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Journal of Ethnic & Cultural Diversity in Social Work

ISSN: 1531-3204 (Print) 1531-3212 (Online) Journal homepage: https://www.tandfonline.com/loi/wecd20

From Cultural Competence to Cultural Consciousness: Transitioning to a Critical Approach to Working Across Differences in Social Work

Corry Azzopardi & Ted McNeill

To cite this article: Corry Azzopardi & Ted McNeill (2016) From Cultural Competence to Cultural Consciousness: Transitioning to a Critical Approach to Working Across Differences in Social Work, Journal of Ethnic & Cultural Diversity in Social Work, 25:4, 282-299, DOI: 10.1080/15313204.2016.1206494

To link to this article: https://doi.org/10.1080/15313204.2016.1206494

Published online: 21 Jul 2016.

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From Cultural Competence to Cultural Consciousness: Transitioning to a Critical Approach to Working Across Differences in Social Work Corry Azzopardia and Ted McNeillb

aThe Hospital for Sick Children, Division of Pediatric Medicine, Department of Social Work, Toronto, Ontario, Canada; bUniversity of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada

ABSTRACT Driven by increasing cultural diversity and growing inequities in health and social outcomes, cross-cultural competence has become a fundamental dimension of effective and ethical social work practice. It has assumed aprominent discourse in social work education, scholarship, professional practice, codes of ethics, and organizational policy; however, how one defines, acquires, applies, and evaluates cultural competencies continue to be issues of debate. Grounded in a postmodern epistemic frame, an integrated model of critical cultural consciousness for working across differences in social work is proposed and implications for micro, mezzo, and macro levels of practice are discussed.

KEYWORDS Cultural competence; culture and diversity; social work education; social work practice

Driven by increasing cultural diversity across North America and growing inequi- ties in health and social outcomes among minority groups, cross-cultural compe- tence has become a fundamental dimension of effective and ethical social work practice. The concept of cultural competence has assumed a prominent discourse in social work education, scholarship, professional practice, codes of ethics, and organizational policy. How one defines, acquires, applies, and evaluates cultural competencies, however, continue to be issues of debate in the social work profes- sion. This article reviews selected bodies of theoretical and empirical literature examining cultural competence in social work and related disciplines, including conceptual underpinnings, practice approaches, and controversies. Grounded in a postmodern epistemic frame, we propose an integrated model of critical cultural consciousness for working effectively across differences in social work and discuss implications for micro, mezzo, and macro levels of practice.

Culture and diversity: framing the constructs

The meanings ascribed to the terms culture and diversity have evolved over time and have held different connotations and significance in the social work

CONTACT Corry Azzopardi [email protected] The Hospital for Sick Children, Division of Pediatric Medicine, Department of Social Work, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.

JOURNAL OF ETHNIC & CULTURAL DIVERSITY IN SOCIAL WORK 2016, VOL. 25, NO. 4, 282–299 http://dx.doi.org/10.1080/15313204.2016.1206494

© 2016 Taylor & Francis

profession at various points in history (Kohli, Huber, & Faul, 2010). Culture, from our perspective, is understood as the shared identity or identities of a group of people based on common traits, customs, values, norms, and patterns of behavior that are socially transmitted and highly influential in shaping beliefs, experiences, and worldviews. Based in anthropological and ethnographic studies and informed by a modernist perspective, the term culture was traditionally narrowly limited to the one-dimensional character- istics of race and ethnicity shared by members of a specific group.

Current conceptualizations of human diversity extend beyond outward manifestations of culture such as race, religious observances, or material arti- facts to include subjective experiences associated with the multiple social loca- tions in which individuals are immersed, including age, gender, sexual orientation, (dis)ability, socioeconomic status, geography, and political affilia- tion, among other diversities. Through a contemporary postmodern lens, culture and diversity are viewed as individually and socially constructed phe- nomena that are ever-evolving (Dean, 2001). From this perspective, diverse groups are not homogeneous in nature despite sharing some common history, attributes, or practices. Individuals are understood to have intersecting and fluid identities, with wide variation between and within different groups.

Cultural competence in social work: significance and controversies

There have been many conceptual definitions of cultural competence and related terms such as multicultural practice proposed in the literature (Boyle & Springer, 2001). Kohli and colleagues (2010) chronicle the history of the inclusion of diversity content in social work education, from the assimilation and melting pot paradigm of the 1950s to the social constructionist ethno- cultural framework of the past decade. It remains a rather complex, elusive, and evolving construct. In its simplest form, cultural competence can be understood as an ongoing process whereby one gains awareness of, and appreciation for, cultural diversity and an ability to work sensitively, respect- fully, and proficiently with those from diverse backgrounds. In one of the most frequently cited definitions across disciplines, Cross, Bazron, Dennis, and Isaacs (1989) describe cultural competence as “a set of congruent beha- viors, attitudes and policies that come together in a system or agency or among professionals that enable effective interactions in a cross-cultural framework” (p. 4). An important feature of this conceptualization is its emphasis on competencies across personal, organizational, and systemic levels, as opposed to simply a characteristic of the individual.

There has been a growing appreciation for the complexity of cultural com- petence, including the trajectory of knowledge development and integration of critical knowledge for practice. Historically limited to racial and ethnic mino- rities, the concept of culturally competent practice has more recently been

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applied to all individuals of diverse backgrounds. The ideological underpin- nings and logistical shortcomings of cultural competence have been the subject of considerable debate. Its controversies, contradictions, and barriers have been discussed extensively in the literature (Ben-Ari & Strier, 2010; Dean, 2001; Furlong & Wight, 2011; Harrison & Turner, 2011; Iglehart & Becerra, 2007; Johnson & Munch, 2009). Based on the assumption that cultural knowledge translates into competent practice, the term competence is criticized for imply- ing that a tangible set of skills and behaviors can be achieved and measured. Williams (2006) notes the problematic emphasis on technique in the absence of a coherent theoretical foundation, which is critical to informing the rationale for why certain practice approaches are believed to be more or less effective than others, as well as providing the groundwork for evaluating their efficacy.

Cultural competence frameworks have also been challenged for their erroneous assumption that clinicians are from the dominant culture (Sakamoto, 2007b), disregard of immense within-group diversities (Tsang, Bogo, & George, 2003), and situating competence as a static characteristic of the clinician (Lee, 2010). Perhaps the greatest shortcoming of much of the literature on cultural competence lies in its apolitical stance, weak or absent analysis of power relations, promotion of othering, and inadequate approach to addressing oppression at systemic and structural levels (Abrams & Moio, 2009; Sakamoto, 2007b). Daniels (2008) calls for a paradigm shift in social work education to embrace a more critical understanding of the experiences of oppressed individuals and groups.

Irrespective of these conceptual and practical tensions, considerable attention continues to be given to cultural competence in the burgeoning theoretical and empirical literature, education curricula, and organizational policies and prac- tice standards. Furlong andWight (2011), for instance, discuss the practical and rhetorical appeal of cultural competence, despite incoherence and ambiguities in definition and operation. This sentiment is echoed by Williams (2006), who asserts that, notwithstanding poorly understood competencies and applications, cultural competence “demands that we practice with skills, attitudes, and values that will make us effective and adequate in service provision to clients who originate from a variety of cultural backgrounds” (p. 210).

Culturally competent practice models: strengths and shortcomings

A number of approaches to culturally responsive practice have developed over time. Grounded in a modernist paradigm, the cultural literacy model was the first broadly applied framework (Dyche & Zayas, 1995). Based on the assumption that culture is knowable, this approach emphasized learning about the shared history, traits, and practices of particular cultural groups and applying culturally specific interventions. Rooted in anthropology and ethnography, the cultural literacy model fit with early definitions of culture

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as a static and monolithic construct, thus neglecting the degree of accultura- tion and sociocultural realities of multiple intersecting identities. It has been criticized for its impracticality, reductionist approach, attention to the abstract over the experiential, and potential for overgeneralization and stereotyping (Ben-Ari & Strier, 2010; Dyche & Zayas, 1995; Tsang & Bogo, 1997). The notion that one can truly know another’s culture or be an expert in the cultures (and subcultures) of others has been challenged as unrealistic and simplistic (Dean, 2001). Furthermore, a cornerstone of early approaches to cultural competence was a celebration of differences relating to distinct cultural histories and traditions. There were, and continue to be, good reasons to celebrate differences; however, this lens can inherently obscure other critical dimensions of experience such as racism and discrimination.

Social work has historically adopted either a cultural deficit approach or a cultural relativist approach to practice, both of which can be problematic (Barn, 2007; Chand, 2008). A deficit perspective is criticized for pathologiz- ing cultural beliefs and practices perceived as deficient, resulting in interven- tions that are overly intrusive or unnecessarily interventionist. A relativistic perspective, on the other hand, is criticized for viewing all cultural practices, including those that are potentially harmful, as equally valid, resulting in interventions that are too weak or hesitant. The challenge comes in striking a fair balance between the two ends of the spectrum. Healy (2007) suggests that social workers are likely to find a midpoint that may shift in one direction or the other depending on client circumstances; however, cultural relativity should never be used as a rationale for violating human rights.

Although several cultural competence frameworks have been proposed in social work practice and academia, no consensus appears to have been reached in the profession thus far. In their synthesis of the cultural compe- tence literature, Kohli and colleagues (2010) conclude that most approaches share some basic assumptions, including the premise that reality is socially constructed, diverse worldviews must be appreciated, multiple realities shape individual personalities, and diversity education has a positive effect on developing cultural competencies. Este (2007) also highlights several key themes emerging from the literature describing the building blocks for culturally competent social work practice, including a specific knowledge base about diversity and oppression, a lifelong process of learning about the worldviews of cultural groups, strong communication skills, a capacity for empathy, and a congruent intrinsic value base.

Informed by a postmodern frame, Sue, Ivey, and Pedersen’s (1996) theory of multicultural counseling and therapy is possibly one of the most influen- tial frameworks for delineating the development of cultural competence in the helping professions. This approach views cultural competence as an active and ongoing process and proposes a 3-by-3 matrix consisting of three characteristics of cross-cultural competencies: (a) counselor’s awareness

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of his or her own assumptions, values, and biases, (b) counselor’s awareness of the client’s worldview, and (c) culturally appropriate interventions—all of which develop across three dimensions: (a) knowledge, (b) beliefs and atti- tudes, and (c) skills. An understanding of macro-systemic factors was more strongly incorporated in later versions of the framework (Sue & Sue, 2013). A major limitation of this theory, however, is its culture-specific focus as opposed to a broader worldview. Nevertheless, the core dimensions of knowledge, awareness, and skills are foundational to most frameworks and standards for culturally attuned practice (Jackson & Samuels, 2011; National Association of Social Workers [NASW], 2001, 2007).

In social work, cultural competence models are increasingly informed by social-ecological theory and target micro-, mezzo-, and macro-level actions and results (Simmons, Diaz, Jackson, & Takahashi, 2008). With their added emphasis on the impact of social injustices and oppressive power relations and the goal of social change through multilevel practice, some of the cultural competence models proposed in the social work literature have addressed the shortcomings of psychologically oriented frameworks. For instance, George and Tsang (1999) examine the social construction of diversity and address the intersectionality of oppressions in their social constructionist approach to cultural competence; Laird (2008) and Sakamoto (2007a, 2007b) advocate for the infusion of anti-oppressive principles into culturally competent practice models; and Saleebey (2012) focuses on client strengths rather than problems with the goal of promoting empowerment. Fong (2004) integrates each of these elements in her contextual approach to culturally competent social work practice using an ecological framework. The person-in-environment focus of ecological theories, the cornerstone of social work practice, encom- passes both individual and environmental factors when assessing problems and finding solutions with clients from diverse backgrounds (Haynes & Singh, 1992). Moreover, the values and ethics underpinning social work practice have been recognized as providing a foundation for understanding and appreciating culture and diversity (Hugman, 2013).

Addressing the power imbalances that shape worker-client dynamics, the construct of cultural humility has emerged as an alternative conceptualiza- tion of cultural competence that underscores authenticity, respect, and hum- bleness in helping relationships. Fisher-Borne, Cain, and Martin (2015) describe the core interconnected elements of cultural humility as institutional and individual accountability, life-long learning and critical reflection, and mitigation of power differentials. Characterized by an “other-oriented” inter- personal stance, cultural humility has been shown to be positively correlated with a strong working alliance and improvements in therapy (Hook, Davis, Owen, Worthington, & Utsey, 2013).

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Toward a critical model for working across differences in social work practice

Integrating cultural competence and social work practice in a coherent and clinically grounded way poses a continuing challenge in the field and conse- quently, a gap in the literature (Lee, 2010). While there appears to be some consensus regarding the broad constructs of what constitutes cultural com- petence, specific practice components have not been firmly established. Thus, building upon the strengths and mitigating the implicit and explicit short- comings identified in the literature, we propose an integrated conceptual framework for culturally responsive social work practice.

Cultural competence has been defined in various ways, but at its core is the ability to work effectively across differences. Given that individuals interpret their world in complex and ultimately unique ways, we argue that social workers are always working across differences, regardless of the extent to which they share a common cultural heritage or social location with their clients. Recognition of this fundamental reality of practice is reflected in the proposed model. Given the power of language in shaping social work dis- course, we have replaced the term competence with the construct of con- sciousness. We agree with others (e.g., Dean, 2001) that one can never unequivocally achieve competence simply through the acquisition of cultural knowledge and skills. That being said, maintaining a continuous, mindful awareness of culture and diversity, including the complex ways in which they construct meaning and experience, promotes effective and ethical practice. We view cultural consciousness, therefore, as an ongoing and dynamic developmental process with no endpoint—one that requires active, critical, and purposeful engagement on the part of the social worker entering the helping relationship.

Our framework offers an integrated and multilevel approach to culturally conscious practice and advances knowledge by addressing the limitations of existing conceptual models in several important ways. First, it is grounded in a strong epistemological and theoretical foundation. Second, it adopts a multidimensional view of culture that extends beyond race and ethnicity to include multiple, intersecting, and shifting identities, thereby not limiting its utility to visible minorities. Third, it offers analyses of asymmetrical power relations contributing to cultural alterity. Fourth, it can be infused into multilevel social work practice across micro, mezzo, and macro concentra- tions. Fifth, the model identifies specific clinical skills and provides a con- ceptual framework focusing on cognitive and affective domains that can be applied to generalist social work practice. Sixth, it can be widely and effec- tively utilized by social workers from both minority and dominant cultures working with clients from both minority and dominant cultures. And finally, cultural consciousness is conceptualized not only at the level of the individual

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social worker, but also at the broader level of the organization, recognizing that systemic support is crucial to delivering culturally responsive services.

With knowledge, skills, and attitudes as overarching dimensions, the core components of the proposed model of critical cultural consciousness in social work are delineated across four fundamental domains: (a) evidence-based knowledge, (b) conceptual framework for practice, (c) intervention strategies, and (d) critical self-awareness. Although each element is discussed next in a sequential manner, together they provide context for one another and inter- act in reciprocal ways.

Evidence-based knowledge

Specialized knowledge in a variety of substantive domains supports an evidence-based approach to working competently across differences and fosters critical thinking. The knowledge relevant to informing practice will vary depending on the unique cultural background, social locations, and situational context of each diverse individual. While reliance on “knowing” culture has been critiqued as reductive and promoting stereotyped assess- ments, we argue that evidence-based knowledge about culture and diversity can be a valuable component of social work practice, when applied appro- priately. Knowledge generated through quantitative and qualitative research, including community- and arts-based designs for example, is ideally suited to inform practice. Opportunities to critique methodological rigor, potential sources of Eurocentric bias, and knowledge claims can remedy some of the implicit tensions between cultural competence and evidence-based approaches, which sometimes privilege certain “ways of knowing” over others (Kirmayer, 2012).

The experiences of individuals, however, are unlikely to mirror exactly the collective experience of groups. For this reason, empirical knowledge must be considered tentative and neither generalizable nor transferable in its applica- tion at the level of a unique individual, family, or group. Consistent with Laird’s (1998) concept of “informed not-knowing,” knowledge should be approached with an open mind, while maintaining a capacity to suspend such knowledge to mitigate against stereotypes and false assumptions. To this end, group-based knowledge can be helpful to sensitize social workers to potential cultural practices and experiences of individuals without essentia- lizing them. This is a subtle yet important distinction. An attitude of “respectful curiosity” (Dyche & Zayas, 1995) augments simultaneous efforts to understand unique variations through a process of empathic confirmation and learning from individual clients, who are the real experts about their lives.

We highlight three broad knowledge domains next, which we purport to be key elements of evidence-based cultural consciousness in social work.

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Discrimination and inequality as social injustices The supposed problem with difference, as pointed out by Cooke (1999), is that some people are discriminated against simply because they are different from the majority or dominant culture. As human beings, we seem to have an infinite capacity to dichotomize others as “us” or “them” depending on how we perceive their similarities or differences. Consequently, an indivi- dual’s experiences and opportunities in life are shaped by the manner in which he or she is potentially subordinated (or privileged) in society based on dimensions of diverse identities. Those who are regarded as different from dominant groups according to socially prescribed power hierarchies are more likely to experience discrimination and adverse outcomes (Wilkinson & Pickett, 2009). This is the profound reality that transforms the issue of being different into one of potential social injustice and thus constitutes essential knowledge for practice.

Evidence-based knowledge from around the world has shown that inequality has reached a critical point. The size of the gap between the rich and the poor has been consistently correlated with virtually any health, socioeconomic, or social outcome (Wilkinson & Pickett, 2009). For example, evidence suggests that socially marginalized groups experience multiple forms of interpersonal and systemic discrimination in health care, which impede access to health services and result in greater health disparities (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003; Mikkonen & Raphael, 2010; Raphael, 2009).

History, colonialism, and neoliberal ideology Working with others takes place within a particular historical, social, poli- tical, and economic context. In Western societies, the past three decades have witnessed a vast expansion in cultural diversity. Knowledge about specific cultures is an important starting point for cultivating cultural sensitivity and insight into the social realities of diverse groups. For instance, group-based historical knowledge about the devastating impact of colonialism on Indigenous populations can raise awareness of potential issues manifesting at the personal level but originating at the societal level. Knowledge of the multifaceted ways in which power-based oppression, marginalization, and systemic discrimination can affect health, well-being, and service delivery is an essential component of critical social work practice with diverse populations.

The broader context of capitalism, globalization, and neoliberalism emphasizes individual (over social) responsibility and shrouds the structural obstacles that disproportionately impact diverse individuals and groups (Coburn, 2010). The global shift toward smaller government, deregulation, lower taxes, laissez-faire capitalism, and the consequent degradation of social welfare programs and services contributes to personal hardships. While

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social and economic policies shaped by neoliberal ideology impact all indi- viduals to some extent, diverse populations such as racialized minorities, new immigrants, and those living in poverty are often more severely affected. This knowledge is inherently political and can inform advocacy efforts for broader social change.

Postmodernism, multiple identities, and intersectionalities A postmodernist paradigm recognizes the continuously changing nature of experience and embraces multiple personal and contextual realities, unique narratives, and subjective interpretations. With an appreciation for multiple truths and sources of knowledge, a postmodern perspective views all cultural beliefs, practices, and worldviews as valid. Individuals may identify with a variety of diverse characteristics and social locations that contribute to them being perceived as different, thereby increasing their risk for various forms of discrimination. The concept of intersectionality is used to capture this com- plex interplay among multiple identities and sites of possible oppression (and privilege).

A postmodern orientation promotes a conceptual shift from situating the social worker as expert, embraces uncertainty, and places emphasis on learning with and from the client. Representing and speaking for the “other” can be hazardous given the (unintentional) potential for harm and disempowerment. To reflect the relational focus and dynamics of clinical social work practice, Lee (2010) envisions cross-cultural competencies as fluid processes that vary over time with each unique individual. This revi- sioning expands the construct of cross-cultural work beyond a static char- acteristic of the social work clinician to encompass the dynamic interactions between dyads within a therapeutic relationship; in other words, from a one- person psychology to a two-person psychology. This interpersonal process is both iterative and reciprocal, reflecting their shared history and interaction. Highlighting the challenges involved in maintaining positive engagement and responsiveness in therapeutic dialogue across cultures, Lee and Horvath’s (2014) work illustrates the importance of focusing on moment-to-moment interactions in cross-cultural clinical practice.

Conceptual framework for practice

In addition to the empirical knowledge domains just described, working effectively across differences requires a broad yet clearly articulated concep- tual framework to integrate components of practice. As social workers, we function in positions of power and are “brokers of reality” (McNeill, 2006); that is, we are in privileged positions to make judgments about the behaviors and actions of our clients. The lenses through which we understand the experiences of others are of central importance. For example, if we are

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oriented solely to a personal growth approach, we may perceive clients as struggling with lifestyle choices, in which case we are likely to formulate the presenting issues as “private troubles” with a corresponding clinical goal of facilitating more individual responsibility. This approach may obscure the broader structural forces at play within the social environment that operate to marginalize and oppress. Alternatively, if we identify exclusively with a structural approach, we may overlook important personal variables while concentrating on societal power imbalances beyond the control of the individual.

Although it is not feasible to explore the full range of theories and conceptual models that may contribute to an overall framework for culturally competent practice, we highlight key complementary approaches that may be particularly helpful in bridging the cultural divide in social work practice.

Ecological and strengths-based orientations Ecological systems theory, with its emphasis on the reciprocal interplay of factors across micro, mezzo, and macro systems, provides an ideal framework for integrating important considerations at multiple levels of the social ecology (Bronfrenbrenner, 1979). At the micro level, attention is drawn to the emotions, behaviors, cognitions, attributions, and relationships that shape and reflect individual experience, and may be suitable targets for clinical interventions to promote personal agency, self-efficacy, and psycho- logical welfare. By contrast, macro-level analysis provides a means of identi- fying powerful structural forces that impact individuals such as the broad social determinants of health (e.g., toxic effects of poverty and social exclu- sion on health and well-being), combined with restricted availability of social welfare programs consequent to neoliberal restructuring. Recognizing the reciprocity of factors across ecological systems contributes to a broader understanding and scope of practice to address multilevel problems.

A strengths-based orientation is an important component of social work practice with clients from diverse communities who experience personal blame for the challenges they face (Larson, 2008; Saleebey, 2012). A strengths perspective guards against pathologizing individuals by shifting attention from deficits to assets. Moreover, a resilience model that identifies both risk and protective factors at all levels of social ecology complements a strengths-based approach while simultaneously validating the obstacles at play. Areas of risk and resilience are understood as subject to interpretation. Attributed meanings are personally and socially constructed and are part of the bedrock of human experience (Wakefield, 1995).

Critical approaches Critical theories such as feminism and political economy offer additional necessary frameworks for understanding diversity, oppression, and aspects of

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experience within a social context. Critical approaches to practice help to expose sociocultural and political processes that reinforce embedded power asymmetries that shape the lived experiences, social exclusion, and material deprivation of marginalized groups.

Together, these complementary approaches comprise components of a conceptual framework that recognizes individual qualities as well as environ- mental factors that are the source of many hardships affecting diverse individuals and communities. It is not our intent to be prescriptive about specific approaches but to identify the importance of including a critical lens as part of a multi-theoretical framework.

Intervention strategies

Through the integration of evidence-based knowledge and an overall con- ceptual framework that promotes the use of various lenses for understanding a client’s circumstances, social workers can apply a range of culturally responsive intervention strategies, including anti-oppressive practices at clin- ical, community, and policy levels. It is beyond the scope of this article to provide a full account of all potentially relevant interventions. Nonetheless, we propose the following as complementary dimensions of social work practice that are helpful in working effectively across differences.

Individualize through clinical empathy On a clinical level, a capacity for empathy is essential to maximize our understanding of others in a way that resonates both intellectually and emotionally. Cultural empathy requires a clinician to understand and be responsive to the experiences of diverse clients based on their interpretation of cultural data, as well as affective and communicative processes (Ridley & Lingle, 1996). It is a “general skill or attitude that bridges the cultural gap between the therapist and client, one that seeks to help therapists to integrate an attitude of openness with the necessary knowledge and skill to work successfully across cultures” (Dyche & Zayas, 2001, p. 246). In her study examining variables contributing to multicultural competence, Constantine (2001) found that clinicians who endorse higher cognitive and affective empathy, along with higher levels of multicultural training and an eclectic theoretical orientation, have better multicultural case conceptualization skills. The importance of empathy and compassion in culturally competent social work services was echoed by members of a range of oppressed groups (Gentlewarrior, Martin-Jearld, Skok, & Sweetser, 2008).

An empathic understanding is instrumental in facilitating cross-cultural engagement, trust, and ontological integrity by increasing the likelihood that the intersubjective co-construction of meaning and experience approximates the “truth” for clients. An empathic understanding therefore individualizes

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clients; that is, it differentiates them from others and reflects their unique aspects of identity, experience, degree of acculturation, and shared experience with other members of the community. As such, it is part of a differential approach to enable a formulation that ensures micro-level interventions are targeted effectively. An empathic understanding of client strengths contri- butes to fostering empowerment through efforts to increase personal agency and self-efficacy to maximize an individual’s internal locus of control.

Deindividualize for anti-oppressive interventions A complementary process of deindividualization is also needed to promote an overall formulation that includes consideration of broader structural forces, thus ensuring that the helping relationship is not limited to a singular focus on personal struggles and individual responsibility. For this reason, an anti- oppressive perspective and culturally conscious practice go hand-in-hand (Ben- Ari & Strier, 2010; Laird, 2008; Parrott, 2009; Sakamoto, 2007a, 2007b). Anti- oppressive principles support a sociopolitical analysis of oppressive power dynamics that often underlie the problems faced by diverse groups and help to expose the Eurocentric knowledge base upon which most social work interven- tions are grounded (Sakamoto & Pitner, 2005). Through the process of deindi- vidualization and contextualization, an anti-oppressive approach helps to identify problems within their broader social context with the goal of transform- ing the power imbalances that perpetuate marginalization and various manifes- tations of discrimination. Thus, cultural consciousness, informed by anti- oppressive practice, incorporates a strong commitment to social justice.

On an individual level, examples of anti-oppressive practice designed to complement clinical-level interventions include the use of a strengths-based approach, efforts to connect clients to necessary resources, and individual advo- cacy to gain access to services and navigate the system. Beyond work at themicro level, efforts to partner with community-based organizations to plan for com- munity development and advocate for changes regarding program availability and policy reform are valuable strategies for addressing social context. Broad- based systemic advocacy (i.e., efforts to ameliorate the unequal power relations and social conditions adversely affecting whole communities) has the potential advantage of mobilizing a coalition of forces to bring about social change.

Agency and institutional context The internal policies and service delivery standards of institutional settings can systemically promote or impede cultural consciousness. Nybell and Gray (2004) call attention to the need for “agencies to undertake an organizational development process that parallels the individual journey of the worker toward cultural competence” (p. 18). This journey begins with organizations embracing cultural consciousness as a strategic priority and entrenching its values across all aspects of its operation, from mission statement to frontline

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service delivery. This requires close examination of existing processes and structures that potentially constrain how well the principles of cultural consciousness get translated into practice. Social workers are in a key posi- tion to raise awareness within their organization and to work with colleagues in other disciplines to advance an agenda of social justice. Some agencies may not be ready for the language of social justice or view it as their mandate, but when reframed as addressing barriers and obstacles that may complicate recovery and compromise outcomes, it is more likely to resonate and align with agency priorities. Moving beyond a “feel-good celebration of diversity” is an important step for organizations because cultural consciousness includes consideration of internal attitudes, practices, and policies that may constitute a form of institutional discrimination.

More specifically, social workers can be advocates for organizational indica- tors of cultural consciousness that include a commitment to recruiting and retaining diverse representation on governing boards, frontline workforce, and leadership positions; formulating anti-oppression policies, practices, and proce- dures that foster a climate of respect and inclusion; arranging opportunities for training in cultural consciousness for staff; helping to plan for access to linguis- tically and culturally appropriate resources; ensuring a barrier-free physical space; promoting meaningful inclusion of clients as stakeholders in decision making; and forming partnerships with culture-specific agencies and commu- nities (Este, 2007; Hyde, 2004; Iglehart & Becerra, 2007; Simmons et al., 2008).

Critical self-awareness

Fundamental to culturally conscious social work practice within an anti- oppressive framework is critical self-awareness about the implications of one’s own cultural background, social locations, preconceived notions, ideo- logical values, and inevitable biases. Akin to a cultural humility framework, ongoing reflection on how one is positioned within the continuum of power and its effects on practice, perceptions about clients, and the framing of problems and solutions is essential to this process. As social workers, we are in positions of relative power and have likely acted in an oppressive manner in some contexts (Daniels, 2008). Recognizing our potential role in a “race for innocence” (i.e., claiming oppressed status ourselves to shield against having to consider one’s own inappropriate use of power or role as an oppressor) is likely to be highly instructive. Exploring personal experiences of privilege and oppression and opening them up to critical self-reflection, including consideration of the complexities associated with the intersection of various identities and social locations in relation to our work with clients, will strengthen cultural consciousness and capacity for working insightfully across differences.

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From an intersubjective perspective, Foster (1999) describes the clinical concept of cultural countertransference as the clinician’s cognitive and affect- laden beliefs and experiences existing at various levels of consciousness, including values and biases about different cultural groups, practice approaches, and theoretical orientations. She argues that clinicians must actively work at understanding these inevitable influences. Although com- plete bracketing of our preconceptions may not be feasible, continual self- reflexivity and mindfulness can minimize adverse effects on practice.

Consideration of how others perceive us and the social locations we repre- sent is often overlooked. Regardless of our own level of self-awareness, those with whom we work view us through the various lenses they bring to the relationship. For example, those who share a similar background may see us as safe, or conversely, as a potential threat to their privacy within the common community. In other circumstances, we may be received positively as an ally or negatively as a representative of social authority. These responses are not always evident initially and although it may not be feasible or even necessary to address them directly, it is important to be aware that they exist as under- lying dynamics that affect the helping relationship.

Critical awareness should not begin and end at the level of self, but must extend to the institution and profession, both of which come with authority and preferred ways of understanding and interacting. While recognizing critical awareness as a crucial element of culturally conscious practice, Iglehart and Becerra (2007) caution against an overreliance on worker self- awareness and recommend expanding the focus to include organizational structures and processes.

Implications for social work

The proposed model of cultural consciousness reflects a continuing shift in social work practice to strengthen our ability to work effectively across differences. As articulated in curriculum policy statements and accreditation standards, content on cultural diversity and oppression is a required component of social work education in Canada (Canadian Association for Social Work Education [CASWE], 2008), the United States (Council on Social Work Education [CSWE], 2008), and elsewhere in the world. Acquiring the complementary blend of knowledge, skills, and attitudes to understand and appreciate diversity is an expectation of graduates qualified to work in social service settings in a multi- cultural environment. This expectation is endorsed in professional codes of ethics that define the intrinsic value base of social work (Canadian Association of Social Workers [CASW], 2005; NASW, 2008). However, there continues to be strong criticismof howwell cultural competence is nurtured in social work education and how successfully educational content translates into practical skills (Boyle & Springer, 2001; Laird, 2008). Parrott (2009) reports on several studies that have

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been critical of how effectively social work practice is meeting the diverse cultural needs of service users. The perceived lack of cultural competence in social work remains a recurring theme in the literature (Harrison & Turner, 2011) and will likely persist in the face of growing social inequalities. As evidence mounts, social workers are in key roles tomitigate potential adverse effects ondiverse populations. Our ability to work effectively across differences and negotiate cultural impasses in the helping relationship is at the root of our potential to achieve positive outcomes.

The core components of the proposed model are consistent with a balanced approach to social work practice that addresses factors atmicro,mezzo, andmacro levels of plural societies that shape the experiences of diverse individuals, families, and groups. Thus, the model aligns with the person-in-environment and human rights frameworks taught in most schools of social work and incorporates a social justice perspective. Indeed, the model aims to transform practice from a neutral, apolitical orientation to an enterprise for fairness and social justice. The mechan- isms bywhich social factors get “under the skin” to adversely affect health andwell- being point to the growing disintegration of the historic nature/nurture divide (McNeill, 2010; Raphael, 2009; Wilkinson & Pickett, 2009). Social workers func- tion at the boundary between individuals and their social context and are thus in a pivotal position to recognize the harmful impact of social forces, particularly in relation tominority groups. The need for cultural consciousness is therefore at the heart of social work practice and a key element of our commitment to social justice. Given that the model includes a strong focus on anti-oppressive principles and practices, it will appeal most to those who perceive an active role for institutions and governments to address structural obstacles and power imbalances in pursuit of a fair and just society.

Engaging in evaluation research has been challenging historically because of the absence of a clear definition of cultural competence and operational understanding of competencies. The nature of cultural consciousness as an ongoing developmental process, as opposed to a learnable technique with a finite endpoint, does not lend itself easily to empirical validation. Despite significant theoretical advances and an abundance of cultural competency educational resources available for professionals, there is limited research exploring the translation of cultural competence principles and approaches into better outcomes for diverse clients. Continued social work research efforts are therefore necessary to support the evidence-based knowledge required to refine our collective effectiveness as a discipline to work across differences.

Acknowledgments

The authors wish to thank the Hospital for Sick Children’s New Immigrant Support Network and the University of Toronto, Factor-Inwentash Faculty of Social Work’s Bertha Rosenstadt Fund for their financial support.

296 C. AZZOPARDI AND T. McNEILL

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