The director of a mental health services agency shared her agency journey towards cultural and linguistic competence. She said that they had done a lot of work to create a culturally competent agency. They had routine trainings, lunch time chats, policies and procedures to promote cultural and linguistic competence (CLC), available interpreters, and a staff that was a little more racially diverse than when she started there.
But it seemed like nothing had changed. There were still disparities in the numbers of families of color who were seeking services, disparities in the completion rates of interventions, disparities in the degree of satisfaction with the services. It was not until after she brought in an “undoing racism” consultant to work with the staff over a period of several weeks, that there was a palpable change in the agency. With the consultant’s assistance, the staff authentically engaged in examining their own attitudes, beliefs, and personal history and engaged in serious reflection and contemplation. They were then able to make use of the infrastructure that had been created for them. The shift in attitude enabled them to engage with families who were culturally different from themselves in a manner that was truly one human being to another.
Robert Heifetz in Leadership without Easy Answers, would label these two approaches as facilitation of change, technical work and adaptive work. The technical work includes those actions for which there is agreement on the goals and the process for which the members of the group only need permission and resources. The adaptive work is much more complex. Adaptive work asks the question: “Does progress on this problem require changes in people’s values, attitudes and/or habits of behavior?” In adaptive work there is not the certainty or clarity about the correct path and there is the need to explore a variety of vantage points by the collective to achieve progress. This director and staff had to face the fact that trainings, policies, interpreters and even culturally diverse staff do not automatically yield a change in practice. As another colleague noted, “people do not assimilate new ways of doing things, unless and until they make emotional space in their current paradigm.”
The work to advance cultural and linguistic competence requires both technical and adaptive work. The technical is captured by such elements as: trainings, interpretation and translation, increased diversity of staffing, use of culturally adapted Evidence-Based Treatments, routine demographic data analysis of service area, and community meetings. These are necessary steps, but they are far from sufficient.
One manifestation of the need for adaptive work is reflected in resistance. This resistance is expected because the topics of prejudice, discrimination, and oppression are controversial and emotionally charged. Examples include the resistance to attend trainings and the resistance to budget for interpretation and translation services. Adaptive work may be indicated in the complaint that qualified persons who reflect diversity cannot be found. Similarly, adaptive work may be indicated by the question, “why should we use an adapted intervention?” or “why should we, the behavioral health experts, include community members in our meetings?” If we explore the reasons for this resistance, we will probably discover that factors such as privilege, conscious and unconscious bias, stereotypes, and power are at play.
Well-meaning people – who are staunch advocates for quality behavioral health services for children, youth, young adults, and their families –want to believe that they are free from bias, prejudicial thinking, and discriminatory behavior. They acknowledge that racism exists, that ableism exists, adultism exists, and so forth. However, there is the tendency to recoil at the invitation to discuss these “isms” because “we’ve already done that” or “we are trying to be politically correct.”
And yet, disparities in behavioral health services and outcomes persist.
The TA Center’s CLC blog series will invite the reader to reflect and engage in a discussion on some of the issues that have served as barriers to authentic change. Readers will be invited to participate in a process to find their way to meaningful, authentic helping or collegial relationships with those who are not like themselves. Concepts such as racism, unconscious bias, privilege, heterosexism, institutional oppression, and internalized oppression will be examined. Readers will be challenged to consider how they personally relate to these concepts, how their colleagues relate to these concepts, and how their organizations relate to these concepts. They will be invited to describe their strategies to address these issues for themselves, with their colleagues and in their organizations. This collective journey is designed to convert the notion of CLC from a once a year training event, to an authentic relationship with a family or colleague, which affirms that we are all cultural beings interacting in a universe constructed of multiple cultures and fraught with institutionalized social injustice.
Look for the TA Center CLC series: georgetowntaclc.wordpress.com. Prompts for discussions will be posted the third Thursdays of each month – stay tuned! Please send us your suggestions for issues to explore to Dr. Vivian Jackson or Teresa King.
“The world in which you were born is just one model of reality. Other cultures are not failed attempts of being you. They are unique manifestations of the human spirit.” Wade Davis, 2009 The Wayfinders: Why Ancient Wisdom Matters in the Modern World.
For questions, please contact
Vivian H. Jackson, Ph.D., LICSW
Assistant Professor, Senior Policy Associate
Georgetown University National Technical Assistance Center for
Children’s Mental Health