JCPSLP November 2016

Awareness and beliefs Clinician is: Table 1. Dimensions of culturally competent practice proposed by Sue et al. (1992). Dimensions Practitioner characteristics Awareness of own assumptions, values and biases Aware of own culture and its influence on beliefs about self, others and clinical practice Knowledge Clinician demonstrates:

Skills Clinician is:

Knowledge of own culture and aspects of this that may impact upon service delivery to diverse populations Knowledge and understanding of different cultural interpretations of worldviews and understands that individuals within a culture may have individualised interpretations of their own culture(s). Desire to develop knowledge and understanding Knowledge of how to adapt intervention strategies and techniques to a variety of populations using culturally appropriate and acceptable methods. Support-seeking from others with implicit cultural knowledge

Aware of own skills and ability to adapt these to diverse populations. Aware of own learning needs in relation to skill development Able to transform understanding of different worldviews into culturally sensitive and safe clinical practice

Understanding of the worldview of the culturally different client

Aware that individuals have varied understandings of the world and that this may impact upon the conceptualisation of their difficulties and response to intervention. Respectful of difference in the face of own cultural values and beliefs. Aware of the need for flexibility, creativity and individualisation in intervention

Use of appropriate intervention strategies

Skilled in innovative, sensitive and safe intervention

Theoretical models of cultural competence This section explores two prominent models of cultural competence and their application to trans-cultural speech-language pathology practice. The models were not specifically designed for speech-language pathologists, but can be applied to allied health professions more broadly. Model 1. Sue, Arrendondo, and McDavis (1992) Sue, Arrendondo, and Davis (1992) identified three dimensions necessary for cultural competence: (a) awareness/beliefs, (b) knowledge, and (c) skills. These three dimensions are complementary to three practitioner characteristics: (a) awareness of own assumptions, values and biases; (b) understanding of the worldview of the culturally different client; and (c) use of appropriate intervention strategies. The relationship between each dimension can be visualised in a matrix to represent the competencies required to be considered culturally proficient (Table 1). In addition to their model of professional cultural competence, Sue et al. (1998) use the concept of “multi- dimensionality of identity” to define how individuals possess different identities at individual, group, and universal levels, with the potential to possess more than one identity at each level 3 (Ridley, Baker, & Hill, 2001). Moreover, they describe how these identities are interactive – a person may be socially limited or liberated by one or more of their identities at each level, depending on their experience. For example, a woman with a communication disability’s participation in society may be limited by both her disability and her gender at group or universal level, but not at individual level. A person’s experience at one level may, over time, alter identity at another, including the way a person views his/herself as an individual (Marsh & MacDonald-Holmes, 1990). For

Individual identity

SELF CONCEPT

Universal identity

Group identity

Figure 1. The interrelationship between levels of multidimensional identity and self-concept.

example, over time, a woman may perceive herself to be limited as an individual due to her social experience – her self-concept is altered. This theory highlights the importance of considering cultural competence as a multidimensional and fluid concept, requiring constant adaptation as we consider individuals within a culture. However, the stand- alone models currently do not reflect this essential relationship between practitioner awareness, knowledge and skills and their interaction with the individual client. Model 2. Papadopolous, Tilki, and Taylor (1998) Papadopolous, Tilki, and Taylor (1998) describe similar attributes for cultural competence as Sue et al. (1992) but also identify “cultural sensitivity” as a key component,

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JCPSLP Volume 18, Number 3 2016

Journal of Clinical Practice in Speech-Language Pathology