Cultural Sensitivity for the Clinician

1. Cultural Sensitivity for the Clinician Sources: Barbara Naki, TIFFE C. Kimo Alameda, Ph. D. Jackie Hong, LSW and Rebecca Beardsley, PH.D. Department of Health-Adult Mental Health www.Hawaii.gov

2. Introductions • Tell us about yourself… • What is your position, what areas of Hawaii Island do you work in… • Tell us something about one or two of the cultures you identify with…

3. What is culture? “The integrated pattern of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups.” “Attributing everything to ethnicity is as dangerous as attributing nothing.”

4. Definitions • Stereotype: A stereotype is an oversimplified, false, or generalized portrayal of a group of people. Stereotyping does not allow for exceptions or individual differences • Prejudice: A preformed judgment or opinion about an individual or group. The term often denotes an unfavorable or hostile attitude toward other people based on their membership.

5. Definitions • Discrimination: to make distinction on the basis of preference or prejudice. Involves any situation in which a group or individual is treated differently and/or unfairly based on their membership in a socially distinct group or category.

6. Definitions • Racism: 1)Any attitude, action, or practice backed up by institutional power that subordinates people because of their color. This includes the imposition of ethnic group’s culture of other races. 2) The socially constructed system of domination that benefits one racial or ethnic group at the expense

7. Why is culture and cultural sensitivity especially important when working in our fields?

8. Cultural will play a large role in whether youth or families even seek help in the first place, and if they do seek help, culture influences… -what types of help they seek -who they prefer to treat them -how they see the world

9. Western and traditional Native Hawaiian Practices • Hawaiian Healing Practices • Focus on spiritual/interpersonal complaints and causes • Causal models based on imbalance in relationships/life roles • Treatment involves prayers, herbs, repairing relationships • Faith-based Western Healing Practices • Focus on physical/ psychological signs, symptoms, and causes • Organic or psychological causal models • Treatment involves medicine, cognitive restructuring, & lifestyle changes • Evidence-based

10. Culture’s influence on people’s world views…

11. So where do we start?

12. We start with ourselves!!! • “We don’t see things as they are, we see them as we are” (Anias Nhim) Humans have a natural tendency to categorize things in order to make sense of our world and build on our past experiences…

13. What is the functionality of being able to discriminate effectively… as an innate function of survival? What happens when our radars are not accurate? Are we able learn to adapt and begin to form more categories…challenge our faulty beliefs…?

14. Prejudice • A prejudice is an implicitly held belief, often about a group of people. Race, economic class, gender or sex, ethnicity, sexual orientation, age, and, religion are other common subjects of prejudice. It can be used to characterize beliefs about other things as well, including "any unreasonable attitude that is unusually resistant to rational influence."

15. Hawaii Census 2000

16. Hawaii is very diverse…Subtle prejudice in Hawaii: • “That boy works hard for one Hawaiian” • “Eh, you smart for one Portuguese” • “How can that gay couple raise kids” • “That girl no good – that’s how the family” • “She probably don’t know cause she don’t speak English”

17. If you don’t think you have any prejudices, ask yourself… • How did your parents express their feelings about other ethnicities and/or races? • Was it expressed openly or in off-hand remarks, jokes, etc? • Were threats made if you dated someone from another ethnicity or religion? • How would your family respond if you were gay?

18. Cultural Identity… Where do you stand?

19. Insensitive • Denial • Your culture is the only culture that exists. You deny and are disinterested in cultural differences. • Defense • You experience your culture as the only good culture. You acknowledge cultural differences but see them as threatening. You use mechanisms such as stereotyping to defend yourself. • Minimization • You experience elements of your culture as universal. You minimize differences between cultures and believe that human similarities outweigh any differences.

20. Sensitive – Competent • Acceptance • You recognize and value culture differences and you are curious about different cultures. • Adaptation • You experience other cultures by acknowledging the behaviors acceptable to that culture. You change your behavior to communicate more effectively in different cultures. • Integration • You value a variety of cultures and continuously define your own identity in contrast and in conjunction with a number of cultures. You move easily in and out of varying worldviews.

21. “It is difficult to be truly understanding and sensitive to someone else’s culture until one has gained some knowledge and appreciation for one’s own culture” (Lynch & Hanson, 1998)

22. Seek first to understand, then to be understood… Obtain basic knowledge of the cultural groups you are likely to serve.

23. Activity: • Slipper on or slippers off? • Hug or handshake? • Pidgin or no pidgin?

24. Now…as a clinician who works with a diverse population…

25. Make the Connection • Pay attention to how we use language • Know basic “hello” and “goodbye” protocol (handshake, head nod) • Know some basic non-English sayings in the language most common to the consumer • Be aware of communication styles and nonverbal cues • Learn how the culture prioritizes their values

26. What do you know about the culturally diverse populations you work with? • What are their social norms? • How did they wind up here in Hawaii? • Are you informed about their basic historical pasts? • How can you become more familiar with this culture? • Do you need an interpreter? • Are there other clinicians you can use to learn more about the culture that you will be working with.

27. What if you are not comfortable working with a particular culture? • Is it okay to ask to work only with specific cultural groups? • How do you become comfortable working with a variety of cultures? • What does it feel like to be comfortable working with a specific culture.

28. Political Correctness Avoid expressions or actions that can be perceived to exclude or marginalize or insult people who are socially disadvantaged or discriminated against. Examples • Asian (non Oriental) • Black or African American (not colored or Negro) • White or Caucasian (use Ha’ole with caution –depends on context, tone of voice, etc) • Be careful with ethnic jokes – not funny to all person with schizophrenia not a schizophrenic

29. 6 Guidelines for Creating Culturally Relevant Services • Be respectful • Watch your assumptions • Be careful of labels • Be open to new experiences • Be able to culturally assess yourself • Be able to adapt your style to different cultures

30. Activity: Develop a basic culturally informed information gathering process.

31. What else…? Questions…? comments…?

32. References

33. Mahalo…