Many terms have emerged as we have discussed working in a diverse society—cultural competence, cultural humility, and culturally responsive practices. All of them have a primary goal—to improve outcomes—but each one offers different nuances on how to get there. Maybe you know where you stand; maybe you're not sure. Read more about the similarities and differences between these approaches.
Definiing "Competence"—and What It Means in CSD
For some, competence implies an end point. If you achieve competence, then you have reached proficiency—with no more learning necessary. For others, competence is the minimum required to demonstrate a baseline of knowledge and skills.
Within the communication sciences and disorders (CSD) discipline, individuals earn ASHA's Certificate of Clinical Competence (CCC) at the onset of their career to demonstrate readiness; Earning one's CCC is not an end point of learning. Clinicians engage in lifelong learning in order to keep up with the competencies that they earned—and were properly recognized for through the CCCs—much earlier in their career.
Models of Cultural Competence
Researchers have developed numerous models of cultural competence. Two such models are discussed in the subsections below.
The Cultural Competence Continuum Model
Terry Cross and colleagues (1989) provided a model to demonstrate cultural competence. that model ranges from destructiveness to proficiency and starts with the all-too familiar "blindness" (as Cross and colleagues called it)—where you don't "see" cultural differences when positioned right in the middle of the pack.
Consider these potential examples of how that "blindness" may show up in service delivery around you. These examples are not comprehensive or all-inclusive but are intended to stimulate actions and ideas.
- Cultural destructiveness&mdashdenying services due to a client's cultural and linguistic background.
- Cultural incapacity—lacking the capacity to help clients from all racial, ethnic, and linguistic backgrounds.
- Cultural blindness—providing the same assessment materials to all clients regardless of cultural background.
- Cultural precompetence—attempting to make some changes and to improve aspects of service delivery.
- Cultural competence—accepting and respecting cultural and linguistic backgrounds and values by adapting services to meet the individual's needs.
- Cultural proficiency—actively seeking to increase others' cultural competence, for example through engaging in research, creating publications, and developing new techniques.
The Cultural Competemility Model
Josepha Campinha-Bacote of Transcultural C.A.R.E. Associates developed a model called The Process of Cultural Competemility in the Delivery of Healthcare Services (Campinha-Bacote, 2020). This model recognizes the relationship and deep connection between cultural competence and cultural humility.
Development of cultural competemility skills requires reflecting upon five main areas of self-examination, as seen in this mnemonic:
A + S + K + E + D = Cultural Competemility
- Awareness—self-awareness—sensitivity to biases/prejudices.
- Skills—access to culturally responsive ways of interacting—culturally appropriate assessment tools.
- Knowledge—cultural world views—conceptual and theoretical frameworks concerning various cultures.
- Encounters—cross-cultural interactions, cultural exposure, or cultural practice.
- Desire—willingness to self-examine.
Cultural Humility
Melanie Tervalon and Jann Murray-Garcia (1988) explained that cultural humility is a commitment to lifelong learning and self-evaluation—and constantly striving to develop mutually beneficial partnerships with individuals from all backgrounds.
In the CSD discipline, cultural humility is an approach that reminds clinicians to follow the lead of the person you are working with. This type of collaboration leads to more meaningful treatment—potentially leading to better outcomes. It reminds us to examine policies and systems as a way of promoting inclusivity and equity.
Check out Have You Heard? for ideas on reducing systemic barriers in your workplace.
Culturally Responsive Practice
Culturally responsive practices remind the practitioner to create plans centered around their client/patient/student, leading to more functional and meaningful services.
Language and culture are dynamic—always growing and shifting. Likewise, all CSD professionals need to grow and shift with their populations. Whether you strive to enhance your cultural competence, cultural humility, or culturally responsive practice, all of these will get you closer to aligning with ASHA's vision—to make effective communication, a human right, accessible and achievable for all.
Additional Resources
For additional reading on these topics, please see the following resources:
Campinha-Bacote, J. (2020). The process of cultural competemility in the delivery of healthcare services. Transcultural C.A.R.E. Associates. http://transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-services/
Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R.. (1989, March). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Georgetown University Child Development Center. https://eric.ed.gov/?id=ED330171
New American. (n.d.). Understanding culturally responsive teaching. New America. https://www.newamerica.org/education-policy/reports/culturally-responsive-teaching/understanding-culturally-responsive-teaching/
Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility vs. cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233
