Practice Notes

Practice Notes: Cultural Humility

A Commitment to Lifelong Learning

Practice Notes is an educational tool designed to help Ontario social workers, social service workers, employers and members of the public gain a better understanding of recurring issues dealt with by the Professional Practice Department and the Complaints Committee that may affect everyday practice. The notes offer general guidance only and College members with specific practice inquiries should consult the College, since the relevant standards and appropriate course of action will vary depending on the situation.

The College’s Code of Ethics sets out the core values of the social work and social service work professions, which include maintaining the best interests of the client, respecting the intrinsic worth of the client, and advocating for change for the overall benefit of society.

Adhering to these values requires self-reflection, continuing education and a desire to continually improve. Members must be aware of the issues which impact their clients, and tailor their approaches and interventions accordingly.

While it is imperative to understand the client’s current realities, it is equally important to understand clients’ past experiences and their socio-cultural context. When working with clients from Indigenous communities, part of this understanding of context also involves being aware of how the professions of social work and social service work are viewed as being connected to historical and current realities of colonization. In the words of Indigenous scholar Raven Sinclair, “[s]ocial work has negative connotations to many Aboriginal people and is often synonymous with the theft of children, the destruction of families, and the deliberate oppression of Aboriginal communities.”[1]

Members should be aware of these contexts when working with clients from Indigenous communities. “An approach that includes the perspectives of Indigenous, non-Western people and their worldviews will help transform the field of Social Work co-creating more effective services with Indigenous peoples.”[2] Of course, the approach adopted must be consistent with the College’s Code of Ethics and Standards of Practice.

Similarly, members must be aware of issues that impact how clients interact with and experience the world. For example, members must be competent to support refugees and new Canadians who come to this country, often fleeing horrific circumstances. Appreciating the unique context for each client and the communities that they come from is essential. Forward thinking and an intersectional understanding of the many factors which can oppress and marginalize clients is required.

This thought process led the College to conduct a review of its resources and a stakeholder consultation to determine if current College resources are sufficient to assist members in providing services to diverse client groups in a sound and ethical way. A description of the consultation process and the results can be found in the article “Cultural Humility Consultation and Stakeholder Engagement,” in this issue of Perspective.

The consultation was conducted through an approach based in cultural humility, which “suggests that social workers [and social service workers] should not view themselves as experts in other people’s cultures but as learners.”[3] The concept of cultural humility includes three factors: a lifelong commitment to self-evaluation and self-critique; a desire to fix power imbalances; and developing partnerships with people and groups who advocate for others.[4] In contrast, the term “cultural competence” can be critiqued for implying that one might achieve mastery over a finite topic, whereas the term “cultural humility” suggests a lifelong commitment to self-reflection and redressing power imbalances.

Information shared by members through the consultation was very helpful in increasing the College’s understanding of members’ practice dilemmas when working with culturally diverse clients. Participants in the stakeholder consultation were asked if they had ever experienced any dilemmas or recurring themes while working within a culturally diverse context, and if so, to identify the resources that were helpful to them in doing this work. As with other practice dilemmas, many respondents replied that the Standards of Practice provide useful guidance when working with culturally diverse clients. This Practice Note presents composite case scenarios that are based on the responses of members during the consultation process.

Scenario 1

A member reported working for an agency that served predominantly Indigenous people. The member had difficulty establishing rapport and building trust with her clients. She found that she was unprepared to understand the enormity of transgenerational trauma, and the relationship between client behaviours and systemic injustices. She acknowledged that she had very limited knowledge of the experience of Indigenous peoples in Canada, and lacked understanding of the complexity of issues that continue to particularly impact Indigenous peoples.

When facing challenging practice dilemmas, members can begin by considering how the Standards of Practice apply. In this scenario, the member reflected on Principle II: Competence and Integrity, which indicates that “College members are responsible for being aware of the extent and parameters of their competence and their professional scope of practice and limit their practice accordingly. When a client’s needs fall outside the College member’s usual area of practice, the member informs the client of the option to be referred to another professional.”[5]

In this example, the member worked in a rural environment. She knew that there were few options to refer clients elsewhere. The member understood that she would need to develop skills and knowledge in order to serve the people of that Indigenous community.

The Standards of Practice allow for members to develop their competence while they continue working with clients, so long as the client wishes to continue the professional relationship with the College member and have the member provide them service.[6] This is permitted so long as the member informs the client of the option to be referred to another professional and “ensures that the services he or she provides are competently provided by seeking additional supervision, consultation and/or education.”[7]

The member sought supervision from an Indigenous professional who had been serving in the community for some time. The member also obtained continuing training and education about the experiences and ongoing issues that impact Indigenous peoples in Canada. This included reading the work of Indigenous scholars, and learning about initiatives led by Indigenous people. The member made a concerted effort to attain the knowledge relevant to her area of professional practice.[8]

Reflecting on this experience, the member realized that without understanding her client group and the issues impacting them, she could have unintentionally contributed to systemic factors that disempower and disenfranchise. This idea was underscored during her review of the Standards of Practice which indicate that “College members do not discriminate against anyone based on race, ethnicity, language, religion, marital status, gender, sexual orientation, age, disability, economic status, political affiliation or national origin.”[9]

The member demonstrated a commitment to practise from a lens of cultural humility to better serve her client group, as well as a “commitment to ongoing professional development by engaging in any continuing education and complying with continuing competence measures required by the College.”[10]

Scenario 2

A member from a hospital setting reported working with a client who was Muslim. The client had been given a terminal diagnosis, and a referral to palliative care was offered. The client and their family were not clear on how their faith viewed the philosophy of palliative care. The hospital could not find resources to support the client’s decision making. Members of the care team felt that given the specifics of the case, referral to palliative care was indicated; they became impatient waiting for the client to make a treatment decision. The team placed pressure on the member to get the client to come to a decision quickly.

This scenario placed the member in a precarious situation, in between the care team and the needs of their client. The member consulted the Standards of Practice and was able to identify several interpretations that equipped them to have a difficult conversation with their colleagues. The member explained that “College members and clients participate together in setting and evaluating goals. A purpose for the relationship between College members and clients is identified.”[11]

Additionally, “[g]oals for relationships between College members and clients include the enhancement of a client’s functioning and the strengthening of the capacity of clients to adapt and make changes.”[12] The member articulated that their responsibility is to support their client in finding the required information and resources they needed to make an appropriate care decision.

During the team conversation, several staff members stated that they could not understand why the client and their family were having difficulty coming to a decision, and reiterated the need to transition the client elsewhere. The College member outlined that in this situation, their professional obligation was to “distinguish their needs and interests from those of their clients to ensure that, within professional relationships, clients’ needs and interests remain paramount.”[13]

Through this dialogue the member was able to advocate successfully for more time to allow the client and their family to make a care decision that reflected their needs and values. In so doing, the member was able to “respect and facilitate [client] self-determination in a number of ways including acting as resources for clients and encouraging them to decide which problems they want to address as well as how to address them.”[14]

The member and the client were able to identify collaboratively resources which would help answer the client’s questions about palliative care in a culturally appropriate way. The member secured the time the client and their family needed to research and consult on their queries, which allowed them to come to a decision that supported their values.

Scenario 3

A member worked at a community agency that provided support to refugees and new Canadians. He was providing service to a client who had come to Canada as a refugee in the context of a recent refugee crisis. The crisis was triggered by a violent conflict between two religious and ethnic groups. The member required an interpreter to communicate with the client during the assessment. The member contacted the interpretation services used by his agency, and was assigned an interpreter who spoke the same language as his client. After the interpreter arrived and the assessment began, an argument occurred between the interpreter and the client, and the interpreter abruptly left the appointment. The member had no idea what had happened. After contacting the interpretation services, the member discovered that the client viewed the interpreter as belonging to the group on the opposite side of the conflict that caused the refugee crisis. The member was able to obtain appropriate interpretation services, but as this took time, he came under pressure from his employer for not completing the assessment in the allotted timeframe.

After this scenario, the member experienced many emotions. He engaged in a process of evaluation and review. This included a review of the Standards of Practice, to reflect on the minimum requirements for professional and ethical practice. The member considered that, “College members maintain current knowledge of policies, legislation, programs and issues related to the community, its institutions and services in their areas of practice.”[15]

The member acknowledged that there were gaps in his knowledge about the issues faced by his client. He determined that he needed to better understand the circumstances that led his client to claim refugee status. The member felt that he could better serve this client group if he understood the context which surrounded the refugee crisis.

Additionally, the member thought about the institutions and services that supported his client group. He thought about the interpretation services, and how a breakdown in communication had a significant negative impact on his client. The member felt that if he had had a better understanding of the interpretation services processes, he may be able to support process improvements.

The member also considered that more time was needed to complete an assessment and offer services to clients who utilize interpretation services. This need for additional time was due to a variety of factors including: the need to provide necessary context to the interpreter; understanding the client’s perspective about receiving services; family members asking to serve as interpreters; a variety of interpreters working with the client; and the need to locate culturally appropriate resources, as well as the time required for clients to consider and make decisions about those resources.

The member’s agency had a policy which set out the timelines in which assessments were to be completed and services put in place. This policy did not take into consideration the further layer of complexity when using an interpreter. The member felt that this oversight could compromise the quality of service being offered to clients.

In his review of the Standards of Practice, the member also considered Principle II: Competence and Integrity, Interpretation 2.2.9:

College members promote social justice and advocate for social change on behalf of their clients. College members are knowledgeable and sensitive to cultural and ethnic diversity and to forms of social injustice such as poverty, discrimination and imbalances of power that exist in the culture and that affect clients. College members strive to enhance the capacity of clients to address their own needs. College members assist clients to access necessary information, services and resources wherever possible. College members promote and facilitate client participation in decision making.[16]

This interpretation further highlighted the need for the member to be aware of the injustices and power imbalances experienced by his clients. It signaled the need to advocate for change, in order to assist his clients in accessing needed information and services. The member determined that he needed to advocate for change with respect to the referral process and the time allotted for assessment when using interpretation services.

As in the previous example, the member began his advocacy role with his team. He spoke to his manager about the extra time required to complete assessments and provide services to clients who utilize interpreters. He was successful in presenting a case based on client best interest, to extend timelines when working with clients who use interpretation services.

The member and his manager approached the translation services to better understand the process of client case assignment. The only information that was provided on the service request form was the language needed for translation services. Assignment of clients was done through a simple matching process. It was agreed that the request form would be modified to contain additional space to indicate where the client was from. This information would be included as appropriate, based on individual client circumstance.

This experience taught the member to imbue his practice with the principles of cultural humility. He committed to learning more about the history and context that surrounded his clients, to engage in ongoing self-assessment, and to develop partnerships with people and groups who advocate to deconstruct power inequity.

Conclusion

Ongoing self-reflection and redressing of power imbalances require commitment and vigilance. Social workers and social service workers are well positioned for this work. Systemic oppression and political climate influence the needs and presenting issues of clients. Therefore, members must maintain an awareness of the issues and inequalities that impact the client populations they serve.

Further development of a cultural humility lens can be gained through consultation, self-study, self-reflection and ongoing training. To this end, it is strongly encouraged that members commit to including cultural humility goals in their annual Continuing Competence Program (CCP).

For more information about this or other practice issues, please contact the Professional Practice Department at practice@ocswssw.org.

 

[1] Raven Sinclair, “Aboriginal Social Work Education in Canada: Decolonizing Pedagogy for the Seventh Generation,” First Peoples Child & Family Review. vol. 1, no. 1, September 2004, pp. 49-61, journals.sfu.ca/fpcfr/index.php/FPCFR/article/view/10/41.
[2] Andrea Tamburro, “Including Decolonization in Social Work Education and Practice,” Journal of Indigenous Social Development. vol. 2, no. 1, September 2013, pp. 1-16, scholarspace.manoa.hawaii.edu/bitstream/10125/29814/1/v2i1_02tamburro.pdf.
[3] Allan Barsky, “Ethics Alive! Cultural Competence, Awareness, Sensitivity, Humility, and Responsiveness: What’s the Difference?” The New Social Worker, 2 Oct. 2018, www.socialworker.com/feature-articles/ethics-articles/ethics-alive-cultural-competence-awareness-sensitivity-humility-responsiveness/.
[4] Amanda Waters and Lisa Asbill, “Reflections on cultural humility,”  American Psychological Association, Aug. 2013, www.apa.org/pi/families/resources/newsletter/2013/08/cultural-humility.
[5] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.1.1.
[6] Ibid.
[7] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.1.1.i.
[8] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.1.2.
[9] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle III: Responsibility to Clients, Interpretation 3.4.
[10] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.1.2.
[11] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle I: Relationship with Clients, Interpretation 1.1
[12] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle I: Relationship with Clients, Interpretation 1.1.1
[13] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle I: Relationship with Clients, Interpretation 1.6.
[14] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle I: Relationship with Clients, Interpretation 1.3.
[15] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.1.3.
[16] OCSWSSW, The Code of Ethics and Standards of Practice Handbook, Second Edition, 2008, Principle II: Competence and Integrity, Interpretation 2.2.9.

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