Defining and Developing Multicultural Competency in the Rehabilitation Profession

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Defining and Developing Multicultural Competency

in the Rehabilitation Profession

Kenneth C. Hergenrather, MSED, MRC, CRC

Mutilculturalism takes place between or among individuals from different cultural backgrounds.The rehabilitation professional must be sensitive to multiculturalism issues when providing quality services to clients. This paper will address the issue of preparing a rehabilitation counselor to become more effective through defining and developing his or her levels of cultural competency. The initial preparation involves addressing the history of multiculturism, changing demographics of the United States, and defining the terms culture, race and ethnicity. This establishes a foundation to be used in understanding the impact of multiculturalism on the field of rehabilitation and further address plans that will meet the needs multicultural clients.

Although the concept of multiculturalism is relatively new in the United States, a review of the literature indicates that it has been present throughout the course of human civilization. Culture has had a significant role in human behavior for thousands of years. It has impacted Hippocrates in the classical Greek era, the reign of the pharaohs of Egypt, the fall of the Roman Empire and the present. In the fifth-century B.C., a Greek historian named Herodotus traveled throughout the Mediterranean, including Mesopotamia and Egypt. He questioned both the working class and the elite about their differences in their ways of doing things. From this, Herodotus set forth his famous dictum Custom is stronger than law to explain why conquerors have so much difficulty getting the conquered people to adopt the conqueror’s law (Ponterotto, Casas, Suzuki & Alexander, 1995). Most of the discussions from ancient sources are devoted to the difficulties that arise from differences in cultures. This includes the assumptions of dominant cultural superiority by conquered or colonized persons.

Ancient civilizations and American society share the understanding that different groups from different backgrounds do not necessarily relate effectively, even though they may live in the same society. Mutilculturalism therefore has an established history. For centuries, people of different cultural backgrounds have recognized the existence of natural conflicts associated with communicating with people from other cultural backgrounds (Betancourt & Lopez, 1993). American history has shown that the ease and extent to which different groups assimilate depend on their race and cultural similarity to the dominant American racial group. Through the mid-1960's, the primary attitude of the United States with respect to racial and cultural matters was that of the melting pot philosophy. Proponents of the melting pot theory believed that all nationalities, ethnicities, and races should assimilate into American culture. The co-existence of several cultures was not desired (Ponterotto, Casas, Suzuki& Alexander, 1995). In fact, belonging to a culture that differed from the mainstream American culture was considered detrimental and undesirable.

During the 1960's when non-white ethnic groups began to demand fair and equal treatment under the law, the ideals of the melting pot theory were challenged. These groups also expressed their discontent with the lack of appreciation and respect afforded to their cultures by members of the white majority group. This initiated a new and more culturally sensitive theory: Cultural Pluralism (Alston & Bell, 1996). This theory explains that ethnic groups can preserve their cultural uniqueness as well as share the universal characteristics of American culture. The central principle of this theory is unity through strength and diversity. The emergence of this theory of cultural pluralism in America was extremely significant because it led to an increased, even if minimal, awareness and acceptance of cultural diversity in favor of the notion of a cultural melting pot.

As the theory of pluralism gained acceptance, the population of racial and ethnic minorities in the United States increased. By the early 1970's, it became extremely difficult for Americans to ignore the presence of its numerous cultural groups. This became quite obvious as the field of human services, including the counseling professions, began serving a greater percentage of minority clients. With an increase of minority clients, it became inappropriate to focus exclusively on the issues of white, middle-class individuals. The unique counseling needs of racial and ethnic minorities were being acknowledged. The issue of multiculturalism within the field of human services was increasingly emphasized to meet the needs of the clients ( Betancourt & Lopez, 1993).

The emphasis on understanding multiculturalism is indeed an issue for aspiring rehabilitation counseling professionals, like myself. The profession of rehabilitation counseling was founded upon the values of dignity and respect for all whom it serves (Sheppard, Bunton, Menifee & Rocha, 1995). This is an essential and practical issue now more than ever. Recently, rehabilitation counseling has placed less emphasis on the impact of multicultural variables in the social adjustment of minorities with disabilities. Statistics have shown that state and federal rehabilitation programs lack the necessary multicultural competencies to serve clients effectively. This is supported by the fact that state and federal rehabilitation counseling clients of minority status have experienced higher rates of service rejection, had less successful case closures, received less training, and have been the recipients of less expenditures for service than the Anglo-American clients (Smart & Smart, 1994; Asbury, Walker, Stokes & Rackley, 1994; Sheppard, Bunton, Menifee & Rocha, 1995).

The changing demographic of the United States will also require the rehabilitation counselor to be competent in the area of multiculturalism. By the year 2010, Anglo-Americans will account for less than 50% of the American population (Davis & Rubin, 1996). By the year 2009, the number of Hispanic-Americans will exceed the African-America population, becoming the nation’s largest minority group with 38 million people. These demographic trends will parallel growth in rehabilitation counseling client services (Smart & Smart, 1994). It will be necessary to ensure that relevant multicultural competencies of rehabilitation counselors gained through masters programs or continuing education requirements are utilized.

The changing demographics in the nation, as well as the rehabilitation counseling client services population, make it imperative that I thoroughly understand the issues of culture, race and ethnicity.

Cultural issues play an important role in the behavior of individuals. Culture is closely intertwined with the concepts of race and ethnicity. This had led to conceptual confusion. Often the concept of culture is interchangeably used with race and ethnicity. An example of this is seen in the application process in which the applicant selects their race/ethnicity from a category including their race, ethnicity and national origin (such as Asian, American Indian, Black, Latino, White). Latinos, for instance, can be White, Black, Asian, American Indian, and any combination thereof. By this loose interpretation of culture, race and ethnicity, these terms are defined as synonymous. To alleviate or at least minimize this, it is important to define culture.

Research has shown a variation in the observed study of groups identified in terms nationality, race, ethnicity, or socioeconomic status (SES) are often attributed to cultural differences without defining what is meant by culture. Although it would be desirable to have a consensus definition, it is not absolutely necessary to advance knowledge. Even without consensus, knowledge is possible if culture is defined in terms that are amenable to measurement. In reviewing the elements found in the anthropological and cross-cultural psychology views of culture, the conception of culture is defined as being learned and shared by a people or an identifiable segment of the populations (Betancourt & Lopez, 1993). This represents a design and way of life that is transmitted from one generation to another.

Culture can also be defined in terms of its subjectivity. Subjective culture includes elements such as social norms, beliefs, and values. These elements, include a wide range of topics, such as family roles, communication patterns, affective styles, and values regarding personal control, individualism, collectivism, spirituality and religiosity (Ponterotto, Casas, Suzuki & Alexander, 1995). When culture is defined subjectively, in terms of these elements it becomes possible to measure. The relationship of these elements to effective rehabilitation counseling can be directly assessed. Then, it is possible to deal with the concept of culture and pursue an understanding of its role in rehabilitation counseling. By incorporating the conceptualization and measurement of specific cultural elements, the comparative study of cultural groups is likely to contribute to the understanding of the role of culture in behavior.

Race is generally defined in terms of physical characteristics, such as skin color, facial feature and hair type which are common to an inbred, geographically isolated population. Although physical characteristics are associated with racial grouping, biological factors associated with groupings are also of interest. In the study of hypertension, African-Americans are at a higher risk than Anglo-Americans. What is of scientific interest is not the race of these individuals, but the relationship between the identified biological factors (plasma renin levels and sodium excretion) and hypertension (Hales, 1994) . Moreover, even if a cause-and-effect relationship is demonstrated between these two biological variables and hypertension, one cannot attribute this relationship to race because of interracial variability and interracial overlap with regard to the biological variables. Psychological stressors such as diet, sedentary lifestyle, and subjective culture could be responsible for the racial-group difference in the biological factors (Ponterotto, Casas, Suzuki & Alexander, 1995). In regard to race and the mobility of people, observations in one race group may not be applicable to those of the same race in another part of the world or under different living conditions. It is important to acknowledge that research that is conducted on the relevant variables, not the racial variables alone. Many times, assumptions are made that apply irrelevant variables to entire races.

Ethnicity is often associated with and used interchangeably with culture and as well as race. In reference to groups, ethnicity is used as a characteristic in terms of common nationality, culture, or language. The concept of ethnicity is related to the Greek concept of ethnos, which refers to the people of a nation or tribe, and ethnikos, which stands for national. Although cultural identity can be a determinant of ethnic identity or affiliation, being part of one ethnic group also can determine culture (Ayos, 1990). As members of an ethnic group interact with each other, ethnicity becomes a means by which culture is transmitted. This issue is particularly important in the United States today. Beyond personal interactions, inter-ethnic community communication takes place through the mass media. Increased specification to what about ethnicity is of importance to the rehabilitation counseling field would reduce the conceptual problems in this area.

An individual’s socioeconomic level can become an element confounded with the influence of culture, race, and ethnicity. In the United States, which hosts a history of ethnic and racial discrimination, segregation may result in significant overlap between culture and Social Economic Status (SES). In the United States, the majority of Anglo-Americans are represented in higher social strata whereas the majority of Hispanic-Americans are represented in lower social strata (Smart & Smart). Therefore, the two cultures are separated due to the effects of SES. This may lead one to wrongly observe that culture does not play a role, but SES does.

If two social classes are represented in two cultures, the economic living conditions of a segregated lower class that includes both cultural groups may generate specific elements of beliefs, norms or values. These elements associated with the lower class may become significantly different from that of other classes of the same cultural group. However, it may be possible that there may exist some cultural elements associated with ethnicity that are consistent across the different SES levels of a given culture. When social classes are compared within the same ethnic group, cultural elements unique to a lower class may be wrongly attributed to the SES - low income or low educational level. Many times these attributions are associated with lower class reality (Ponterotto, Casas, Suzuki & Alexander, 1995).

A thorough understanding of the history of multiculturalism, changing demographics of the United States and the attributes of a client’s culture, race and ethnicity form a baseline of knowledge to build upon. This knowledge will impact the delivery of professional rehabilitation counseling services. The profession of rehabilitation counseling was founded upon the values of dignity and respect for all whom it serves (Sheppard, Bunton, Menifee & Rocha, 1995). The issues of respect and attitude are extremely important in service delivery to multicultural clients. A review of the literature has shown that the rehabilitation counselor’s attitude impacts the quality of services provided in a multicultural client counseling. People with a disabilities want to be treated with dignity and respect by the counselor. In rehabilitation counseling client rankings of the characteristics of the rehabilitation counselors, an attitude of respect and support for the individual’s multicultural independence and worth, was continually cited as being first and foremost (Anderson, Wang & Houser, 1993; Sheppard, Bunton, Menifee & Rocha, 1995). Rehabilitation counseling clients also reported that the value accruing from having a rehabilitation service provider of the same racial or ethnic background was diminished if respect and support for independence was not part of the relationship (Sheppard, Bunton, Menifee & Rocha, 1995).

Within the rehabilitation environment, one’s abilities to listen and respond comfortably to minority clients with a wide range of culturally sensitive verbal and nonverbal response modalities is necessary. An emic approach to rehabilitation counseling is appropriate. This approach permits counselors who are culturally different from their clients to perceive life experiences and dilemmas through the eyes of the client (Feist-Price, Harley & Alston, 1996). Rather than imposing constructs, the rehabilitation professional would discover from the client what is important to their culture through effective interactive communication. Many of these skills will be learned from participation in comprehensive rehabilitation educational programs.

In the area of rehabilitation evaluation, an emic approach to rehabilitation counseling is necessary in addressing multicultural issues. When evaluating a client, one must have a cultural context, as well as be specific to the client’s needs. Several factors should be addressed when assessing multicultural clients. To be effective in this process, the evaluator, shall observe the practice session of the test to determine the client’s response style. This will assist in determining any necessary adjustments to be made. The evaluator should also consider administering the tests without time constraints, if applicable. The removal of this pressure may yield better test results (Alston & McCowan, 1994). One must also be aware of the potential effects of client distrust with the evaluation process. To assist the client with any of these factors, the evaluator must provide open communication and clarity regarding the purpose and interpretations of the evaluation tools throughout the entire evaluation process (W.W. Stewart, Director, University of South Carolina School of Medicine Rehabilitation Counseling Program, personal communication, November 7, 1996).

Regarding cross-cultural evaluation, one must constantly be aware of be aware of four variables that have been identified to enhance one’s effectiveness : (1) vocational evaluators must be culturally competent in regard to their clients, (2) test results must be meaningfully interpreted from a cross-cultural perspective, (3) evaluators must use multiple tests and instruments to appropriately assess client constructs and (4)evaluators must maintain scoring accuracy (Feist-Price, Harley & Alston 1996). As a vocational evaluator, one must face cross-cultural evaluation with a commitment to learn more about cultural values and world values of one’s clients and constantly challenge one’s self to learn and incorporate appropriate strategies of interventions.

One venue by which to improve one’s knowledge base of multiculturalism is through the usage of printed media. Although there exist many multicultural textbooks, the research has indicated that none of these is specific to rehabilitation counseling. However, one can acclimate oneself to professional journals that deal with multi-cultural issues in psychology and mental health counseling such as Hispanic Journal of Behavioral Sciences, Inter-American Journal of Psychology, Journal of Mutlicultural Counseling, and Journal of Black Psychology. Since the printed media is still the most commonly used media resource in rehabilitation counseling, raising awareness about the need for multicultural training has been taken with establishment of the Rehabilitation Cultural Diversity Initiative (RCDI). In response to the changing racial profile of the United States, the 1992 Amendments to the Rehabilitation Act called for the establishment of the RCDI (Smart & Smart, 1994). The RCDI is a federal program which will be funded through 1995. The RCDI directors and staff specialists are housed at 11 universities across the U.S. and work in conjunction with the Regional Rehabilitation Continuing Education Program (RRCEP). Professional development, may be initiated by contacting a RRCEP regional office. Professional development can also be attained through membership in such organizations as the National Rehabilitation Association and the American Counseling Association (ACA). Each organization addresses the issues of multiculturalism. Through membership in the ACA, one can also become a member its Association for Multicultural Counseling and Development (AMCD) division. This division provides leadership, resources and information unique to multicultural counseling. The mission of the AMCD is to improve cultural, ethnic and racial empathy and understanding by designing programs to advance and sustain personal growth (American Counseling Association, 1995).

Effective multicultural communication is dependent upon one’s knowledge and sensitivity of the client’s culture. Communication in a culturally sensitive manner demonstrates respect for the client and a willingness to learn. Every encounter between a rehabilitation counselor and client is to some degree multicultural. As the client and the rehabilitation counselor will undoubtedly differ on one or more cultural variables, the counselor must acknowledge and embrace the pervasiveness of mutilculturism. Acquiring fluency in multicultural issues is an ongoing process that is imperative to rehabilitation counseling. With this imperative, the rehabilitation counselor must address the client with respect and support. When these two issues coincide within my client’s rehabilitation counseling session, then you, the counselor can empower the client to have full and equal participation in society.

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American Counseling Association. (1995). American Counseling Association welcomes you. [Brochure]. Alexandria, VA: American Counseling Association.

Anderson, D., Wang, J. & Houser, R. (1993). Issues and needs of persons with disabilities in Hawaii: an exploration of racial/ethnic differences. Journal of Rehabilitation. 59(4), 11-16.

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a minority perspective. Journal of Applied Rehabilitation Counseling. 26(2), 36-40.

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