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Providing Culturally Competent Services
by William Ebenstein
As a pluralistic society we celebrate our differences in heritage, language, religion and ethnicity. Acknowledging the importance of culture in a person’s actions, thoughts, communications, beliefs, and values related to his or her disability, and in how disability is viewed by family members and others within the community, is an important step in developing a more consumer-oriented delivery system. Delivering quality services to persons with disabilities from diverse cultural backgrounds requires that agencies provide more individualized services and supports, a shift that will benefit all people receiving services.
Sensitivity to cultural differences among service recipients also requires a closer look at the culture of existing provider organizations. Part of the dynamic of these differences is reflected in how an agency is perceived and experienced by individuals and family members from a variety of cultures. Too often, minorities with disabilities mistrust mainstream agencies, whereas minority agencies tend to have higher consumer satisfaction rating. The integration of consumers into the culture of their own communities, rather than into the culture of the service system, means many agencies must reinvent themselves.
Quality services are more likely to be delivered by a staff that is acquainted with the language, history, current events, and common practices of local minority communities. Cultural identification and participation are key aspects of community inclusion. Social customs that include religious celebrations, ethnic foods, and music give a meaningful context to activities of daily living. Culture binds together the networks of family, friends, and neighbors that constitute a world of natural supports. Besides being more fun, participation in the communal life of an identified group fosters a sense of belonging and self-esteem. Transforming the style of a human services organization to facilitate these cultural connections and nuances, and building a diverse and culturally competent workforce, will help to create a more soulful system of supports for minorities, immigrants, first-generation Americans, and all consumers.
One way to evaluate the cultural sensitivity of existing human services agencies is to examine their inclusion of people from different ethnic, racial, religious and cultural backgrounds on their governing boards. In our 1993 survey of 24 nonprofit agencies in New York City, 78% of board members were white, 18% were African-American, and 4% were Latino. However, only 7% of board members at mainstream agencies were minorities, and half of the agencies reported having no African-American or Latino board members. Also, of the 27 different types of board committees identified through the survey, none were directly related to diversity issues. Agencies need to develop outreach and training programs for minority consumers and community leaders to increase their participation on boards of directors. Agencies should also assess their organizations’ policies and procedures, as well as the overall style and setting of services, and draft a specific plan to further cultural competence.
Cross-cultural training is needed by all administrative and clinical staff. In our survey, administrators represented 14%, and clinicians represented 18%, of all personnel at responding agencies. African-Americans accounted for only 15% of all professional-level positions. Two-thirds of all mainstream agencies had top management teams that were all white, while most minority agencies had executive management teams that were entirely minority. In a part of the country where people from culturally diverse backgrounds comprise a significant percentage of the consumer population, many will be served by mainstream agencies. At the same time, given the increasing diversity within the minority community, it is likely that in the future minority agencies will also work with individuals and families from a wide variety of cultural, linguistic, religious and ethnic backgrounds. In either case, professionals from diverse backgrounds, who are schooled in the dynamics of cross-cultural practice, will have to deliver quality services in an individualized and culturally sensitive manner.
As America’s demographic profile continues to evolve, more persons from culturally diverse backgrounds will enter the disability workforce. In our New York City survey, minorities comprised 60% of all direct care staff. African-Americans were especially well represented, accounting for 40% of all frontline workers. In New York City, and in many other parts of the country, where a large percentage of direct care staff are minorities and immigrants, their retention, continuing education, and career advancement are critical components in creating a more culturally competent workforce.
As an agency chooses to become more responsive to the needs of minority staff, it should be prepared to make the necessary organizational changes this may entail. In general, empowering direct care workers and consumers contributes to a minority voice being heard. Strategies to develop a more culturally competent delivery system are consistent with the move toward more individualized, consumer-oriented services. To be effective and permanent, these strategies need to be integrated into a more comprehensive plan to strengthen the workforce as a whole, and improve services to all consumers.
William Ebenstein is Director of the CUNY Consortium for the Study of Disabilities, City University of New York, New York, NY. He may be reached at 212/794-5486.
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