Cultural humility

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 Services (CLAS) standards 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.”[3] Thus discovering and incorporating these differences help foster an environment that allows cultural humility to grow and take shape.

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.[4] Cultural humility is a term coined by Melanie Tervalon and Jann Murray-Garcia in 1998 to describe a way of incorporating 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.[5]

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] 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.[7] As such, this reflective practice,[8] 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.[9] 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[8]

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.[10]

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. [11]

• Cross cultural sensitivity
• Social work