UC-Davis - The place for cultural humility in safety ... ORTEG… · Finding a place for cultural humility in safety planning Dr. Robert M Ortega , LMSW ... Cultural humility versus

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Findingaplaceforculturalhumilityinsafetyplanning

Dr.RobertMOrtega,LMSW,PhDSafetyOrganizedPracticeTitleIV‐EWaiverCollaboration

CrockerArtMuseumSacramento,California

March2,2017

Agenda

• Safetyand“gettingitright”• Doesculturalhumilityaddmuch?• Culturalhumility,childandfamilyvictimization– implicationsforsafety

• Demonstratingculturalhumilityinassessingsafety

• Theculturallyhumbleorganization• Summary

Safetyerrors:Lessonsfrommedicine

Safety

“Errors”

“Nofault”

SystemDeficiencies

“Cogni‐tive

Misalignments”

TimeCon‐

straints

BiasedExpecta‐tions

PoorCommu‐nication

Inform‐ation

Misappli‐ cation

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Reducingerror…

AssuringSafety

EducationTraining&Coaching

Compre‐hensiveAssess‐ment

OptimizingDecision‐making

Conditions

CaseConsulta‐tion

(Secondopinion)

StructuredProtocols

ImprovedCommuni‐cation

CulturalHumility

Whyfocusonculturetoday?

Culture

DiversePopula‐tion

Growth

“6A’s”

Ethical

Assess‐ment asCultureBound

Help‐SeekingPath‐ways

CultureandSocialContexts

Whydoesculturematter insafetyplanning?

• Cultureisinternalizedasbothcognitiveandemotionalexperiences andinfluencesourbehaviors

• Culturemaintainsourcomfortwiththe“familiar”(i.e.,our“internalworkingmodel”)

• Cultureismorethancategorical;itistheintersectionofmultipleexperiences influencedbycontextsandchangesovertime;

• Cultureshapesourcopingskillsandpatternsofresilience!

Ungar,M.(2013).Resilience,trauma,contextandculture.Trauma,Violence&Abuse,14(3),255‐266.

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Strangersinanewcultureseeonlywhattheyknow.Unknown

Ifweviewtheworldfromourownframesofreferenceweseeonlywhatweallowourselvestosee;westaywithinthemarginsofwhatweknowandremainblindtothoseaspectsoutsidetheboundariesofourculturalframes…

Examining our “blindspots”

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“Culturalhumilitychallengesustobroadenourculturalperspectivesandframesofreference…toseewhatwedonotsee.”Ortega,R.M.andFaller,K.C.(2011).Trainingchildwelfareworkersfromaculturalhumilityperspective.ChildWelfare,90(5),27‐49.

Recall:TheFoundationofVictimizationandRecovery

FEAR

(TherapeuticObjective:Safety)DISTRUST

(TherapeuticObjective:Trust)

ABANDONMENT

(TherapeuticObjective:Support)LOSS

(TherapeuticObjective:Hope)

VICTIMIZATIONIMPACTANDTHERAPEUTICOBJECTIVES

Culturalhumilityandchildmaltreatment

Inchildmaltreatmentweareofteninvitedtoseefirsthandtheremnantsofachild’svictimizationandtheaftershocks(oftrauma);wewitnesstheirprocessesandresponsesthatreflectthephysical,emotional,psychologicalandspiritualdamage,alongwiththeirsuffering

Ourattunementtotheneedsofchildmaltreatmentvictimsandtheirfamilyfromtheirculturalperspective,remaininginthepresentandacceptingourownlimitationsarefundamentaltoculturalhumility

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Culturalhumilitydefined:• Culturalhumilityreferstoaninterpersonalstancethatisother‐orientedratherthanself‐focused,characterizedbymutualrespectandlackofsuperioritytowardanindividual’sculturalbackgroundandexperience

• Researchindicatesthatifaworkerisperceivedasdemonstratingculturalhumilitythelikelihoodofformingastrongtherapeuticallianceincreases,andtheyaremorelikelytoassociatepositiveimprovementintreatmenttoculturalhumility.

Hook,J.N.,Owen,J.Davis,D.E.,Worthington,E.L.&Utsey,S.O.(2013).Culturalhumility:Measuringopennesstoculturallydiverseclients.JournalofCommunityPsychology,60(3),355‐366.Owen,J.,Tao,K.W.,Drinane,J.M.,Hook,J.,Davis,D.E.,&Kune,N.F.(2015).Clientperceptionsoftherapists’multiculturalorientation:Cultural(Missed)opportunitiesandculturalhumility.ProfessionalPsychology:ResearchandPractice.Advanceonlinepublication.http://dx.doi.org/10.1037/pro0000046

CulturalCompetenceandCulturalHumility

• Isaacson, M. (2014). Clarifying concepts: Cultural humility or competency. Journal of Professional Nursing, 30(3), 251‐258.

• Pre‐immersionresultsindicatedthatthemajorityofstudentsconsideredthemselvesculturallycompetent,whereasafterimmersion,therewasadownwardshiftinscores.

• Threecommonthemesemerged:seeingwithclosedeyes,seeingthroughafusedhorizon,anddisruptiontoreshaping.

• Conclusion:adoptanethicofculturalhumility• emphasizetheimportanceofself‐reflectionandself‐critiqueinourinteractionswithothers

• Engageinattentivelistening• Maintainanopennesstoothercultures,includingtheirexperiencesofstress.

Goalsof“culturalhumility”• Increaseculturalexploration,comprehensionandappreciation

• Learntoengageinself‐questioningandcritique,bi‐directionalculturalimmersion,mutuallyactive‐listening,andtheflexibilityofnegotiation.

• Establishcorebuildingblocksforculturallyrelevant“caring”• Recognizeourown“culturalepistemicprivilege”• Maintainanopennesstoothersandtheiruniqueculturalexperiences

• Acknowledgethelimitsofourculturalawarenessandneedtocontinuetolearnandgrowinallaspectsofourlives

Chang, E., Simon, M. & Dong, X (2012). Integrating cultural humility into health care professional education and training. Advances in Health Sciences Education, 17, 269‐278.

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ThreeFacesofCulturalHumility(AdaptedfromMorris,JA,Brotheridge,CM&Urbanski,JC(2005).Bringinghumilitytoleadership:Antecedentsandconsequencesofleaderhumility.HumanRelations,p.13331.)

CulturalSelf

Awareness

CulturalOpenness

CulturalTranscen‐dence

CulturalHumility

Knowledgeofculturalself

Knowledgeofother’sculture;outsideofself

Culturalknowledgebeyondselfandother

Safety,riskandethicalloneliness:Challengestoculturalhumility

Thevoiceofsilence…theuntoldstories• Ourprofessionalprivilegereliesonthemiseryofothersandourassumptionsaboutthe“depthoftheirdespair”

• Werespondinmultipleways;firstwithsafetythenrecovery,reunification,restoration,retribution,reconciliation,remediation,legalaccountability,truthcommissions,internationalcourts…

• Missingaretheeffectsofharm,threat,andsecondaryadversities– theuntoldstoriesaboutbefore,nowandthenwhathappensnext…

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Thevoiceofsilence…theunheardstories…

Theexperienceofbeingabandonedbyhumanityandthennotbeingheardoccurswhenaworker’sownassumptionsaboutsafetyandrisktakeprecedenceoverindividualandfamilytalesofsociety’sinhumanity.

Expertiseasabarrier toculturallyresponsivepractice

• Thereisanexpectationthatprofessionalismdemonstratesexpertise:(“expert”definedasknowledgeable,proficient,savvy,competent

• Expertiseassertsauthorityandpower

• Expertisedrawsfromandvaluesproceduralknowledgeyetrarelyaccountsforgeneralizedorheuristicknowledgeandassumptionsofcompetence

Anderson, H., & Goolishian, H. (1992). The client is the expert: A not‐knowing approach to therapy. In S. McNamee & K. Bergen (Eds.), Therapy as social construction (pp. 25–39). Newbury Park, CA: Sage.

Thedifferencebetweenculturalcompetenceandculturalhumility…

• Aculturalcompetence frameworkcallsforexpertknowledgeaboutandfamiliaritywithculturaldifferences.

• Aculturalhumility perspectivechallengesustolearn fromthepeoplewithwhomweinteract,reservejudgment,andactivelybridgetheculturaldividebetweenourperspectives.

Tervalon,M.&Murray‐Garcia,J.(1998)Culturalhumilityversusculturalcompetence:Acriticaldistinctionindefiningphysiciantrainingoutcomesinmulticulturaleducation.JournalofHealthCareforthePoorandUnderserved,9(2),117‐125.

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Ourbeliefs‐ whyit’sdifficulttobelieveothersandsetasideourownbeliefsWVOQuine

Webofbeliefs• Beliefsareinter‐related;everybeliefisinterconnectedandcanbeontheperiphery,intermediateorcentrallypositionedrelativetooursystemiccore.

• Maintainingcorebeliefsisconsideredadaptiveandcanbetracedtoour“survival”experiencesintheworld.

• Ourbeliefscanberevisedhowevertheirstrengthofresistancecorrespondstotheirlocationandrelationshiptoourcore;ourstrongestheldbeliefsareclosesttoourcore.

• Ourbeliefsoperateatmultiplelevelsofawareness–consciousandunconscious;thefirststepto“knowthyself”(Socrates)istoknowourconsciousbeliefsandbeopentoexaminingourunconsciousbeliefs.

Linker,Maureen(2015).IntellectualEmpathy:CriticalThinkingforSocialJustice. AnnArbor,MI.:UniversityofMichiganPress.

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Testingyourbeliefsaboutrandomfacts:TrueorFalse…

• Thelightertheroastofcoffeethemorecaffeineithas!

• Honeydoesnotspoil.• Thelighterwasinventedbeforethematch!• Ifyousatandwatchedeveryyoutube videouploadedonanygivendayyouwouldbespending16yearsofyourlifedoingso.

• Everyyearnearlyalloftheatomsinyourbodyarereplaced.

http://www.cs.cmu.edu/~bingbin/http://thoughtcatalog.com/bobby‐viner/2013/07/30‐weird‐facts‐most‐people‐dont‐know/

Without humility there can be no 

humanity John Buchan

Toexceedourculturalbeliefswemustasculturallyhumbleclinicians,shiftfromassessingtouncovering,fromtellingtodiscovering,fromtalkingtolistening,andfromjudgingtoinquiring…

Applying“culturalhumility”toworkinassessingsafety… Inchildwelfare,culturalhumilitychallengesustolearnfromthepeoplewithwhomwework,reservejudgment,andbridgetheculturaldividebetweenourperspectives,inordertofacilitatechildsafety,securityandwell‐being,andpromotepermanency.

essexcc.gov.uk

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Intermsofsafetyandrisk,culturalhumilityisaselfrespectandselfregardthatissecureinuncertaintyandinrisk‐taking;itreflectsanabilitytoenterintotheunknown,sharing,andblendingdisciplinewithcompassion

Throughculturalhumility,theworkerremainssecureinseekinginsightsfromtheclientsandinaffordingculturallyappropriatetherapeuticresponsesinfullappreciationofwhatmatterstothesafetyofallclients;

culturalhumilityinvolvesrespectingtheculturaltruthoftheperson,reservingjudgmentaboutitandremainingresponsivetoit

Culturalhumilityskills:Bridgingtheculturaldivide:• Activelistening:focusesattentiononwhatthepersonissayinganddoing;usesheadnodsandutterancesthatindicateyouare“listening”tothem.

• Reflecting:“holdsthemirrorup”toourclients;demonstratingourappreciationoftheir“epistemicprivilege”

• Reservingjudgment:Ratherthan“mind‐guard,”orinterrogatetheclient’sperceptionsoftheirexperience,remainopentowhattheclientissaying(e.g.,“inquiry”over“interrogation”);

• Entertheirworld:Sometimesreferredtoas“joining,”considerourselvesinthecontextoftheclient’sworld(andaspartoftheircultureandculturalexperience)ratherthanpsychologicallyretreattothesecurityofourprivilege

Culturalhumilityisrareinhumanserviceworkyethealthy!

• Indemonstratingculturalhumilityinthecontextofsafetywedonotrelysolelyonthe“expertise”ofthefamilyoronourownculturalexpertise;

• Expertisedrawsattentiontothe“self‐enhancement”biasinwhichweaccentuateourpositivesanddeflectthenegatives(sometimesreferredtoasthe“attributionerror”)

• Ironically,weassociateexcessiveself‐focuswithpsychologicalconsequences(e.g.,anxiety,depression,socialphobias,narcissism)

• Inhumanservicework,itsuggeststhataculturalhumilityperspectivewhichisinclusiveoftheperspectiveofothers(beyondaselffocus)haspsychologicalandphysicalbenefits!

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ActingculturallyhumbleisNOTnecessarilyculturalhumility…• BeingculturallyhumblebasedonpoliticalcorrectnessisNOTsufficient(e.g.,sayingthe“rightthings”oractingthe“rightway”whenworkingwithchildrenandtheirfamilies,whilemaskingourbiasesandbehavinginwaysthatarecontrarytowhatwesay)

• Publicadulation,seekingattentionforone’sowndemonstrationofculturalhumility,andpointingoutourowneffectiveness“may”enrichourculturalpride butdiminishesourculturalhumility

• (p.209)“…humilityisessentialtoanypossibilityofjoy…ourvulnerabilities,ourfrailties,andourlimitationsareareminderthatweneedeachother:Wearenotcreatedforindependenceorself‐sufficiency,butforinterdependenceandmutualsupport.”

OkayDr.O,whathappensifI’mdemonstratingculturalhumilityandit’snotreciprocated…?

• Abandoningothersphysically,emotionallyorspirituallyforourownbenefitunderminesourprofessionalintegrityanddemonstratesaflighttoourown“privilegeofsafety”

• Inhumanservicesettings,expressionsofculturalhumilityonthepartofothersisnotguaranteed;

• Howothersrespondshouldnotprecludeourprofessionalresponsibilitytointeractandcommunicateinwaysthatreflectself‐awareness,opennesstoothers,andappreciationforallthatistobeknown

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Acallforculturalhumilityinassessingandplanningforsafety…• Inassessingsafety,ourchallengeistorecognizevulnerabilityand“revision”awaytosensitizeourselvestohardshipthatourowncopingandprivilegedexperiencesallowustoavoid

• Wemustconsiderhowourinternalprocessesinterferewithourcapacitytojoinothersinordertoassistwiththeirownrevision

Culturalhumilityinaculturallycaringhumanserviceorganization

• Acaringcultureisembeddedinthedualfunctionsof“caringasservice”and“careasrelational”inhumanserviceorganizations

• Ourstrongethicalfocusonalleviatingharmandthreatstosafetydoesnotprecludepromotingdignity,andrespectsanindividual’sautonomy

• Weadheretoinstitutionalexpectations,maintainserviceboundaries,andadministrativeoversightwhileassuming“naturalsupport”(aspartofthehelper’spsyche)

[NOTE:Rytterstrom,P.,Unosson,M.&Arman,M.(2012).Carecultureasameaning‐makingprocess:Astudyofamistreatmentinvestigation.QualityHealthResearch,23(9),1179‐1187.]

Challengesto“caring”culture:Thedilemmaforindividualism • Attheorganizational

level,caringisatoddswithorganizationaltraditionssuchasjobperformanceexpectationsandaccountability,evaluationbasedonsoloefforts,andarewardstructurebasedonindividualexcellence

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Otherorganizationalchallengestocaring…

• Highstakesandmultipledemands• Complexsystems• Lackofadequateandcontinuoustraining• stressfulworkconditions(time‐limited,

unrealisticexpectations,highworkforceturnover,entrenched,austere,managed,technology‐dependent,“bottomline”)

• Inadequatecompensation• Shiftingculturalnorms• “Highstakes”oversight

Consequencesforthecaringprofessional

• Poorselfcare• Trauma;Unresolvedtrauma;PTSD• Inabilitytoboundaryworkandfamilylife• Lackofjobsatisfactionduetoinabilitytomanagejobstressors

• Relationalinjuries• “compassionfatigue”• Culturalloneliness

Culturalhumility…illuminatesourcollectiveartisanship;ourabilitytocometogethertoweaveatapestrythatbindsustogether;thatstrengthensourresolvetoliveinharmony.Instillsineachofusascaringprofessionalsthecapacitytorepairfracturesorfaultlines withSTITCHEScomprisedofthefollowing:SolidarityToleranceInclusionTrustCulturalhumilityEmpowermentSharedResponsibility&Leadership

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Insearchofculturalhumilityinaculturallycaringandinclusiveworkplace…

[Caseexample:Theculturallyhumbleagency]

Keyorganizationalsupportiveinputs:Promotingandsustainingculturalhumilityincaringorganizations

• Exemplarymodelingofculturalhumilitythruone’sactionsespeciallyinleadership

• Explicitinclusionofculturalhumilityasanimportantvalue• Recruitmentandretentionofpersonnelthatreflectvaluesassociatedwithculturalhumilityandcaring

• Workload,support,andsupervisionthatsupportsaculturalhumilityapproach

• Sharedconversations,organizationrituals,visioningaculturallyhumbleandcaringworkplace

Keyorganizationalsupportiveinputs:Promotingandsustainingculturalhumilityincaringorganizations(cont.)

• Usecriteriainperformanceevaluations,meritincreases,promotions,andotherincentivesthatrewardpracticesconsistentwithculturalhumilityandcaring

• Identify(ordevelop)anduseresources,forums,trainingworkshops,andcelebrations,

• Recognizecaringleadershipanddesignateemotionalsupports

• Publiclypraisebehaviorsincludinglanguagethatreflectsculturalhumilityandcaring(andalsochallengebehaviorsandlanguagetothecontrary)

• ConnecttheorganizationwithcaringcommunitiesAdaptedfrom:Vera,D,&Rodriguez‐Lopez,A.(2004).Strategicvirtues:Humilityasasourceofcompetitiveadvantage. OrganizationalDynamics,33(4),393‐408.

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Implicationsforculturalhumilityandsafetyorganizedpractice• Maintaina“foundation”uponwhichculture,culturalhumility,diversityandinclusioncanthrive– considersafety,trust,supportandhopeinanengagingclimate

• Fromaculturalhumilityperspective,recognizeourimperfectionsandblindspots thatlimitofourexpertise,andourcomplicityinsustainingcontextsthatareadversetoculturalinclusion…

• Recognizeourenduringbeliefsystem,includingthecommunication“discourse”thatuncriticallysustainsbeliefsandchallengesourwillingnesstochange

Implications(cont.)

• Promoteopportunitiestoincreaseculturalexploration,comprehensionandappreciation

• Learntoengageinself‐questioningandcritique,bi‐directionalculturalimmersion,mutuallyactive‐listening,andtheflexibilityofnegotiation.

• Establishcorebuildingblocksforculturallyrelevant“caring”• Recognizeourown“culturalepistemicprivilege”• Maintainanopennesstoothersandtheiruniqueculturalexperiences

• Acknowledgethelimitsofourculturalawarenessandneedtocontinuetolearnandgrowinallaspectsofourlives

Implications(cont.)

• Continuouslyexamineourcommitmenttoa“strength‐based”perspective

• Identifyexamplesthatclearlyillustratethebenefitsofaculturallyhumbleandcaringworkforceandworkplacecultureincludingleadershipandworkforcebestpractices

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Thereistheworldoftheflesh,andthereistheSpiritworld.Whenthefleshisgone,theSpiritforeverremains.Theirvoicesspeaktothosewhoknowhowtolisten.Wisdomisbornintheheart,andthenspoken.

WolfClassSong

TheEndThank you very much!