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.
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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
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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.
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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
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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.
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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.