Cultural humility

Cultural humility is the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person].^[1]” Cultural humility is different from other culturally-based training ideals because it focuses on self-humility rather than achieving a state of knowledge or awareness. Cultural humility was formed in the physical healthcare field and adapted for therapists and social workers to increase the quality of their interactions with clients and community members.

Background

To understand cultural humility, it is important to think about how culture is central in these interactions. The authors of the Culturally and Linguistically Appropriate Standards (CLAS) explain the importance of culture in that “culture defines how health care information is received, how rights and protections are exercised, what is considered to be a health problem, how symptoms and concerns about the problem are expressed, who should provide treatment for the problem, and what type of treatment should be given. In sum, because health care is a cultural construct, arising from beliefs about the nature of disease and the human body, cultural issues are actually central in the delivery of health services treatment and preventative interventions.”^[2] Thus discovering and incorporating these differences help foster an environment that allows cultural humility to grow and take shape.

Cultural humility was born out of the medical field for medical educators looking for a new way to frame multicultural understanding for new health care professionals. It was introduced as an alternative to cultural competence, which has many negative connotations. Competence assumes that one can learn or know enough, that cultures are monolithic, and that one can actually reach a full understanding of a culture to which they do not belong. Cultural humility can also be associated with cultural sensitivity, which encourages individuals to be thoughtful when considering culture. However, sensitivity does not touch on the necessity of learning, reflection, or growth.^[3]

Cultural humility incorporates a consistent commitment to learning and reflection, but also an understanding of power dynamics and one’s own role in society. It is based on the idea of mutually beneficial relationships rather than one person educating or aiding another in attempt to minimize the power imbalances in client-professional relationships. There are three main components to cultural humility: lifelong commitment to self-evaluation and self-critique, fix power imbalances, and develop partnerships with people and groups who advocate for others.^[4]

History

Cultural competence was an idea first promoted in the healthcare profession. Competence educational programs are aimed at preventing medical misdiagnoses and errors due to lack of cultural understanding. However, with the increasing diversity in the United States combined with an added cultural awareness, competence was not serving the needs of all medical professionals.^[5] Cultural humility is a term coined by Melanie Tervalon and Jann Murray-Garcia in 1998 to describe a way of infiltrating multiculturalism into their work as healthcare professionals. Replacing the idea of cultural competency, cultural humility was based on the idea of focusing on self-reflection and lifelong learning. Tervalon and Murray-Garcia believed that health care professionals were not receiving appropriate education or training in terms of multiculturalism, and developed a new method of approaching the topic.^[3]

	Cultural Competence	Cultural Humility
Goals	To build an understanding of minority cultures to better and more appropriately provide services	To encourage personal reflection and growth around culture in order to increase awareness of service providers
Values	Knowledge Training	Introspection Co-learning
Shortcomings	Enforces the idea that there can be 'competence' in a culture other than one's own. Supports the myth that cultures are monolithic. Based upon academic knowledge rather than lived experience. Believes professionals can be "certified" in culture.	Challenging for professionals to grasp the idea of learning with and from clients. No end result, which those in academia and medical fields can struggle with.
Strengths	Allows for people to strive to obtain a goal. Promotes skill building.	Encourages lifelong learning with no end goal but rather an appreciation of the journey of growth and understanding. Puts professionals and clients in a mutually beneficial relationship and attempts to diminish damaging power dynamics.

Cultural humility in social work

Recently, the social work profession has begun adopting cultural humility into frameworks for service delivery and practice. Most cultural humility rhetoric focuses on interpersonal, individual micro practice social work^[6][7] in terms of worker/client relationships and culturally appropriate intervention procedures. However, social work posits cultural humility as a strong self-reflection tool for the worker. Most importantly, it encourages social workers to realize their own power, privilege and prejudices, and be willing to accept that acquired education and credentials alone are insufficient to address social inequality.^[8] As such, this reflective practice,^[9] enables social workers to understand that the client is an expert in their own lives and that it is not the role of the worker to lean on their own understanding. In short, clients are the authority, not their service providers when it comes to lived experiences.^[10] Those who practice cultural humility view their clients as capable and work to understand their worldview and any oppression or discrimination that they may have experienced as well^[9]

In terms of the workplace of a social worker, supervisors should try to help workers to:

• Normalize not knowing. Supervisors and managers should aim to instill in staff the understanding that it is not only okay to not know—it is a necessary condition for growth, central to the practice of cultural humility and good social work practice.
• Create a culture-based client self-assessment tool. Workers need to offer clients a mechanism by which they can be seen and heard—an instrument such as this affords that opportunity. While clients have the right to refuse to complete it, practitioners can nonetheless remain vigilant and true in the practice of cultural humility.
• In-service: A cultural self-identification workshop. Supervisors or program managers can lead an in-service style conversation where staff members self-report how they differ from the cultural stereotypes others may believe about them.^[11]

Cultural humility is a tool that can be utilized by both macro (community organizing, social policy, evaluation, management) and micro (therapy, interpersonal) to better connect with individuals and communities as well as to gain more insight into personal biases and identities. Cultural humility can lead to both personal and professional growth of a social worker.

The Code of Ethics from the National Association of Social Workers has no mention of cultural humility in its latest edition that was approved in 1996 and revised in 2008. ^[12]

See also

• Cultural Competence
• Cross Cultural Sensitivity
• Social Work

References

1. Hook, J.N. (2013). Cultural Humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology.
2. U.S. Department of Health & Human Services. "Culturally and Linguistically Appropriate Services". Retrieved 24 February 2014.
3. Tervalon, Melanie (1998). "Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education". Journal of Health Care for the Poor and Undeserved. 9 (2): 117–125.
4. Asbill, Lisa. "Reflections on cultural humility". American Psychological Association. Retrieved 24 February 2014.
5. Ashford, Jose (2008). Human Behavior in the Social Environment: A Multidimensional Perspectiv. California: Cengage Learning.
6. Ortega, Robert; Faller, Katherine (2011). "Training child welfare workers from an intersectional perspective: A paradigm shift.". Child Welfare. 5 (90): 27–49.
7. Schuldberg, J.; Jones, N.; Hunter, C.; et al. (2012). "Same, same but different: The development of cultural humility through an international volunteer force". International Journal of Humanities and Social Science. 2 (17): 17–30.
8. Chavez, Vivan. "Cultural Humility".
9. Hohman, Melinda. "Cultural Humility: A Lifelong Practice". San Diego State University School of Social Work.
10. Moncho, Craig. "Cultural Humility, Part I - What is it?". The Social Work Practitioner.
11. Moncho, Craig. "Cultural Humility, Part II - Promoting Cultural Humility in the Workplace". The Social Work Practitioner.
12. "Code of Ethics (English and Spanish) - National Association of Social Workers". www.socialworkers.org. Retrieved 2015-10-19.