Beyond the Tip of the Iceberg: Five Stages Toward Cultural Competence
Jerome H. Hanley
I am fond of saying that the journey toward cultural competence is both lifelong and painful. This is perhaps no better illustrated than through the efforts of the Truth and Reconciliation Commission of South Africa to address the abuses of apartheid so that healing might occur. Established by President Nelson Mandela and chaired by Archbishop Desmond Tutu, the commission’s work has allowed the people of South Africa to openly discuss the pain and suffering caused by the intentional and enforced racial and cultural divisions within their country.
The commission’s activities have also opened the doors to deeper cultural knowledge and positive change—key elements in the journey toward cultural competence. Although the United States has not yet embarked on such a visionary journey to reconciliation, individuals and organizations can open cultural doors to the youth they serve by striving to achieve cultural competence themselves.
Competence and Culture
Dr. Carter G. Woodson may have introduced the concept of cultural competence in 1927 when he put his life on the line to create the Society for the Study of Negro Culture and Life and instituted Negro History Week (Goggin, 1993), the precursor of Black History Month. Though these special events have been recognized commercially, few people today understand their origin, significance, or the broad social changes they were intended to achieve.
Dr. Woodson was only the second person of African descent to receive a doctorate from Harvard University, and he was the first Harvard graduate to have been born to enslaved parents. He understood that the country was in danger of splitting apart along racial, regional, and cultural lines. As a historian, Dr. Woodson believed that if a people understood their history and contributions to the society in which they lived, then (1) they would feel better about themselves, (2) other groups of people would feel better about the oppressed group and be more accepting of them, and (3) there Would be greater acceptance between and within groups of people, reducing the level of racism in society. Although Dr. Woodson was right about the first and second effects, knowledge alone cannot lead to the third effect. The third effect can only be achieved when all groups in society have achieved cultural competence.
Beyond the Tip of the Iceberg
Gary Weaver (1986) uses the image of an iceberg to explain these many layers of culture (see figure below). Like an iceberg, part of a culture is "above the water" in that it is visible and easy to identify and know. This part includes surface culture and elements of folk culture—the arts, folk dancing, dress, cooking, etc. But just as nine tenths of an iceberg is out of sight below the water, Paige explains, nine tenths of a culture is also "hidden" from view. This out-of-awareness part of culture has been termed "deep culture," although it does include some elements of folk culture. Deep culture includes elements such as the definition of sin, concept of justice, work ethic, eye behavior, definition of insanity, approaches to problem solving, fiscal expression, and approach to interpersonal relationships. Ogbu (1988) presents this essential idea most clearly when he states that "cultural tasks vary from culture to culture because different populations have worked out different solutions to common problems in life, such as how to make a living, reproduce, maintain order within their border, defend themselves against outsiders, and so on" (p. 13).
Building Cultural Competence
The most important ingredient in cultural competence is self-knowledge, the direct result of what Dr. Wade Nobles, an African-American social psychology professor at San Francisco State University, calls deep thought. Deep thought is similar to the iceberg concept in that the thoughtful analysis and understanding of the idea goes beyond the superficial level to that of introspection and self-understanding.
A second vital ingredient in cultural competence is experience. One cannot learn about a people or culture exclusively through books, movies, and classes. The Sierra Leone proverb, "a paddle here, a paddle there—the canoe stays still," predicts the outcome of such one-dimensional efforts. The best teacher is firsthand experience with a culture, if not immersion in it. Although the lessons can be painful, you must touch it, try it, make mistakes, apologize, internalize what you have learned, and try again. Honest self-knowledge and unmediated experience with the cultures of the individuals you serve will help you become a far superior helper.
The third ingredient in cultural competence is positive change. Cultural competence does not exist without demonstrated positive change both in the educational/clinical setting and the real-life environment in which the student or client must function. Cultural competence replaces the earlier ideas of cultural sensitivity and awareness that were often embraced with no corresponding change in behavior.
The Cultural Competence Continuum
Cultural destructiveness. The most negative end of the continuum is represented by attitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the cultures. Examples include:
Misuse of psychometric instruments on populations that were not included in the standardization process (e.g., giving the SAT test to Appalachian and Sea Island children).
Cultural incapacity. The system or agency does not intentionally seek to be culturally destructive but rather lacks the capacity to help minority clients or communities. Examples include:
Drawing accurate but inappropriate clinical or educational conclusions based on the professional’s view of the world, not on the child’s view that may affect how he or she makes eye contact, responds to group activities, etc.
Failing to understand what mistreatment based on cultural background is so it can be avoided. For example, one program serving chronically mentally ill adults, who happened to be African Americans, would have the patients wait in the waiting room until their day program began. An administrator became worried that the program’s paying, Caucasian patients would be uncomfortable with the mentally ill adults and go elsewhere for service. To avoid this, the program began delivering the mentally ill adults to the back of the building. A Caucasian nurse took offense and contacted the NAACP. The practice stopped. The decision had not been intentionally racist, but the outcome was certainly not in the patients’ best interest.
Cultural blindness. At the midpoint in the continuum, the system and its agencies provide services with the expressed intent of being unbiased. They function with the belief that color or culture makes no difference and that all people are the same (e.g., the melting pot theory that ignores cultural strengths).
However, Ogbu (1988) states that the competencies minority children acquire or develop in the community are often different from competencies the children are required to demonstrate at school. . . . Researchers have shown that because the competencies minority children bring to school are different from those required, the children encounter conflicts in competencies that cause adjustments and learning difficulties (e.g., verbal versus written emphasis, speech patterns, acceptable behavior)" (p. 15).
An example of cultural blindness would be treating all clients in the same way, regardless of their cultural background. This was the prevailing attitude when programs and services were developed in response to the civil rights movement. Evidence of this surfaced when I received no nominations of programs that were culturally competent from the Southeast region of the United States. Intrigued, I conducted an informal survey of Caucasian individuals over 50, asking each one what the purpose of the civil rights movement was. (Persons over 50 were asked because they would remember it.) The unanimous answer was to "treat everyone the same." The services offered in response to the civil rights movement were thus developed to treat everyone equally, not necessarily to treat everyone with his or her best interests in mind.
Cultural precompetence. Agencies and individuals move toward the positive end of the continuum by recognizing cultural differences and making efforts to improve. Examples include:
Making other cosmetic changes to reflect the community served. (In Asian communities, for example, a bonsai garden might be added outside and green tea might be provided in the waiting room.)
Employing people who resemble the population being served or educated. (This is a first step, but does not ensure cultural competence nor does it ensure positive outcomes.)
Cultural competence. Culturally competent agencies and individuals accept and respect cultural differences, continue self-assessment of cultural awareness, pay careful attention to the dynamics of cultural differences, continually expand their cultural knowledge and resources, and adopt culturally relevant service models in order to better meet the needs of minority populations. Examples include:
Diversifying the professional staff.
Involving the community in the development of services and in planning and decision-making activities.
Bringing in representatives of the community served to conduct workshops for the professionals who will serve them. (In children’s services, parents are now asked to conduct these workshops.)
Although moving along the cultural competence continuum is a complex and potentially painful lifelong journey, the journey does offer tremendous personal and professional rewards. As a professional, you have been trained to know it all, to have the answers. But the journey toward cultural competence begins with the courage to realize that you do not know it all. On this journey, you will learn about yourself in a thoughtful, honest, and intense way. You will also learn about other cultures through books, movies, workshops, and, most important, through firsthand contact. Direct experience can lead to the deep knowledge that results in behavior change. One must experience culture directly and on many occasions to acquire its secrets. Even though the doors to this kind of cultural knowledge are more difficult to open in this country, gentle and persistent efforts to become culturally competent can reap significant rewards for the agencies and individuals who work with children, adolescents, and their families.
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