Direct Practice with Immigrants and Refugees: Cultural Competence
Carmen Ortiz Hendricks, DSW, ACSW, LMSW, Professor and Associate Dean, Yeshiva University Wurzweiler School of Social Work
A principle challenge for the social work professional is to understand the minds and hearts of immigrants, their desire for education and economic advancement, their interest in mainstream issues while maintaining their own traditions and their inevitable impact on modern day culture. All social workers have to appreciate the vital role and power of immigrant communities in the U.S. while simultaneously serving thousands of immigrants who walk into social agencies each day with a range of human needs.
“Cultural competence requires hard work, commitment, and experience. It entails more than speaking the language of the client or gaining specialized knowledge about a particular cultural group. Cultural competence means understanding the value of culture as perceived by clients, and appreciating how culture guides behavior and gives meaning to life. Culture shapes and influences individual health and mental health beliefs, family practices, human behavior, and even the outcomes of interventions (Ortiz Hendricks & Fong, 2006, p. 136. ) Culture affects everything we think about and do- from how we interact with family members, to how we recognize a child’s transition into adulthood, to what we do when we feel sick. The Indicators for the Achievement of the NASW Standards for Cultural Competence in Social Work Practice (2007) define cultural competence as “the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each” (p. 12-13.) Fundamentally, cultural competence is the ability and the will to respond to the needs of clients arising from their culture, and the worker’s and client’s ability to use their culture as a resource and strength to meet common human needs. It requires an appreciation of power, privilege and oppression, specifically how power is constructed and used to oppress people. Social workers then have to work to change the conditions that continue to oppress immigrants. In the NASW Code of Ethics (1999), social workers have an ethical responsibility to the broader society which includes Social and Political Action (6.04) in the form of expanding choice and opportunity for all people, promoting respect for diversity, and preventing and eliminating domination, exploitation and discrimination. Therefore, understanding of and sensitivity to clients’ cultures is insufficient without translating this understanding and sensitivity into social action.
Language barriers, the stress of immigration, sociocultural dislocation, and discriminatory U.S. policies towards immigrants contribute to the likelihood that immigrant families are more vulnerable and therefore more likely to have health and mental health problems. Child abuse and neglect may be the result of failed systems of care that further traumatize immigrant parents and children who are at greatest risk. When parents cannot find adequate help for their own or their children’s problems, they are at a loss as to where they can turn to for help and often lack understanding of the kind of help they will receive.
In addition, there are tremendous disparities around who gets quality health and human services in the U.S. Several factors impinge on an immigrant’s effective use of services: (1) length of stay in the U.S.; (2) size of the family or extended family; (3) documented or undocumented status; (4) minimum wage or less than minimum wage jobs; (5) financially supporting family members in the country of origin; (6) youth of the population; (7) single-parent households; (8) family support systems; (9) lack of marketable skills; (10) residence in inner city neighborhoods with substandard housing, inadequate schools and services; and (11) limited English-speaking proficiency. Racism and discrimination further oppress immigrants in the U.S., and put all immigrant groups at risk.
New immigrants are more likely to live in resource-poor communities, and are isolated from other communities that might offer support and services. Impoverished immigrants have more need to contact public service systems like public hospitals or welfare agencies due to the problems they are experiencing, and frequent contact with these systems makes them more visible at times of greatest risk. Immigrants often lack important information about how the health and mental health care system works, the financial resources to negotiate the system, and the confidence to advocate for themselves.
Social workers can play an important role supply in closing the gaps. We need to emphasize preventive services in work with immigrant communities. We need to build public and private agency partnerships that can address the range of service needs that immigrants present with, and support immigrants especially as they transition to a new way of life. Agencies need to outreach and establish connections with immigrant communities, and establish coalitions, councils or other collaborative boards to examine the issues confronting immigrants and problem-solve ways to reduce them.
Social workers need the support and guidance of culturally competent organizations that can enact a two-prong strategy: (1) continue recruitment and retention of diverse workers that can understand the language and culture of diverse clients; and (2) prepare all staff as culturally and linguistically effective practitioners. Cultural competence begins with administrative supports and encouragement, quality supervision and oversight, strong peer relationships, and manageable caseloads. It also requires well-educated, well-trained and experienced social workers who can effectively deal with increasingly diverse and troubled immigrant individuals and families. Agencies need to help workers keep abreast of new policies and procedures, and changing state and federal laws. Cultural competence includes knowledge of a range of cultures, histories, world views, values, and beliefs; understanding of communication patterns and appropriate interviewing techniques; strengths and differences among and within diverse racial/ethnic groups; cultural expectations and help-seeking behaviors; and the integration of traditional, indigenous, spiritual practices that attend to the spiritual needs of families and children of color. Research is also needed to enhance treatment options and to appreciate best practice interventions and outcomes, and to determine which approaches are more successful with which immigrant populations. Research is particularly needed on resiliency to determine the factors that keep immigrants in tact and healthy.
It is not hard to imagine the possibility of depression and health problems among immigrants, particularly single individuals or families, struggling financially with little education and job skills, with little social support and often enormous social isolation, and with extensive life-long histories of trauma. Culturally competent social workers are central figures in the health and well-being of countless immigrant populations now and into the future.