Indigenous people and the social work profession: defining culturally competent services.
In part, striving for cultural competence is a recognition of the profession's ethnocentric foundation. Social work has historical roots in England, and this cultural legacy may lead social workers to operate from a professional belief system antithetical to cultural values, norms, and beliefs of some clients (Weaver, 1998). "The acknowledgement that Eurocentric values have dominated the sciences and have been propagated as cultural universals . . . begins to set in motion the inevitable clash between dominant and nondominant cultural behaviors. This distinction often represents a point of friction between systems (and the professionals therein) and consumers" (Mason et al., 1996, p. 168). In the past social workers and social welfare systems have imposed American middle-class norms as rigid standards for clients (Pinderhughes, 1997).
The current NASW Code of Ethics (1996) is evidence of social workers' increasing recognition of the importance of cultural competence. In earlier versions, issues of culture and race were listed or implied in various subsections. Now, the code is not only explicit but dedicates a full section (section 1.05) to cultural competence.
Most models of cultural competence consist of qualities that fall under the general components of knowledge, skills, and values (Matthews, 1996; McPhatter, 1997). Knowledge about various cultural groups is essential for cultural competence (Dana, Behn, & Gonwa, 1992; Manoleas, 1994; Mason et al., 1996; Matthews, 1996; Pierce & Pierce, 1996; Ronnau, 1994; Sowers-Hoag & Sandau-Beckler, 1996). It is important to know that diversity exists within ethnic or cultural groups (Mason et al., 1996). Social workers must recognize that relationships between helping professionals and clients may be strained because of historical or contemporary distrust between various groups, in particular, but not limited to, relationships between groups of color and the dominant society (Mason et al., 1996). The legacies of devastating colonial histories are a constant part of the contemporary reality of groups of color (Manoleas, 1994). "The significance of difference in the helping encounter is compounded by the dynamics of power, for the power inherent in the practitioner role is compounded by the status assignment (power) associated with the cultural/social group identity of both client and practitioner" (Pinderhughes, 1997, p. 22).
Awareness of the professional's own values, biases, and beliefs is important for cultural competence (Mason et al., 1996; Ronnau, 1994; Sowers-Hoag & Sandau-Beckler, 1996). A culturally competent helping professional must value diversity and understand the dynamics of difference (Manoleas, 1994; Mason et al., 1996; Ronnau, 1994; Sowers-Hoag & Sandau-Beckler, 1996). Culturally competent practitioners go through a developmental process of shifting from using their own culture as a benchmark for measuring all behavior (Krajewski-Jaime, Brown, Ziefert, & Kaufman, 1996).
Knowledge and values must be integrated with social work skills for culturally competent practice (Manoleas, 1994; Sowers-Hoag & Sandau-Beckler, 1996; Weaver, 1997). Skills must be adapted to meet the needs of diverse clients (Ronnau, 1994). The three components of cultural competence are interactive, and none is sufficient in and of itself to bring about appropriate practice. Striving for cultural competence is a long-term, on-going process of development (McPhatter, 1997).
In addition to material that discusses general components of cultural competence, an increasing amount of literature focuses on cultural competence with African Americans and Latinos. Several current articles cover culturally competent services with various ethnic populations, including Green (1999) and Iglehart and Becerra (1995). Articles that focus on culturally competent social work with African Americans include Gray and Nybell (1990), Jagers and Mock (1993), Randolph and Banks (1993), Schiele (1996), Stevenson and Renard (1993), and Williams (1992). Readers seeking to increase their cultural competence with Latinos may consult Castex (1994), Gutierrez and Ortega (1991), Simoni and Perez (1995), Mason, Marks, Simoni, Ruiz, and Richardson (1995), and Zuniga (1992).
The literature on cultural competence is primarily theoretical and conceptual. Often models are based on practice experience but have not been evaluated in a systematic way. Among the few empirical works are Dana et al. (1992), and Krajewski-Jaime et al. (1996). Dana and colleagues used a content analysis of the literature to develop a checklist of characteristics of culturally competent agencies. Krajewski-Jaime and colleagues applied a cultural competence scale to students in an international setting. I have not been able to identify any empirical work on cultural competence with Native Americans; however, this article begins to address that gap in the literature.
There are roughly 2 million Native Americans in the United States (U.S. Bureau of the Census, 1993). Although their survival in the face of decimating diseases and destructive U.S. policies speaks to the resilience of indigenous cultures and peoples, they are greatly overrepresented in the child welfare system (Hogan & Siu, 1988; MacEachron, Gustavsson, Cross, & Lewis, 1996; Mannes, 1995; Wares, Wedel, Rosenthal, & Dobrec, 1994; Weaver & White, in press), suffer disproportionately from a variety of health problems (May, 1988; Parker, 1994; Stillman, 1992; Wuest, 1991), and are among the poorest people in the United States (Little Eagle, 1993; Stillman, 1992; U.S. Bureau of the Census, 1993). Practice with Native Americans dearly falls within the social work mandate to serve vulnerable and oppressed clients. Although it is not possible to pinpoint the exact number of native people receiving assistance from social workers and other helping professionals, indigenous people are present in many helping systems. Likewise, it is difficult to estimate the number of Native American social workers. With the exception of the American Indian Social Work Educators' Association (active membership approximately 30), there is no functioning national association of Native American social workers. Although it is critical to train indigenous social workers to provide care in their home communities, all social workers must be accountable for providing culturally competent services.
I used a survey to gather information from Native American social workers and social work students on their beliefs about culturally competent services with Native American clients. The cultural competence portion of the survey consisted of three questions: (1) What knowledge should a helping professional bring to working with Native American clients or groups in a culturally competent manner? Explain; (2) What skills should a helping professional bring to working with Native American clients in a culturally competent manner? Explain; and (3) What attitudes or values should a helping professional bring to working with Native American clients in a culturally competent manner? Explain.
The study replicates a project that my colleagues and I conducted with Maori helping professionals in New Zealand. We developed the survey instrument, then a Native American doctoral student and I modified the instrument to fit the Native American cultural context. A later publication will examine similarities and differences in these indigenous populations. The areas of cultural competence examined in this survey reflect areas of cultural competence consistently identified in the human services literature. Another phase of the project will gather data from Native American clients on their beliefs concerning culturally competent helping.
Using data from the Council on Social Work Education (CSWE), I identified eight schools of social work with the highest number of Native American students. Surveys were distributed in seven of the eight schools, and two schools provided lists of graduates to whom surveys were mailed. In addition, surveys were sent to the membership of the American Indian Social Work Educators' Association, and snowball sampling techniques were used to identify other Native American social workers. An instructional cover letter that introduced the project was attached to each survey. Batches of surveys were sent to schools because exact numbers of Native American students often were unknown, or contacts anticipated distributing additional surveys in the community (that is, 25 surveys may have been sent to a contact at a particular school, but fewer probably were distributed). Although the exact number of surveys that reached potential respondents is unknown, 240 were sent. Eleven surveys were returned by the post office, five were returned with incomplete data or blank, and 62 completed surveys were returned. In all, 78 of the 240 were accounted for, leading to an approximate response rate of 33 percent. It is difficult to say if those who did not respond differed from their counterparts who completed the survey; however, respondents came from a variety of tribal backgrounds representative of the population of Native Americans.
I reviewed the data and categorized it according to themes. Initially, I reviewed the data in groups on the basis of education level (BSW student, MSW student, post-MSW, post-PhD) and gender. No differences were identified in statements made by people with different levels of education or based on gender, so I merged and reviewed all data together. It is possible that cultural competence did not vary by education level, because CSWE requirements for cultural content do not vary between the BSW and MSW level, and no accrediting body monitors or requires cultural content in doctoral education. As I reviewed the data, it became clear that many people had similar responses. Such responses were then grouped together. For example, many respondents indicated that knowledge of history was imperative. Each response that discussed history was then sorted into a group that became the history theme described in the next section. A second Native American researcher was involved in the initial stages of the project but withdrew for health reasons before the data were analyzed. Although the withdrawal of the researcher presented challenges for reliability and validity, my extensive immersion in the data and reviewing of the data over an extended period helped to ensure the quality of the analysis. The work in progress was presented to a group of qualitative researchers and modified with their input.
Table 1 Education Level Student Practitioner/Administrator Teacher BSW MSW BSW MSW PhD MSW PhD Male 0 7 0 3 2 2 4 Female 7 21 1 9 0 2 4
Respondents were mostly female, roughly half were students, and most practitioners and all teachers had at least an MSW (see Table 1). Nineteen people identified with more than one tribe or nation, with one person listing six nations. (Those who listed more than one nation in a confederacy, such as Colville Confederated Tribes, were counted as one nation.) Many people who identify with more than one nation are descended from different Native American groups or have strong nonbiological ties such as marrying into another nation. Thirty-six nations were represented in the survey with 18 represented by two or more people. The nations with five or more respondents - Lakota, 14; Chippewa, 7; Navajo, 7; Iroquois, 7; Cherokee, 5; Blackfeet, 5 - roughly correspond to the Native nations with populations over 100,000 (Cherokee, Navajo, Chippewa, and Lakota/Sioux) (U.S. Bureau of the Census, 1993).
The themes that emerged from the data were classified into the three categories commonly identified in the literature as necessary for culturally competent social work practice: (1) knowledge, (2) skills, and (3) values. All subsequent quotations are the words of the respondents.
Four important areas of knowledge were identified: (1) diversity, (2) history, (3) culture, and (4) contemporary realities. The diversity theme is important in and of itself and provides a context for other themes. Social workers must recognize that variation exists among Native nations in factors such as beliefs, customs, and spirituality. One respondent stated, "American Indians are not alike, [do not] speak the same language, [n] or have the same tribal system. Each tribe is different." It is also important to recognize that diversity exists among people within nations. Each client is an individual who may or may not have a strong cultural connection or may experience that cultural connection differently than another native person.
Another theme was the importance of history. Historical knowledge includes understanding treaties, the sovereign status of Native American nations, and federal Indian policy. Social workers also must be familiar with history and laws related to social services with Native Americans, including how the federal government and its policies have fostered dependence. Respondents said that social workers must understand the "effects of oppression, colonialism, [and] racism, [they must know the] history of U.S. extermination and 'assimilation' policies. [they must have] knowledge of the history of government relations and the creation of dependency, [they must also have] knowledge of the amount of loss on all levels that Indian people have experienced." Social workers must understand the atrocities of the indigenous holocaust in this country and the unresolved pain associated with it.
A third theme was cultural knowledge, which includes a knowledge of communication patterns, worldviews, belief systems, and values. A native person's identity often is grounded in a sense of community or being a member of a group rather than based on a sense of individuality. Although diversity among Native American groups exists, common core cultural values were mentioned, such as the importance of family and extended family, respect for elders, matriarchal structures, spirituality, importance of tradition, and issues of death and mourning. "When individuals have no knowledge base then it seems that it is easier for both service providers and clients to get offended. Actions, words, etc., go misunderstood, unnoticed, misinterpreted. It's very hard to teach, help within a culture if you have no understanding of the people, culture, rituals, traditions, etc."
Contemporary realities was the final knowledge theme. Social workers must understand tribal politics, indigenous organizations, the structure of reservations, and urban Native American communities. Social workers also must become familiar with the federal trust responsibility, federal agencies such as the Indian Health Service and the Bureau of Indian Affairs, and federal laws such as the Indian Child Welfare Act and how these relate to the concept of tribal sovereignty. Social workers must understand contemporary roles of native peoples, families, and communities. They must understand issues of loss and posttraumatic stress disorder while also recognizing strengths in contemporary Native American communities.
Skills for culturally competent social work with Native Americans are not radically different from those generally required for practice. Some skills, however, do have particular importance or relevance given cultural considerations with this population. The skills identified can be grouped into two major themes: (1) general skills and (2) containment skills.
Among general skills, communication and problem solving were frequently mentioned as important. One respondent commented, "The biggest (most important) skill I can think of is the ability to interact and engage Indian people (collectively and individually) in a problem-solving process that's based on the definition of the problem and arrival of the solution from an Indian perspective." A strengths perspective and the ability truly to empathize with Native American clients are important skills.
In addition to general skills, many respondents emphasized the need for social workers to have containment skills, involving patience, the ability to tolerate silence, and listening - all skills that require social workers to be less verbally active than they might be with clients from other cultures. Containment skills require social workers to refrain from speaking, as opposed to the skills listed earlier that require more verbal activity (Shulman, 1992). As one respondent observed, competent social work with Native American clients requires "patience, tolerance, to actively listen, to avoid 'jumping' in to say what is on one's mind. To be humorous and to accept being the target of the humor." As another respondent put it, patience is required because "generations of oppression . . . takes time to change" (ellipses in original). Social workers must respect silences and be willing to sit quietly to listen and learn. They must resist impulses to talk to fill silences.
Four major value themes emerged: (1) helper wellness and self-awareness, (2) humility and willingness to learn, (3) respect, open-mindedness, and a nonjudgmental attitude, and (4) social justice. The theme of helper wellness and self-awareness is based on the belief that without balance in their own lives, helpers are not able to provide competent services. Social workers should be grounded in their own cultures and spirituality. As one respondent described it: "The professional should have their own set of values taught by their role models. These positive values and a sense of positive self-respect and things around them will enable continued positive helping." In addition, social workers must be aware of their own biases, beliefs, and stereotypes and keep these out of the helping relationship.
Another theme was the importance of humility and a willingness to learn. As one respondent stated, "An attitude of 'I will continually be educated by others including my clients' is utmost. If one is based in academic arrogance, then they are useless to Native Americans."
Respect, open-mindedness, and the ability to be nonjudgmental were other themes: "I think it's more important for a service provider to be more accepting, appreciative, respectful of other's values; appreciate the differences, not define people by them, not judge people or cultures, but learn from, respect, appreciate, and help." A social worker must "set aside prejudices regarding race, religion, socioeconomic class, etc. [One must have an] ability to grasp [a] different worldview [and an] ability to appreciate different value systems even when it clashes with one's own."
In a theme that goes beyond respect and withholding judgment, many respondents called for social justice, which includes decolonization, and an active acknowledgment of oppression and the unique status of Native Americans. Decolonization involves recognizing, then shedding, the mindset associated with colonial processes by which one culture subjugates another and defines it as inferior. Respondents stated that social workers must acknowledge and support the fact that "special rights of American Indians [are] not based on race but on laws and special legislation. Services provided to American Indians [should] not [be] viewed as [a] handout or moral obligation - but as payment for land and rights given up by American Indians." Social workers should be dedicated to the concept of tribal sovereignty and carry through with a commitment to individual and tribal self-determination. Many respondents called for advocacy for Native American rights and cultural empowerment. Social workers must recognize the power and control aspects found in many human relationships and not replicate these within the social work context. They must demonstrate a value for change by "recognizing [their] own class bias and colonial presence; . . . [they must show] unconditional acknowledgment."
The data provide answers to the following questions: What knowledge is necessary? What skills are needed? and, What values are associated with culturally competent services for Native Americans? It is noteworthy that there are no major contradictions in the data. Although respondents did not give identical answers, strong agreement and consistency among responses led to emergence of clear themes.
The findings confirm and expand the literature on culturally competent social work with Native Americans. Theoretical and conceptual writings in this area generally focus on culturally specific knowledge and skills tailored for this population. With the exception of self-awareness, less has been written about value stances associated with culturally competent social work with this population. In particular, the emphasis on social justice in this study adds another dimension to the literature.
It is not possible for social workers to know all aspects of all cultures, but it is important for them to understand that diversity exists within and among Native Americans and to have a general sense of history, culture, and contemporary realities of clients. Skills for work with Native American clients reflect those necessary for competent helping with any population, yet some skills are particularly important. Social workers assisting indigenous clients should pay particular attention to containment skills - patience, listening, and allowing productive silences.
The respondents identified certain value stances necessary for culturally competent helping. In particular, social workers must be aware of their own stereotypes and focus on their own wellness as helpers and human beings. They must display humility and willingness to learn, rather than arrogance and professional superiority. They must show respect and be open-minded and nonjudgmental. Last, these values must be mobilized into an active stance of social justice. The helper must recognize and combat oppression while supporting rights derived from the inherent sovereignty of indigenous peoples.
This study was conducted with a national sample, which helps the reader generalize the findings to many Native American populations. Caution must be used, however, in rigidly applying any concepts to a particular Native American client without a comprehensive assessment of that person as a cultural being. As the findings indicate, diversity exists among native peoples. These findings serve as general guidelines for all social workers interested in increasing their cultural competence with Native American clients. Beyond the general guidelines, the client is the practitioner's best source of assistance in developing cultural competence.
It is difficult to speculate whether people who did not return surveys differ from those who did. It is clear, however, that surveys were returned from all regions of the country and were representative of the most populous Native American nations, making it reasonable to speculate that the findings are representative of the general population of Native American social workers.
The data have clear implications for practice. To provide culturally competent social work to Native clients, a social worker must
* understand and appreciate diversity among and within Native American populations
* know the history, culture, and contemporary realities of specific Native American clients
* have good general social work skills and strong skills in patience, listening, and tolerance of silence
* be aware of his or her own biases and need for wellness
* display humility and a willingness to learn
* be respectful, nonjudgmental, and open-minded
* value social justice and decolonize his or her own thought processes.
This study builds on theoretical work on cultural competence. Researchers must find ways to measure cultural competence empirically. This study examined the beliefs of indigenous social workers. Studies that examine the beliefs of indigenous clients and evaluate the actions of social workers will be important steps in building this knowledge base. This study currently is being replicated with other Native American helping professionals and other indigenous populations. Research also should be conducted with other cultural groups. With these studies we can develop an empirically based picture of cultural competence and better serve clients from a variety of backgrounds.
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Hilary N. Weaver, DSW, is assistant professor, School of Social Work, State University of New York, Buffalo, 311 Baldy Hall, Buffalo, NY 14260-1050; e-mail: email@example.com.
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|Author:||Weaver, Hilary N.|
|Date:||May 1, 1999|
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