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It is of paramount consideration that social workers are conscious of, aware and sensitive to the cultural demands of their clientele. This is because culture is a pivotal factor upon which a great deal of conduct, norms, social connections and mindsets of clients revolve. For social workers there is need to understand and appreciate how cultural traditions influence relationships with a diverse panorama of client needs and demands. This literature review seeks to create a foundation regarding the facts stated above through filtering and analysis of relevant and interesting research studies and works by previous authors. This review of literature focuses on how social workers develop or maintain cultural competence following graduation from Masters of Social Work Program. It aimed at providing answers for further research regarding how social workers maintain cultural competence post graduation. In addition, this literature review seeks to consider that social workers are not enhancing their cultural awareness post graduation as mandated by the National Association of Social Workers (NASW) code of ethics.
DEFINITION OF CULTURAL COMPETENCE
There are many definitions of the term cultural competence. Davidhizar et al, (1998) defines it as the process of developing awareness about one’s own thoughts, feelings and the environment without allowing influence from the background of others. Another definition of cultural competence is the ability to have adequate understanding and knowledge of client’s culture. Yet another definition describes it as the process of recognizing, accepting and respecting cultural differences. These definitions are universal and provide definitions of cultural competence in all dimensions of life. In the context of social work, cultural competence is defined as the ability of social workers to carry out their duties in a manner consistent with the expectations of cultural groups they serve. Goldberg (2000) asserts that cultural competence is not an ultimate goal that organizations should strive to achieve but rather it is a continuous process that should progressively grow over time. Experiences during practice should enable social workers to identify strengths and vulnerabilities that will enable them to develop into culturally competent professionals.
Despite integration of comprehensive cultural studies into the academic curriculum, a gap still exists in the response to the problem and needs of the ever-growing culturally diverse community.
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It is therefore, clear that social workers are not adequately equipped with cultural competence skills after graduation from Masters of Social Work Program (MSW). It has prompted managers in social work service to find other avenues of equipping their workers with the skills in order to practice what they actually profess. In order to explain the scope of the matter, researchers have conducted many studies across the globe. Additionally, public service managers are striving to ensure continuous cultural competence training for their staff regardless of their academic knowledge in cultural awareness.
In their study on ways of reducing ethnic and racial health disparities through cultural competence, Brach and Fraser (2000) point out various techniques of cultural competence. They argue that cultural competence among health providers cannot be achieved without support from the entire health care system and therefore, the issue of cultural competency should be institutionalized. Although much of the literature has detailed the importance of culture knowledge, awareness, skills and attitude, very little has highlighted ways that the health system should be revived to support cultural competence among health care professionals. According to Tocher and Larson (1998), cultural competence techniques identified in literature discuss a single approach thus causing fault lines in the practice of health workers. Brach and Fraser (2000) identify nine techniques to culturally competent health service practice.
The first method is use of interpreter services. According to Lynch and Hanson (2004), language barriers hinder 21% of American minorities from receiving good health care. Research indicates that individuals with Limited English Proficiency (LEP) have a higher rate of low patient satisfaction. Findings from this research show that such patients are more likely to miss their subsequent appointments or fail to adhere to medical prescriptions. A study conducted on Vietnam refugees in the USA shows that they do not utilize health care services due to language differences. The research revealed that of paramount concern is lack of interpreters in health facilities. Interviewees expressed willingness to use the health care facilities if interpreters were availed. Communication forms an integral part in service delivery (Tocher and Larson, 1998). Communication between individuals speaking in different languages and from different cultures could be improved by the use of interpreter services. Interpreters can offer services in either interpretation of foreign language or sign language for the sake of the deaf and blind patients. Depending on the hospital policy, various interpretation approaches are available; professional on-site interpreters; informal interpreters (other staff, family and friends, patients in the waiting room). Tocher and Larson (1998) revealed similar outcomes for diabetic patients who are non-English speaking but received informal interpretation services from English-speaking patients. Although many hospitals consider the use of professional interpreters as an expensive undertaking, other interpreter methods such as the informal interpreters raise the question of confidentiality of the patient’s medical details.
With the use of interpreter services, there is satisfaction for non-English speaking clients and more importantly keeping confidentiality. This therefore, brings up the second technique of cultural competence, which is recruitment, and retention of minority staff.” Social workers should reflect the client population demographics. Brach and Fraser (2000) argue that for instance in the health practice, certain aspects important during practice such as developing rapport with patients may lack if their race and cultures differ. Patients and health providers with the same race, hence culture communicate more effectively thus making the treatment process successful. Hiring minority staffs who share a common language and cultural beliefs with clients from minority cultures provide a welcoming and comfortable environment that also reflects the needs of everyone in the particular society (Tocher and Larson 508). Presence of minority staff enhances ‘user friendliness’ of services delivered to minority populations which in turn enhances accessibility to health care. Another rational to recruitment and retention of minority staff is the fact that such individuals are less likely to engage in ethnic and racial discrimination. Discrimination, whether overt or subconscious, is believed to contribute greatly to treatment differences of clients by social workers.
Training is another strategy of enhancing cultural competence among social workers following their graduation from master’s degrees. Cultural competence training programs are designed to achieve one or all of these goals: (1) increase staff knowledge about minority groups; (2) to perfect their communication skills; and (3) to change attitudes and improve self-awareness towards minority populations. According to the third standard of the NASW (2006), social workers are expected to continually seek knowledge on matters of cultural competence as the globe is radically becoming culturally diverse. They should strive to take part in every training opportunity in order to expand their knowledge and expertise. The behavior of social workers can be renewed through training that in turn is to improve client communication, treatment outcomes in patients and adherence to prescription and advice. Matsunaga et al (2003) observes that activities and interests in cultural competence training have increased tremendously over the past years. In the increasing efforts to promote continuous training of social workers within their practice, the American Academy of Pediatrics’ Committee issued a policy in 1999 stating the importance of competency training for all medical practitioners throughout their practice. According to New York and New Jersey legislatures, physicians are mandated to have cultural competence training as requirement for licenses for their practice. However, critics argue that training is not necessarily effective especially if it involves the education and shorter course approach. A short-term training program has less effect in changing the behavior of the trainee. Other critic such as Davis et al posits that training may be uneven such that trainees acquire knowledge in some area and have a deficit in another. Insufficient research however, has been conducted to identify training strategies that will ensure maximum results.
COMMUNITY SOCIAL SERVICE
Community social service is another branch with social service that enhances cultural competence. Such include community health workers. The United States adapted programs of community health workers for the international arena. Such programs are mostly common in developing countries and are for most part used to reach out to the underprivileged where health systems are limited. By definition, social health workers are professional members of the society who are assigned to work outside their locales and they serve as connection point between the underserved populations and health care providers. Community health workers vary depending on the program they are undertaking; indigenous health care providers, neighborhood workers, and lay health advisers. Social health workers provide a good example of cultural competence. They are adequately equipped with cultural skills that enable them to effectively interact with people in remote places (Matsunaga pg 39).