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Literature Review
It is of paramount consideration that social workers are conscious of, aware and sensitive to the cultural demands of their clientele. This is because culture is a pivotal factor upon which a great deal of conduct, norms, social connections and mindsets of clients revolve. For social workers there is need to understand and appreciate how cultural traditions influence relationships with a diverse panorama of client needs and demands. This literature review seeks to create a foundation regarding the facts stated above through filtering and analysis of relevant and interesting research studies and works by previous authors. This review of literature focuses on how social workers develop or maintain cultural competence following graduation from Masters of Social Work Program. It aimed at providing answers for further research regarding how social workers maintain cultural competence post graduation. In addition, this literature review seeks to consider that social workers are not enhancing their cultural awareness post graduation as mandated by the National Association of Social Workers (NASW) code of ethics.
There are many definitions of the term cultural competence. Davidhizar et al, (1998) defines it as the process of developing awareness about one’s own thoughts, feelings and the environment without allowing influence from the background of others. Another definition of cultural competence is the ability to have adequate understanding and knowledge of client’s culture. Yet another definition describes it as the process of recognizing, accepting and respecting cultural differences. These definitions are universal and provide definitions of cultural competence in all dimensions of life. In the context of social work, cultural competence is defined as the ability of social workers to carry out their duties in a manner consistent with the expectations of cultural groups they serve. Goldberg (2000) asserts that cultural competence is not an ultimate goal that organizations should strive to achieve but rather it is a continuous process that should progressively grow over time. Experiences during practice should enable social workers to identify strengths and vulnerabilities that will enable them to develop into culturally competent professionals.
Despite integration of comprehensive cultural studies into the academic curriculum, a gap still exists in the response to the problem and needs of the ever-growing culturally diverse community. The mainstream educational values, policy statements and practices have not effectively guided social professional activities, program techniques and approaches. For many years, the social work profession has taken pride in the recognition of its alliance with culture, gender, and racial matters and the fact that practitioners in the field do interact with diverse groups in the society. However, many scholars including Matsunaga et al, (2003) have criticized the mainstream knowledge and notions about cultural competence stating that they do not correlate with actual performance of social workers. Similarly, Tocher and Larson (1998) argue that accreditation and curriculum standards in social work education only reflect aspects of humanitarian ideologies while they tend to overlook how to work with cultures different from our own. As a result, no clear evidence of positive results can be attributed to these programs. Studies of social diversity and justice in education institutions are rather unfocused and uneven as it does not teach the actual practice of a social justice framework.
It is therefore, clear that social workers are not adequately equipped with cultural competence skills after graduation from Masters of Social Work Program (MSW). It has prompted managers in social work service to find other avenues of equipping their workers with the skills in order to practice what they actually profess. In order to explain the scope of the matter, researchers have conducted many studies across the globe. Additionally, public service managers are striving to ensure continuous cultural competence training for their staff regardless of their academic knowledge in cultural awareness.
In their study on ways of reducing ethnic and racial health disparities through cultural competence, Brach and Fraser (2000) point out various techniques of cultural competence. They argue that cultural competence among health providers cannot be achieved without support from the entire health care system and therefore, the issue of cultural competency should be institutionalized. Although much of the literature has detailed the importance of culture knowledge, awareness, skills and attitude, very little has highlighted ways that the health system should be revived to support cultural competence among health care professionals. According to Tocher and Larson (1998), cultural competence techniques identified in literature discuss a single approach thus causing fault lines in the practice of health workers. Brach and Fraser (2000) identify nine techniques to culturally competent health service practice.
The first method is use of interpreter services. According to Lynch and Hanson (2004), language barriers hinder 21% of American minorities from receiving good health care. Research indicates that individuals with Limited English Proficiency (LEP) have a higher rate of low patient satisfaction. Findings from this research show that such patients are more likely to miss their subsequent appointments or fail to adhere to medical prescriptions. A study conducted on Vietnam refugees in the USA shows that they do not utilize health care services due to language differences. The research revealed that of paramount concern is lack of interpreters in health facilities. Interviewees expressed willingness to use the health care facilities if interpreters were availed. Communication forms an integral part in service delivery (Tocher and Larson, 1998). Communication between individuals speaking in different languages and from different cultures could be improved by the use of interpreter services. Interpreters can offer services in either interpretation of foreign language or sign language for the sake of the deaf and blind patients. Depending on the hospital policy, various interpretation approaches are available; professional on-site interpreters; informal interpreters (other staff, family and friends, patients in the waiting room). Tocher and Larson (1998) revealed similar outcomes for diabetic patients who are non-English speaking but received informal interpretation services from English-speaking patients. Although many hospitals consider the use of professional interpreters as an expensive undertaking, other interpreter methods such as the informal interpreters raise the question of confidentiality of the patient’s medical details.
With the use of interpreter services, there is satisfaction for non-English speaking clients and