Modeling Cultural Competence

We want the best possible outcomes for our clients/patients/students. For most, this means working across a wide range of populations, including cultural and linguistic backgrounds, that may not be a match to yours. And, even if you are from the same background, that doesn’t mean that you share the same beliefs, values and systems. With so many variables to consider, how do you get the best outcomes? Does clinical competence require cultural competence or is there something more to it?

Many terms have emerged as we have discussed working with diverse populations—cultural competence, cultural humility, and culturally responsive practices. All of them have a primary goal of improved outcomes with 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.

Cultural Competence

For some, competence implies an end point. That if you achieve competence, you have reached proficiency—with no more learning necessary. Others feel that competence is the minimum required in order to demonstrate a baseline of knowledge and skills. Within the CSD discipline, ASHA’s Certificate of Clinical Competence is earned by individuals at the onset of their career to demonstrate readiness, not an end point of learning.

Cultural Competence Continuum

Terry Cross (1989) provides a model to demonstrate competence ranging from destructiveness to proficiency with the all-too familiar “blindness”—where you don’t see cultural differences right in the middle of the pack. Consider these potential examples of how they may show up in service delivery around you. These examples are not comprehensive or all-inclusive, but intended to stimulate actions and ideas.

  • Cultural destructiveness is denial of services due to a client’s culturally and linguistically diverse (CLD) background.
  • Cultural incapacity is when agencies lack the capacity to help clients from all racial, ethnic, and linguistic backgrounds.
  • Cultural blindness is when agencies provide the same assessment materials to all clients  regardless of cultural background.
  • Cultural precompetence is when agencies attempt to make some changes and improve aspects of service delivery.
  • Cultural competence is when agencies accept and respect cultural and linguistic backgrounds and values by adapting services to meet the individual’s needs.
  • Cultural proficiency is when agencies actively seek to increase others’ cultural competence, for example through engaging in research, creating publications, and developing new techniques.

Cultural Competemility

Josepha Campinha-Bacote of Transcultural C.A.R.E. Associates developed The Process of Cultural Competence in the Delivery of Healthcare Services | Transcultural C.A.R.E Associates ( This model that recognizes the relationship and deep connection between cultural competence and cultural humility. Development of these skills look at a number of areas:

A + S + K + E + D = Cultural Competemility

  • Awareness (A)—self-awareness—sensitivity to biases/prejudices.
  • Skills (S)—access to cultural modes of interacting—culturally appropriate assessment tools.
  • Knowledge (K)—cultural world views—conceptual and theoretical frameworks concerning various cultures.
  • Encounters (E)—cross-cultural interactions, cultural exposure, or cultural practice.
  • Desire (D)—willingness to self-examine.

Cultural Humility

Melanie Tervalon and Murray-Garcia explain that cultural humility is a commitment to lifelong learning and self-evaluation to constantly strive 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 from the client/patient/family member. It underscores the importance of collaboration allowing for meaningful treatment to maximize the potential for desired outcomes. It reminds us to examine policies and/or systems to find ways to promote inclusivity and equity.

Culturally Responsive Practice

The term culturally responsive practice came from a similar phrase that Gloria Ladson-Billings coined.  She defined culturally responsive instruction as “a pedagogy that empowers students intellectually, socially, emotionally, and politically by using cultural referents to impart knowledge, skills, and attitudes.” Read more at Culturally Responsive Teaching: Understanding Culturally Responsive Teaching ( Responsive practices remind the practitioner of the responsibility to create plans centered around their client/patient/student. This deliberate focus structures relevance in the functionality and treatment to enhance overall meaning.

Language and culture are dynamic—always growing and shifting. Therefore, all CSD professionals also 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 only get you closer to aligning with ASHA’s vision—to make effective communication, a human right, accessible and achievable for all.

For additional reading on these topics, please see:

Campinha-Bacote, J. (2020). The process of cultural competemility in the delivery of healthcare services. Transcultural C.A.R.E. Associates.

Cross, T. L. (1989). 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 and the CASSP Technical Assistance Center, Washington, DC.

Ladson-Billings, G. (n.d.). Understanding culturally responsive teaching. New America.

Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility vs. cultural competence: a critical distinction in defining physician training outcomes in multicultural education.

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