Culturally Competent Assessments Of Children In Need

Culturally Competent Assessments Of Children In Need This article critically analyses cultural competence as a theoretical construct and explores the need for a framework that will assist social workers to carry out culturally competent assessments of children in need and their families. It is argued that the necessary components of a framework for practice in this area are a holistic definition of culture, an ethical approach to difference, self-awareness, an awareness of power relations, the adoption of a position of complete openness in working with difference and a sceptical approach to a commodified conception of cultural knowledge. The approach must avoid the totalisation of the other for personal or institutional purposes. It is argued that the Furness/Gilligan Framework (2010) reflects these concerns and could be easily adapted to assist with assessments in this area. Key words: assessment; children in need; children and families; culture; cultural competence Introduction The purpose of this paper is to critically analyse cultural competence as a theoretical construct and to explore the need for a framework that will assist social workers to identify when aspects of culture are significant in the lives and children in need and their families. The 1989 Children Act places a legal requirement to give due consideration to a childs religious persuasion, racial origin, and cultural and linguistic background in their care and in the provision of services (Section 22(5)). This provision established the principle that understanding a childs cultural background must underscore all work with children. However, there has been a longstanding concern that services to children are failing to be culturally sensitive. Concern over the disproportionate number of children in need from ethnic minorities led to their specific mention in The Governments Objective for Childrens Social Services, which states that the needs of black and ethnic minority children and families must be identified and met through services which are culturally sensitive (Department of Health, 1999a: para 16). Government policy documents increasingly recognise the multicultural reality of Britain. Yet, government assessment guidance provides practitioners with little assistance in terms of establishing ways in which cultural beliefs and practices influence family life. Social work has acknowledged the need to respond respectfully and effectively to people of all cultures, ethnic backgrounds, religions, social classes and other diversity factors in a manner that values the worth of individuals, families and communities and protects and preserves the dignity of each (BASW, 2009). There are many indications that culture is significant in determining the ways in which some people interpret events, resolve dilemmas, make decisions and view themselves, their own and others actions and how they respond to these (Gilligan, 2009; Hunt, 2005). Practitioners may not, therefore, be able to engage with service users or to facilitate appropriate interventions if they take too little account of these aspects of peoples lives or consider them on the basis of inaccurate, ill-informed or stereotyped knowledge (Gilligan, 2009; Hodge et al., 2006). Culturally competent practice is so fundamental to assessments of children in need that one might expect a well developed literature on the subject. This would act as a robust knowledge base to underpin excellence in service delivery. Thompson (2006, p. 82) admits, there is a danger that assessment will be based on dominant white norms without adequate attention being paid to cultural differences. Failure to take such differences into account will not only distort, and thereby invalidate, the basis of the assessment but will serve to alienate clients by devaluing their culture. However, the literature in this area is surprisingly sparse. Almost two decades ago it was described as a void of published information (Lynch and Hanson, 1992, p. xvii) and Welbourne (2002) argues that progress is still slow. Boushel (2000) argues that despite the governments stated concern to know more about the impact of race and ethnicity on child welfare, the limited extent to which research reflects the experience and needs of culturally diverse children fails to support a true evidence base for policy or practice. There is evidence that aspects of culture can all too easily be underestimated, overlooked or ignored, sometimes with extremely serious consequences (Laming, 2003; Gilligan, 2008; OHagan, 2001). Many mainstream childcare and child protection texts make little reference to culture (OHagan, 2001). Not one of the twenty pieces of research into differing aspects of child protection work considered in Messages From Research (Dartington, 1995) explore the cultural aspects of any of the cases dealt with. There is now a growing body of literature written for health and social care professionals about the importance of developing and incorporating cultural sensitivity and awareness in their work with others (Campinha-Bacote, 1994; CHYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=hits=10RESULTFORMAT=fulltext=social+work+religion+and+beliefsearchid=1FIRSTINDEX=0resourcetype=HWCIT#BCP159C4andHYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=hits=10RESULTFORMAT=fulltext=social+work+religion+and+beliefsearchid=1FIRSTINDEX=0resourcetype=HWCIT#BCP159C4a HYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=hits=10RESULTFORMAT=fulltext=social+work+religion+and+beliefsearchid=1FIRSTINDEX=0resourcetype=HWCIT#BCP159C4andHYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=hits=10RESULTFORMAT=fulltext=social+work+religion+and+beliefsearchid=1FIRSTINDEX=0resourcetype=HWCIT#BCP159C4 Furman, 1999; H odge, 2001, 2005; Moss, 2005; Gilligan and Furness, 2006; Sue, 2006; Laird, 2008). However, despite the apparent emergence of a more general recognition and acknowledgement of these issues amongst many professionals, relevant day-to-day practice remains largely dependent on individual views and attitudes (Gilligan, 2009). A Department of Health (2002) study of 40 deaths and serious injuries to children found that, information on the ethnic background of children and carers was vague and unsophisticated in that it failed to consider features of the childs culture, religion and race, as specified in the Children Act 1989 (Department of Health, 2002, p. 26). The failure to conceptualize accurately the cultural and social context within which minority ethnic parents are operating impacts on interventions offered, which served to reflect and reproduce existing powerlessness. . . (Bernard, 2001, p. 3). If, as this suggests, there is a deficit in social workers ability to conceptualize mi nority ethnic service users social and cultural context in assessments of children, partly accounted for by a paucity of literature in this area, the implications for practice are potentially a failure to carry out culturally competent practice for many vulnerable children. In The Victoria Climbie Inquiry Report 2003, Lord Lamming commented that, The legislative framework is sound, the gap is in the implementation (2003, p. 13). Report after report has expressed concern over the limited skills of social services staff when undertaking assessments and designing interventions with ethnic minority children (Batty, 2002). While many professionals acknowledge that there is a need to work in culturally sensitive ways, there is evidence that many professionals working with children and families do not always feel equipped to do so (Gilligan, 2003). Gilligan (2009) found that whilst professionals may recognise that service users beliefs are very important, there is little consistency in how such recognition impacts on practice. Even within his small sample, there was considerable variation in attitudes and much to suggest that actions and decisions are the product of individual choice rather than professional judgement or agency policies (Gilligan, 2009). Pract itioners are able to continue with culture-blind approaches without these being significantly challenged by agency policies or by professional cultures (Gilligan, 2009). There is a clear need to look again at what we mean by cultural competence and to develop a framework that will assist social workers to identify when aspects of culture are significant in the lives and children in need and their families. Defining culture There is a clear recognition that aspects of culture are significant in the lives of children and their families and that this needs to be considered in assessment practice. In order to address the lack of understanding and ineffective practice among practitioners in this area it is necessary to provide clear definitions of culture and cultural competence. Assessing children in need and their families is a complex task. There is evidence of considerable variation between social workers definitions of the essential components of good enough parenting, reflecting the variation between professionals in definition of need (Daniel, 2000). When reviewing cases of serious injury or death, the Department of Health concluded that: . . .areas suggested by this research as ripe for development [include] reaching common definitions of being in need or at risk of significant harm (Department of Health, 2002). It is in this context of ambiguity that culture must be defined. The 1989 Children Act uses the wording culture as a statutory requirement in addressing the needs of black children, but does not offer guidance about its definition. Culture is a highly discursive term and the object of an intensive theoretical and political dispute (Benhabib, 1999, 2002). The construction of culture as a theoretical concept has always been affected by entangled perspectives, particularly in social work (Boggs, 2004). Harrison and Turner (2010) found that participants in their study spent considerable time discussing the complex nature of culture and the difficulties in defining it. This means that when looking at the practice of cultural competence as part of assessing need and risk the scope for conceptual ambiguity is vast (Welbourne, 2002). Eagleton (2000, p. 1) states that, culture is said to be one of the two or three most complex words in the English language. OHagan (2001) argues that culture is a complex concept, with virtually limitless parameters, which cannot be defined or explained in the two or three sentences usually allocated to them in much health and social care literature. For example, Payne (1997, p. 244) provides a rather ambiguous definition of culture: a difficult concept. It implies a relatively unchanging, dominating collection of social values, and assumes that members of an identified group will always accept these. It is possible to examine definitions of culture that stem from anthropology, sociology, psychology and cultural geography (OHagan, 2001). The anthropologist Edward Tylor (1871) formulated the most enduring definition of culture: culture is that complex whole which includes knowledge, beliefs, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society. The sociologist Giddens (1993: 31) says that culture refers to the ways of life of the members of a society, or of groups, or within a society. It includes how they dress, their marriage customs and family life, their patterns of work, religious ceremonies and leisure pursuits. OHagan (2001) defines culture as the distinct way of life of the group, race, class, community or nation to which the individual belongs. It is the first and most important frame of reference from which ones sense of identity evolves. OHagans definition draws on anthropology and is wide enough to challenge essentialist notions of culture, yet defined enough to be meaningful. It also balances the community and individual aspects of culture. When we consider this definition of culture it can be seen that all assessment of children in need occurs within a cultural context. In fact it is perhaps better understood as taking place within a number of interacting cultural contexts, with the culture of the c hild at the heart of the process. The use of the concept of culture in developing cultural competence and not race has been a deliberate shift in terminology from anti-racist theorising. Anti-racist theory, with its emphasis on race, has been criticised for dichotomising blackness and whiteness which does not permit any differentiation in the experience of racism between different ethnic groups (Laird, 2008). The idea of racial homogeneity has been enduring but this idea must be challenged. White people and black people are not homogeneous groups (Laird, 2008). Culture is a broader term than race or ethnicity and can include aspects of age, gender, social status, religion, language, sexual orientation and disability (Connolly, Crichton-Hill and Ward, 2005). Using the term culture allows for difference of attitude and experience between individuals who are part of the same ethnic or racial grouping. If one considers that culture is learned from generation to generation, it is inevitably person specific and shaped by o nes personal and societal context. The Challenge of Cultural Competence There are a variety of paradigms in the study of race, ethnicity and culture which are located in particular socio-historical and political contexts. Cultural competence is just one of these and has not escaped criticism in the professional literature. Writers in social work have argued that cultural competence depoliticises race relations and promotes othering (Pon, 2009), assumes workers themselves are from a dominant culture (Sakamoto, 2007) and is based on the flawed assumption that acquiring cultural knowledge will result in competent practice (Dean, 2001; Ben-Ari and Strier, 2010). Despite its wide acceptance, the concept remains subject to multiple, often conflicting, views. There is a need to critically analyse cultural competence as a theoretical construct in order to make it meaningful to practitioners and to provide a basis for best practice. Concern with racism emerged in the social work profession in the 1970s and during the 1980s major texts appeared to guide practice (Payne, 2005). The concept of anti-racist practice emerged built on the principles that race is a social construct that has been used to justify oppression and that it is necessary to critically examine the dynamics of power relationships that produce oppression. Anti-racist theorists have criticised advocates of cultural competence for creating an exotic understanding of people from ethnic minorities and for not recognising practice issues of social inequality or racial discrimination (OHagan, 2001). Cultural competence has been presented as apolitical and has been criticised for failing to address the power struggles of history (Barn, 2007). Key issues of power are absent from much of the analytical thinking around the paradigm of cultural competence (Barn, 2007). Given that the political, cultural and professional perspectives on race and ethnicity hav e important consequences for minority ethnic children and families, social workers need to incorporate an understanding of power relations as a key tool for subverting racism. A more sophisticated and nuanced approach is necessary, which will involve a paradigm shift from essentialist notions of race which view culture in rigid and inflexible ways to one in which cultural sensitivity is understood within the context of power relations (Barn, 2007). It is important to widen the debate beyond black and white, to recognise that racial, ethnic and cultural groups are not homogenous, but to not abandon the challenging of racism and other forms of oppression. Culturally competent practice needs to take account of the tensions between different cultural norms and values within the UK, not only between ethnically and culturally distinct groups of people. Social work norms and values may not be those of the majority of Europeans, or even of the mainstream white UK population, as the case of A v UK demonstrates. Writers such as Olsen (1981), Korbin (1981, 1991) and Thorpe (1994) have problematised the notion of a universal standard of childcare, pointing to significant cross-cultural variability. The essence of this challenge is that standardized definitions of child abuse must be contested as they necessarily relate to culturally defined norms. Korbin HYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=hits=10RESULTFORMAT=fulltext=how+and+when+does+athnicity+mattersearchid=1FIRSTINDEX=0resourcetype=HWCIT#KORBIN-1991(1991), in what is now a classic essay, warns against the dangers of both Eurocentric practice and over ly culturally relativist practice. On the one hand, Eurocentric practice serves only to impose one set of cultural beliefs and practices as preferable and therefore reproduce patterns of domination and oppression. In the British literature, concern has been expressed that minority families are too frequently pathologised and stereotyped, with workers over-relying on cultural explanations for their problems and utilizing a model of cultural deficit (Williams and Soyden, 2005; Chand, 2000; Ahmed, 1994). It is argued that they receive more and speedier punitive services than preventative/care services (Williams and Soyden, 2005). Lees (2002) argues from her research that there is a tendency to pathologise behaviour that is not culturally normative, an example being negatively evaluating the act of running away from an abusive home among young black women rather than adopting passive coping strategies. At the other extreme, Korbin notes extreme cultural relativism, in which all judgements of humane treatment of children are suspended in the name of cultural rights, may be used to justify a lesser standard of care for some children (1991, p. 68). It has been suggested that cultural relativism freezes the status quo by making standard-setting according to universal norms impossible (Laird, 2008). Barn et al (1997) found that adoption of a position of cultural relativity through fear of being labelled as racist affected statutory provision to children and families. They found that some social workers were reluctant to intervene to protect children because they believed that abusive behaviour was sanctioned by their culture (Barn et al, 1997). The child abuse inquiry reports of Jasmine Beckford (Blom-Cooper, 1985) and Tyra Henry (Lambeth, 1987) concluded that culture had impinged upon events leading to the deaths of these children. It was suggested that workers were too optimistic in their assessments of carers and that abusive behaviours were interpreted as aspects of culture. Whilst these concerns turn on the recognition of aspects of cultural difference as significant in the process of assessment, it has long been noted in the social work literature that practitioners fail at the first hurdle, in as much as they do not recognise at all the importance of culture: a culture-blind approach (Dominelli, 1998; Boushol, 2000; Graham, 2002). The culture-blind approach eschews difference in its search for a universal formula. It suggests that a standard of good practice can be established which fits all. For example, Payne (1997) rejects the argument that western social work theory may be incompatible with some of the core components of other cultures and ignores the fact that it was used extensively in the processes of annihilation of various indigenous cultures (OHagan, 2001). Despite being consistently criticised as naive and oppressive, this approach represents a powerful paradigm within social work (Williams and Soyden, 2005; Dominelli, 1998). Finding the balance between these concerns poses considerable difficulties for those charged with assessments of children in need (Dominelli,HYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=hits=10RESULTFORMAT=fulltext=how+and+when+does+athnicity+mattersearchid=1FIRSTINDEX=0resourcetype=HWCIT#DOMINELLI-1998A HYPERLINK http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=hits=10RESULTFORMAT=fulltext=how+and+when+does+athnicity+mattersearchid=1FIRSTINDEX=0resourcetype=HWCIT#DOMINELLI-1998A1998). What is needed is an approach to practice that can challenge normative stereotypes of appropriate behaviour by parents or children while promoting the rights of children to safety and good enough parenting. Brophy (2003, p. 674) states Balancing a respect for differing styles of parenting and guarding against inappropriate inroads into lifestyles and belief systems, while also protecting children from ill-treatment, remains an exacting task. Professiona ls can be castigated for intervening too quickly or too slowly. Social workers must operate with cultural sensitivity within the assessment process but at the same time recognize that at the heart of anti-oppressive practice is a commitment to the non-relative core value of human equality. A Knowledge Based Competency? Cultural competence as a practice response to these issues has been conceptualised in several ways. There are not one, but multiple definitions of cultural competence and it appears to be a changeable, evolving concept (Harrison and Turner, 2010). The frameworks available to assist practitioners in assessing aspects of culture are predominantly of two types: assessment models that try to aid in the collection of information and the understanding of specific service users strengths, needs and circumstances (Carballeira, 1996; Hodge, 2001, 2005; Hogan-Garcia, 2003; Sue, 2006) and reflective models that aim to help the practitioner to develop relevant skills and awareness in general terms (Green, 1999; Connolly, Crichton-Hill and Ward, 2005; Papadopoulos, 2006). Assessment models of cultural competence frequently refer to the integration and transformation of knowledge about individuals and groups of people into specific standards, practices and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes (Davis and Donald, 1997). To work effectively with diversity, practitioners are expected to gain knowledge of different cultural practices and worldviews, to have a positive attitude towards cultural differences and develop cross-cultural skills (Ben-Ari, 2010). Examples of assessment models include the LIVE and LEARN Model developed by Carballeira (1996) which identifies a series of activities which practitioners need to engage in to be culturally competent: Like; Inquire; Visit; Experience; Listen; Evaluate; Acknowledge; Recommend and Negotiate. Another example is Campinha-Bacotes (2002, pp. 182-3) ASKED model which identifies five dimensions of cultural competence: cultural Awaren ess; cultural Skill; cultural Knowledge; cultural Encounter; and cultural Desire. In line with this approach Sue (2006) argues that culturally competent social work practice is defined as the service providers acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (2006: 29). However, there is disparity in the literature as to the knowledge that is necessary for effective culturally responsive practice. The above models adopt a cultural literacy approach in which culture specific information and practice is categorised under broad ethnic group categories (Connolly, Crichton-Hill and Ward, 2005). For example, Lairds (2008) book Anti-Oppressive Social Work contains chapters entitled communities with roots in India, communities with roots in the Caribbean and communities with roots in China. Similarly, OHagan (2001) includes chapters about Islam, American Indians and Australian Aborigines in his book about cultural competence. Laird (2008, p. 156) states It is only by gaining cultural knowledge, that is, learning to appreciate the variety of ways in which people with different heritages organise their lives, that practitioners from the white-majority community can gain cultural awareness. This is because cultural knowledge offers practitioners a comparative analytical tool with which to examine cultural influences upon their own lives. From this approach knowledge is seen as central to the development of cultural competence skills, which are fundamentally knowledge-based learned capacities (Ben-Ari and Strier, 2010). It is widely believed that cultural knowledge is the key to interpreting the code of cultural diversity (Ben-Ari and Strier, 2010). It is argued that without knowledge, one cannot be aware of the presence of biases in professional practices and practice could remain ethnocentric (Adams et al., 2001). There is a tendency to think that if a worker learns about a culture, what Spradley (1994) calls explicit cultural knowledge, then they will have a framework for working with that culture. Widely existing conceptions of cultural competence assume that the other is knowable and that this knowledge is a prerequisite for being culturally competent (Ben-Ari and Strier, 2010). A radically different stance has been suggested by Ben-Ari and Strier (2010) who examine cultural competence through the lens of Levinas (1969) theory of other. Levinas (1969) proposes that ethics precedes knowledge. He argues that our humanity is realised through the wisdom of love and not through the love of wisdom (the literal Greek meaning of the word philosophy). In other words, ethics precedes any objective searching after truth (Beals, 2007). Levinas thesis ethics as first philosophy means that the pursuit of knowledge is but a secondary feature of a more basic ethical duty to the other. Within this framework, the main question becomes what relation to the other is necessary in order for knowledge to be possible? He argues that the other is not knowable and cannot be made into an object of the self, as is done by traditional philosophy. By emphasising the primacy of ethics to knowledge, Levinas creates a new framework for working across differences. This raises fundamental questions with regard to the nature of social knowledge. Laird (2008) argues that the most critical requirement of culturally sensitive social work is to keep open the dialogue between people from different ethnic backgrounds and to ensure that each individual emerges as a unique composite of values, beliefs and aspirations. It is necessary to consider how accumulated knowledge about other cultures has the potential to limit our openness in our encounters with people who are other to us. Knowledge about other cultures can lead to the experience of totality: something is nothing more than what I make out of it (Ben-Ari and Strier, 2010). When we totalise the other we reduce our understanding of it. Levinas (1987) proposes that we should aim for the experience of infinity, that is, the recognition that something is more than what we could make of it. Berlin (2002, p. 144) notes the danger of totalising people from other cultures, stating classifying people on th e basis of group membership only gives us the illusions that we are being culturally sensitive, when, in fact, we are failing to look beyond easy characterisations for the particular and specific ways this person is understanding, feeling and acting. A knowledge based approach to cultural competency has a tendency to create overgeneralisations of cultural groups and can lead to the worker perceiving themselves as an expert despite the likelihood of them being in a position of cultural naivety (Connolly, Crichton-Hill and Ward, 2005). The implication of this is that culturally competent assessments must come from an ethical standpoint of openness on the part of the practitioner. OHagan (2001) states, The workers need not be highly knowledgeable about the cultures of the people they serve, but they must approach culturally different people with openness and respect. It must be recognised that thoughts, feelings and actions are influenced by external and internal variables that are cultural in origin and, as a consequence, that each individual who enters the child welfare system is unique (Connolly, Crichton-Hill and Ward, 2005). A consequence of this is that perceptions of the child welfare problem will be unique to each client or family. Understanding how the family perceives the problem enables child protection workers to work in a more culturally responsive way in developing solutions. Cooper (2001, p. 732) states the meanings in context of a childs injury are not revealed through objective facts or through expe rt objective assessment or diagnosis. An agreed meaning, understanding and potential for change can only be co-constructed, with the service user and their social relationships and networks, within a situated organisation and multi-agency context. Aligning solutions with the cultural identity of the family provides the potential for family-centred responses. Cultural competence must move away from an emphasis on cultural knowledge if it is to provide an ethical framework for working with difference. A Matter of Reflection? The second main type of cultural competence model is a reflective model. Reflection has been part of practice discourse for a number of decades (Schon, 1983; 1987). More recently the concept of critical reflection has taken hold (Fook, 2002). A critically reflective response challenges the values and attitudes associated with professional conduct (Connolly, Crichton-Hill and Ward, 2005). An example of a reflective model of cultural competence is the cultural-reflective model developed by Connolly, Crichton-Hill and Ward (2005). This model includes the processes of cultural thinking; critical reflection and reflective practice outcomes. A strength of the model is that is recognises the interaction between the self and the other within interactions between people of different cultures. Ben-Ari and Strier (2010) argue that the development of the concept of cultural competence could benefit from considering the significance of self and other interdependence in contemporary debates on cultural diversity. They analyse relations between self and other using Levinas theory of other and explore the ways in which these relations play a pivotal role in working with differences. A persons definition of the other is part of what defines the self (Levinas, 1969). The idea that the self requires the other to define itself has been expressed by many writers (Brown, 1995; Riggins, 1997; Gillespie, 2007). It has been recognised that the concept of otherness is integral to the understanding of identities as people construct roles for themselves in relation to an other. The implication of this is that that all cross-cultural encounters between social workers and service users bring into play not only the heritage of the service user, but also that of the practitioner (Laird, 2008). Connolly, Crichton-Hill and Ward (2005, p. 59) note that assessments of the social world are likely to say more about the perceiver than the persons under study. Social workers need to discover and reflect upon their own value system and traditions in order to be culturally competent. Reflective models, such as Connolly, Crichton-Hill and Wards (2005), recognise that our cultural thinking responses are often automatic and outside of our control. It is necessary to ask where our responses and language come from (Connolly, Crichton-Hill and Wards, 2005). The reflective process encourages an examination of values and beliefs underpinning reactions. It involves challenging our assumptions, recognising stereotypes and recognising power and its effects. Without this it is easy to think that it is our way of being is the norm and other people who are ethnic, idiosyncratic, culturally pe