality and bisexuality are not indicative of mental illness. b. Case managers are encouraged to recognize how their attitudes and knowledge about lesbian, gay, and bisexual issues may be relevant to assessment and services. c. Case managers should strive to understand the ways in which social stigmatization poses risk to the mental health and well-being of lesbian, gay, and bisexual clients. d. Case managers should strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client’s services. e. Case managers must recognize that the families of lesbian, gay, and bisexual people may include people who are not legally or biologically related. Mental Health Targeted Case Management Training f. Case managers are encouraged to increase their knowledge and understanding of homosexuality and bisexuality through continuing education, training, supervision, and consultation. B. Multicultural Case Management Competencies 1. Case Manager Awareness of Own Cultural Values and Biases: a. With respect to attitudes and beliefs, culturally competent case managers: 1) Believe that cultural self-awareness and sensitivity to one’s own culture heritage is essential. 2) Are aware of how their own cultural background and experiences have influenced attitude, values, and biases about psychological processes. 3) Are able to recognize the limits of their multicultural competencies and expertise. 4) Recognize their sources of discomfort with differences that exist between themselves and clients in terms of race, ethnicity, and culture. b. With respect of knowledge, culturally competent case managers. 1) Have specific knowledge about their own racial and cultural heritage and how it personally and professionally affects their definitions of and biases about normality / abnormality and process of counseling. 2) Possess knowledge and understanding about how oppression, racism, discrimination, and stereotyping affect them personally and in their work. This allows individuals to acknowledge their own racist attitudes, beliefs, and feelings. 3) Possess knowledge about their social impact on others. c. With respect to skills, culturally competent case managers. 1) Seek out educational, consultative, and training experiences to improve their understanding and effectiveness in working with culturally different populations. 2) Are constantly seeking to understand themselves as racial and cultural beings and are actively seeking a nonracist identity. 2. Understanding the Client’s Worldview: a. With respect to attitudes and beliefs, culturally competent case managers. 1) Are aware of their negative and positive emotional reactions toward their racial and ethnic groups that may prove detrimental to the case management relationship. They are willing to contrast their own beliefs and attitudes Mental Health Targeted Case Management Training with hose of their culturally different clients in nonjudgmental fashion. 2) Are aware of stereotypes and preconceived notions that they may hold toward other racial and ethnic minority groups. b. With respect to knowledge, culturally competent case managers. 1) Possess specific knowledge and information about the particular client group and with whom they are working. 2) Understand how race, culture, ethnicity, and so forth my affect personality formation, vocational choices, manifestation or psychological disorders, help-seeking behavior, and the appropriateness or inappropriateness of case management approaches. 3) Understand and have knowledge about sociopolitical influences that impinge on the lives of racial and ethnic minorities. c. With respect to skills, culturally competent counselors: 1) Familiarize themselves with relevant research and the latest findings regarding mental health and mental disorders that affect various ethnic and racial groups. 2) Become actively involved with minority individuals outside the counseling setting so that their perspective of minorities is more than an academic or helping exercise. 3. Developing Culturally Appropriate Intervention Strategies and Techniques: a. With respect to attitudes, and beliefs, culturally competent counselors. 1) Respect client’ religious and spiritual beliefs and values, including attributions and taboos, because these affect worldview, psychosocial functioning and expression of distress. 2) Respect indigenous helping practices and respect helpgiving networks among communities of color. 3) Value bilingualism and do not view another language as an impediment to case management. b. With respect to knowledge, culturally competent case managers. 1) Have a clear explicit knowledge and understanding of the generic characteristics of counseling and therapy and how they may clash with the cultural values of various cultural groups. 2) Are aware of institutional barriers that prevent minorities from using mental health services. 3) Are aware of institutional barriers that prevent minorities from using case management services. Mental Health Targeted Case Management Training 4) Have knowledge of the potential bias in assessment instruments, use procedure, and interpret finding in a way to recognize the cultural and linguistic characteristics of clients. 5) Have knowledge of family structures, hierarchies, values, and beliefs from various cultural perspectives. They are knowledgeable about the community where a particular cultural group may reside and the resources in the community. 6) Are aware of relevant discriminatory practices at the social and the community level that may affect the psychological welfare of the population being served. c. With respect of skills, culturally competent counselors. 1) Are able to engage in a variety of verbal and nonverbal helping responses. They are able to send and receive both verbal and nonverbal messages accurately and appropriately. They are not tied to only one method and approach to helping but recognize that helping styles and approaches may be culture bound. 2) Are able to exercise institutional intervention skills on behalf of their clients. They can help clients determine whether a problem stems from racism or bias in others so that clients do no inappropriately personalize problems. 3) Are not adverse to seeking consultation with traditional healers or religious and spiritual leaders and practitioners in the treatment of culturally different clients when appropriate. 4) Takes responsibility for interacting in the language requested by the client and if not feasible, make appropriate referrals. 5) Have training and expertise in the use of traditional assessment and testing instruments. 6) Attend to and work to eliminate biases, prejudices, and discriminatory contexts in conducting evaluations and providing interventions and develop sensitivity to issues of oppression, sexism, heterosexism, elitism, and racism. 7) Take responsibility for educating their clients to the processes of psychological intervention, such as goals, expectations, legal rights, and the counselor’s orientation.