An expected standard in the behavioral health industry is for treatment to be culturally responsive. That is, cultural competence should be demonstrated by the organization, as well as, by the clinical staff delivering services. But what exactly does it mean to be culturally competent?
To answer this question we must first recognize what culture is and how it impacts all of us. Each person, client and clinician, comes to the therapeutic environment with their own history and experiences which provide a framework for how each views the world.
In addition to universal human experiences (e.g., birth, death) and unique individual experiences, we are all strongly influenced by the “groups” in which we identify ourselves as belonging. This group experience influences values, beliefs, behaviors and perceptions. While we may immediately think of race and ethnicity when considering cultural factors, many other groups provide individuals an identity and experience which needs to be considered and addressed if treatment is to be truly culturally responsive. These groups may reflect age, gender, religion, socioeconomic status, sexual identity/orientation, ability/disability, professional groups (e.g., military, police, fire fighters) and immigrant/refugee status. Even experiences like prison and gang involvement, can significantly influence individual values and beliefs.
The addiction counseling field has moved from a “one size fits all” approach to one where treatment is individualized, recognizing that when the “group experience” is addressed and treatment tailored to consider these factors, outcomes improve. This first occurred when gender considerations were made. Recognition that women faced additional stigma and had other concerns, such as parenting and childcare, led to programming designed specifically for their needs. Today, we look at needs in regards to language, provide interpreters for deaf individuals and promote access to facilities for those who use wheelchairs. But we must also remember that there is a “culture” that comes along with these experiences.
Recently, much focus has been directed at the “emerging adult” (ages 18-25) population in recognition that they have different treatment concerns from adolescents or older adult groups. As an agency, Spectrum Health Systems has embraced the opportunity to address this population. For instance, we operate a residential treatment program funded by the Massachusetts Department of Public Health specifically for males in this age group. In our outpatient services division, a committee was formed to identify specialized curriculum, provide family education to improve outcomes and explore the use of technology to engage a group where technology has typically been a strong influence in their lives.
In summary, to be culturally competent is to recognize that our group experiences, both as client and clinician, are powerful variables influencing how we think, behave and define events including substance use and mental illness. We need to recognize where culture can present potential challenges to recovery, but also provide positive reinforcing aspects leading to a rewarding, healthy, improved quality of life.