how can multicultural competence be an ethical issuehow can multicultural competence be an ethical issue

2000;15:5038. Crandall SJ, George G, Marion GS, Davis S. Applying theory to the design of cultural competency training for medical students: a case study. Required fields are marked *. Underlying these views of culture and medicine there are three essential principles: Within the context of the patientphysician relationship, application of the first principle yields the notion that for doctors and patients to understand each other, clinicians must learn to appreciate the broad influence of cultural factors in their patients lives. Global literacy, therefore, cannot be learned in a classroom. 19. This means that the difficulty a child or adolescent faces is not just their problem. Rather, their issues arise in a social environment. If the CE is specifically oriented to these issues, that is helpful. The more pieces of the puzzle you have in place, then the closer and closer you are to fully understanding that person, and the more effective you can be with your helping. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Stay in the loop! Medical training is a period of moral uncertainty for many people.7,8 As medical trainees are at different stages of acculturation to the iatroculture (the culture of physicians), pluralism may be a challenging concept. Acquiring multicultural competence can occur in small steps [such as] identifying a social issue or cultural factor we feel passionate about or seeking community resources to begin building a list for clients. Social justice counseling is about advocacy and empowerment. Ethical Issues Nie J-B. Rather, it is the result of ones attempt to become a lifelong student 2023, American Counseling Association. How can multicultural competence be an ethical issue Explicit evaluation of the role ethics may play in cultural competence curricula has been lacking. 16. Where are counselors in terms of multiculturalism competencies? To talk about similarities, differences, biases, stereotypes, prejudices talk about these issues honestly, talk about history with these issues, talk about the current state of these issues. 3. Over the next couple of years, I hope to examine the impact of this type of training on multicultural competency and self-efficacy in working with culturally different clients. Examination of the literature reveals a strong mandate, for example, to remove barriers of access to medical care and to eliminate health disparities. In the future, I hope we can utilize some of the excellent skill-based work that Im sure is being done in counselor education across the country and work to enhance and emphasize the skills involved in becoming multiculturally competent. West J Med. He is also founder of Counselors Without Borders. Cultural competence goes beyond cultural sensitivity and must replace it. What logic does a teacher use to explain to trainees that he or she would not accommodate a patient's request for their daughter's clitorectomy? As all counseling is now defined as multicultural, all of us need to make that central in our educational efforts. How are multiculturalism and multicultural competencies taught in counselor education? The ethics of cultural competence involves (1) learning about culture, (2) the embrace of pluralism, and (3) accommodation. 11. It is very obvious that we have made great strides in establishing the idea of multicultural competency as a cornerstone of professional counseling practice. Where is counseling as a profession in terms of multicultural competence? WebMulticultural competency is the ability to adapt, understand and appreciate people that have different beliefs and/or different cultural backgrounds then our own. How does the teacher justify asserting his or her moral system and disregarding the moral system of such a patient? Baker R. Negotiating international bioethics: a response to Tom Beauchamp and Ruth Macklin. Ann Intern Med. Academic Medicine79(4):347-350, April 2004. One of the ways counselors can continue to gain ongoing education on multiculturalism is through their own daily living. How do counselors go aboutstanding in anothers shoes? Indeed, while these are important aspects of ongoing professional development, they should be seen as small components of a lifelong personal journey. WebMulticultural competence can be an ethical issue as it pertains to counseling because not having the knowledge or the willing to learn about new cultures, values, and/or beliefs you can cause harm to the clients that you are trying to help. 2000;10:23960. This multi cultural competence leads to enhanced and effective communication between people that can strengthen relationships. 1 In this context, cross-cultural can be defined as differences between client and counselor in terms of ethnicity, religion, gender expression, income, disability or other social factors. (Sue, Arrendondo & McDavis, 1994; Sue I think that we must think outside the box when training effective counselors. Social justice counseling discourse pushes the envelope even further. The biggest challenge in attempting to become multiculturally competent involved my moving beyond viewing multicultural counseling from a very narrow racial/ethnic lens that focused exclusively on the issues and challenges facing African American clients. Ongoing continuing education is critical in any profession. Some error has occurred while processing your request. She has been studying multiculturalism since the late 1970s and is a founding member of the National Institute for Multicultural Competence. I have also drawn from existing work in a number of fields to develop intervention skills specific for nonverbal signals. Other ways of staying current with respect to issues of multiculturalism are through their own research/scholarship production and professional development activities. Getting out of the office and into the community and its many multicultural events is important, as is becoming active in working toward positive change in social issues. Acad Med. We accomplish this by using and teaching these competencies to others. Acad Med. The Ethics of Cultural Competence Davidhizar R, Bechtel G, Giger JN. It should not come as a surprise that there is a difference in nonverbal communication patterns across cultures, and neither should the idea that nonverbal miscommunication can negatively impact the formation of a cross-cultural counseling relationship. At times, physicians have been slow to allow cultural practices that come in conflict with Western medical practice. Better Serve All Clients With a Culturally Competent Mental Health Counseling Practice. If all counseling is multicultural, then we need to maintain awareness that all counseling inevitably involves issues of social justice. A common obstacle, for example, relates to the notion of having an asymptomatic chronic disease, like hypertension. Multicultural Competence At my university, we teach about racial identity, white privilege, racism and discrimination, social justice, the relationship between poverty and mental health, and the multicultural competencies in the first Introduction to Counseling class and every class thereafter through practicum and internship. 2003;78:5609. Nonverbal communication is very closely linked with our emotional selves, and because of this, I believe it should be a critical area of focus for counselors. 4. It is not enough just to have one course. 1978;88:2518. Rather, I think that building multicultural competence in this area comes from building awareness of the types of differences that can exist and then developing general intervention skills to target nonverbal signals in counseling. I think the future of multiculturalism lies with building effective multicultural skills training for counseling students and professionals. Summary: Todays model of healthcare has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. Multicultural discourse has now evolved to include issues related to social justice, which looks at the negative societal factors that work to complicate the psychological wellness of individuals. Intentional practice is the best approach. Does cultural competence endorse cultural relativity? Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. 20. Facilitating health care is complex enough for patients who are interacting in their primary language and do not need to adapt to different social conventions or bureaucratic procedures. Cultural Competence Thus, as graduates become licensed and obtain their supervisory credentials, there is usually no requirement of obtaining CEUs related to multicultural understanding. 15. When engaging with others, I try to stay mindful of my own emotional experience, reactions and attitudes. And, for mere survival as a counselor, it becomes essential that one is able to work with people of all colors, ethnic groups, genders and sexual orientations, physical and mental abilities, rich and poor, and all forms of diversity. Please try after some time. If a supervisor has been in the field for 15 to 20 years, only their clinical experience may help with understanding multicultural issues, but more formal training may be needed. While all of this is good, we still dont seem to know how to assess multicultural competency beyond subjective self-report processes. 18. Is the problem in the client or the system? How are multiculturalism and multicultural competencies taught or how should they be taught in counselor education? Can multiculturalism be taught, or must it be learned through experience? Professional development and movement toward a culturally competent work environment is the leaders responsibility. To practice culturally competent medical care, I maintain that health care providers must advance the three principles outlined earlier in this essay. 1999;130:82934. WebAsk an expert. If educators do not differentiate between cultural competence and ethical relativism, trainees may experience conflicts between their own values and what they perceive to be the values of cultural competence curricula. He has been researching, teaching and practicing in the area of cross-cultural counseling for more than 50 years. Counseling Today articles such as this one have been important in building awareness and teaching some level of skills. I say perceive because some people perceived to be different from the counselor are not always different. The essence of being an effective counselor with any person is to truly understand this person and the many aspects of who they are and their life. Web( 1) Cultural competence requires that organizations: have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally. In doing so, I hope to catch myself when this habit is occurring so that I can attempt to limit its impact. Ethical multiculturalism: an evolutionary concept analysis This is quite a challenge for many of us. Today, I teach my multicultural counseling course from a conceptual approach, as opposed to studying specific groups of people. In all courses where you are teaching adults, experience is critical to effective learning. All human beings do. Your email address will not be published. We have a great distance to go in terms of understanding what skills fostermulticultural competency while promoting client and student welfare. 1 How can multicultural competence be an ethical Ive found that stepping outside of this habit has been a very individual process for the students Ive discussed it with, so I try not to recommend any particular approach as the right way to do it. WebSummary. The AMCD multicultural competencies have been established as the baseline for counselor training and provide a shared and universal foundation of awareness, knowledge and skills. Along with Paula Britton, Feisthamel presented on multicultural supervision at the ACA 2013 Conference & Expo in Cincinnati. In the one-course model, there is a stand-alone course in multicultural counseling, and in the infusion model, multicultural counseling competencies are infused throughout the curriculum and included in each course that counseling students take as part of their degree program. Multicultural Competence This can be seen, for example, in Crandall's adaptation of Bennett's enthorelativism; Crandall presents the highest developmental phase of cultural competence to be one where the clinician lacks strong cultural identification and has the ability to unconsciously adjust to a wide range of cultural beliefs.14. I always tell students that they have to be intentional about wanting to seek out new information and new experiences with others. 6. WebThough rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Fundamentalism is the view that all cultures endorse certain shared fundamental principles (e.g., human rights), which are specified in various ways and upheld across cultures. Counselors-in-training might be required to live in a home or community that they or someone else perceives [as being] culturally different from them. Given this, students learn about important concepts that must be understood in a cultural context anywhere in the world. Nutrition and architecture, color schemes, even the conceptualization of time or the idea of rationality, are common examples of what may have to be adapted to cultivate a culturally competent health care environment.11. Cultural Competence These strategies help to dismantle the notion of expert counselor and provide a model of interpersonal growth for clients. Multicultural competence or cultural competence is your ability to understand, appreciate, and interact with people who identify with cultures and/or belief systems different from your own. There are two theories of how to include multicultural counseling skills in the counselor education curriculum: 1) the one-course model and 2) the infusion model. Some counselor educators and practitioners think, incorrectly, that once they have learned about multiculturalism in a class or by reading a book, that they have checked the box and are done, Brooks says. First and foremost, we are here to serve all people. Being a multiculturally competent supervisor also includes being culturally sensitive in assigning DSM diagnoses to certain races. How do you see thathappening in practical terms? The four main movements in Western moral theory. The truth is that you need both. I think supervisors lag behind supervisees in multicultural awareness and knowledge. Just as each counselors work is never done when it comes to multicultural competence, West-Olatunji says the profession as a whole must continue reaching higher as well. Cultural Competence Where is the intersection between multiculturalism and social justice? I am currently working on the creation of a training module focusing on nonverbal awareness and skills that can be utilized in multicultural counseling course work. Professional development and movement toward a culturally competent work environment is the leaders responsibility. 14. Most writing on cultural competence has depicted its purpose exclusively in utilitarian terms. Knowledge will set in as we practice what we have learned about multiculturalism and multicultural competencies. It calls for counselors and other mental health professionals to consider not only issues of diversity and culturally appropriate counseling strategies, but it requires counselors to tap into their own social consciousness regarding where a society and all its institutional structures education, business, health arenas have failed to provide equal opportunities and access to all its citizens. Over time, I expanded the curriculum to include counseling other client groups of color in the United States. The oval connects the movements whose approaches can create tension for medical trainees as they learn about cultural competence. The main impediment is our tepid embrace, as physicians, of patient-centeredness.6 The process of enthusiastic engagement with the human beings who are our patients will facilitate culturally competent medical care. Part of facilitating multicultural competency is knowing what you do not know and growing with your client learning together in some cases. Summary: Todays model of healthcare has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. Danica Hays is an associate professor and chair of the Department of Counseling and Human Services at Old Dominion University. The Plurality of Chinese and American Medical Moralities: Toward an Interpretive Cross-Cultural Bioethics. While privilege and oppression related to other cultural group memberships certainly matters, socioeconomic status often has a moderating effect that perpetuates social injustice. Multicultural competence is an essential component of the clinical mental health counseling field and has increasingly become a focus for the profession in order to address disparities in mental health services. It is better to think of it as there is evidence of reliability and validity, just like with a counselor being multiculturally competent. Kagawa-Singer M, Wellisch DK. All of us need to read and learn more, but especially we need to get out in our communities and learn face-to-face. Acad Med. First, counselors-in-training and practitioners still evidence resistance to the topic of multicultural counseling. The true nature of the process by which one develops multicultural counseling competency is indeed challenging because it entails first developing global literacy. Clemmont Vontress is professor emeritus of counseling at George Washington University. The choices of patients who are Jehovah's Witnesses, for example, have needed to be upheld by judicial intervention. WebHow can multicultural competence be an ethical issue as it relates to professional standards regarding competence to practice? Your message has been successfully sent to your colleague. What are the challenges to becoming multiculturally competent? It includes being aware of, gaining knowledge and acquiring skills so that a counselor can be effective when providing therapy to their culturally diverse clients. 2003;78:57787. One of my areas of research is on nonverbal communication in therapeutic relationships, and Ive recently focused on its impact on multicultural counseling. For example, the Council for Accreditation of Counseling and Related Educational Programs requires only one multiculturalism course that is basically an overview of the various types of cultures and what future counselors should particularly pay attention to. Ethical conflicts in clinical medicine will arise, and most of the time mutually agreeable options can be explored.19 Nevertheless, when true ethical conflicts emerge, clinicians cannot be forced to embrace the full spectrum of cultural relativity. Although many graduate programs do an excellent job in expanding multiculturalism beyond the one class, many programs maintain that the multicultural course is sufficient for multicultural training [that is], checkthe requirement box. In my own experience, addressing the habit has involved focusing on developing my own mindfulness and curiosity. What are the challenges to becomingmulticulturally competent? The challenges can be many: believing there isnt enough time to seek continuing education, personal resistance to stepping out of ones own comfort zone, lacking knowledge of where to start when it comes to learning new skills [and] lack of research on best practices with clients of diverse backgrounds who are facing a variety of concerns. First, I dont think that we can speak of a counselor being multiculturally competent. Its kind of like reliability and validity. You can never say that an inventory is reliable or valid. In my opinion, although the acceptance of the multicultural competencies as a baseline for training has significantly advanced the field, there are still some serious gaps. Mark Pope is professor and chair of the Department of Counseling and Family Therapy at the University of Missouri-St. Louis. As awareness, knowledge and skills suggest, becoming multiculturally competent requires learning and practicing, as well as seeking exposure to diverse races, cultures and worldviews. Part of dealing with discomfort and knowing where to start is the realization that you are not alone and that the profession has only fairly recently started operationalizing multicultural competence. 10. When the door closes, what evidence-based practices do I have available to me that use spirituality for working with African American clients?. It would be ludicrous, for example, to assume that all Haitian patients believe in Voodoo or that all white U.S. patients will only pursue allopathy. Psychooncology. However, a couple or so come to mind. Since breaking any habit requires consistent effort, I think that if I can stay curious, Im more apt to make the effort needed to understand their unique worldview. Multicultural Competence: 8 Ways Also, be an active consumer of research and develop methods for collecting data with your clients to inform practice; share with a professional audience as well as your community. There are at least five. This can range from helping parents understand and work with social benefits, to working in a soup kitchen, to direct participation in social justice action groups within a church or community. Mary Bradford Ivey is courtesy professor at the University of South Florida. The values of cultural competence dictate that health care providers should alter their practices to facilitate better medical care. Specifically, if the values of cultural competence are thought to embrace ethical relativity, inexorable conflicts will be created. Perhaps the challenges are around ego and vulnerability. WebMulticultural competency is the ability to adapt, understand and appreciate people that have different beliefs and/or different cultural backgrounds then our own. Instead, he says, remaining multiculturally competent requires constant work, study and development as counselors move through their careers. These matters have to get addressed as we work on our multicultural competency. She coauthored Developing Multicultural Counseling Competence: A Systems Approach with Bradley T. Erford, the second edition of which Pearson published earlier this year. We need to continue to investigate resistance to multicultural counseling. Question: How can multicultural competence be an ethical issue as it relates to professional standards regarding competence to practice? Through my research, I have identified a few key nonverbal areas that differ across cultures that I believe can be utilized in counselor education to demonstrate the range of nonverbal differences that exist. Current research on cultural competence focuses on sensitivity to cross-cultural differences and the ability to adapt to other cultural environments (e.g., Hansen, Pepitone-Arreola-Rockwell, & Greene, 2000), or reflective awareness of cultural influences on one's thoughts and behaviors (Chao, Okazaki, & Hong, 2011). Our relationships give us insights into what it means to be different or to come from a cultural background different from our own. Branch WT Jr. I encourage professional counselors to think of multicultural competence as the basics of being a professional and ethical counselor [to] view their help-seeking behaviors to expand their cultural knowledge as a professional strength rather than a weakness, says Browne-James, president-elect of the Florida Counseling Association That feeling would invite involvement and buy-in at a deeper level than just a theory in a book. How would you describe the current state of multicultural competency within the field of counseling? Med Educ. It is more than just volunteering. To probe this issue further, Counseling Today contacted several ACA members who have studied, researched or worked in the area of multiculturalism. J Health Care Poor Underserved. Building multicultural competence and combating racism require systematic shifts at individual and societal levels. This type of evaluation should explore the range of corrective actions needed, from the removal of frank bias to the discussion of health beliefs and negotiation of a shared model of care. This is an internally contradictory notion, whereby cultural competence seems to endorse both a fundamentalist or even absolutist rule (all providers must fulfill this set of principles) while advancing the multicultural principle of ethical relativity to respect all the various and sundry views of patients. How can Multicultural Competence be an Ethical Issue Present three examples of how a counselor's lack of cultural awareness could affect the quality and outcomes of counseling. Gradually, as my conception of multicultural counseling grew, I began to include ideas on how to counsel people from other disenfranchised groups, such as gay and lesbian clients and people with disabilities. It is the only real way learning can have a lasting impact on the human psyche. 5. Editorials of Laura Weiss Roberts, MD, MA, Addressing Race and Racism in Medical Education, Climate Change Education and Sustainability in Academic Medicine, The Role of Academic Medicine in Firearm Injury Prevention. First, each school, counseling center, and local and regional counseling association needs to establish action plans and serious in-service training to make this important leap. Because of this, believing that everyone else sees and experiences reality the same way you do is a very easy habit to fall into. We believe that since multiculturalism is a foundation in counseling, it must be a core component of every class, along with the parallel social justice issues that systematically impact our clients. I believe the greatest challenge is learning how to step outside of your own worldview. Kleinman A, Eisenberg L, Good B. Such a move would inextricably place it at odds with mainstream Western medical ethics. 1998;76:226. How can multicultural competence be an ethical issue Question: How can multicultural competence be an ethical issue as it relates to professional standards regarding competence to practice? Issues Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. How can multicultural competence be an ethical issue 8. That was the dialogue of 20 years ago. WebThough rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Counselors also need to be prepared to help clients uncover inner and external resources to combat negative societal stressors. The Ethics of Cultural Competence She offers the concept of ambiguity as an example. What responsibility do counselors have to find ongoing continuing education on multiculturalism, and how do they go about doing that? Virtually absent from the literature on cultural competence is any discussion of the role of ethics. Where do you see the future of multiculturalism within counseling? Individually, we each need to make a commitment to learning and change, but this is not enough, as we cannot do all this alone. In addition, most of what we know in terms of changes in counselor multicultural competency is self-report from counselor trainees. There is definite content that can be learned didactically, but experiential learning is a critical component to real learning of most anything, [and it is] especially important to multicultural competence. How can multicultural competence be an ethical issue