Excerpt from: A Primer On Cultural and Linguistic Competence (CLC Primer): Practical Approaches for Effective Implementation of Cultural and Linguistic Competence in Children's Mental Health Read Comments | Post Your Own Comment 
Section 2: Making Connections: Understanding Cultural And Linguistic Competence in a Larger Context What You Will Find in this Section
Transformation of an enterprise begins with a sense of crisis and urgency. No institution will go through fundamental change unless it believes it is in deep trouble and needs to do something different to survive. Louis V. Gerstner, IBM (Legace, 2002)
The first critical concept embedded in cultural and linguistic competence is that of change and transformation. We must recognize that the implementation of cultural and linguistic competence requires us to change and to change in more profound ways than “tinkering at the edges”. Thomas Lonner (2007) states this clearly in his advice to health care organizations: “Cultural competency requires a new way of seeing one’s role and work in the community or marketplace and some significant change in the industry, and its facilities, professions, and practices…Cultural competency requires more than a new set of skills, knowledge, and techniques but a sea change in the way the organizations see themselves” (p.15). So, cultural and linguistic competence is about fundamental change in an organization – its policies, practices, structures, and interventions. The desire to change must also be keenly felt, if action is to result. If addressing cultural competency does not have a sense of urgency within your organization, then very little action will occur. In the health field, for example, there are extensive activities related to cultural and linguistic competence underway in the private, public and policy sectors of the field. That same urgency and flurry of congruent activities have not been observed as much in the mental health arena. Thus, one of the questions that you might ask from the outset is whether you believe there is any real urgency to address cultural competency issues in the mental health field. Unless your organization feels the urgency to change, whether for self-preservation, expanded markets, improved quality, or another compelling reason, then you are not as likely to see a wholesale uptake of cultural competency strategies in your work. Hence, the need to change the way you do business may not be one of the driving forces of your particular cultural competency efforts.
If we are committed to change within our organizations, then it is important to understand more about how change occurs. In order to change, it is important for organizations to understand that change is a developmental process, which has several stages and level of activities. Prochaska, Redding and Evers (1999) identified five stages of change:1) precontemplation, 2) contemplation, 3) preparation, 4) action and 5) maintenance. In 2001, Prochaska, Prochaska and Levesque, identified processes of change -- that is the covert and overt activities that people and organizations use to progress through the stages of change. By understanding the processes of change for both individuals and organizations, strategies can be developed that are appropriate for each stage. In addition, some change processes are only appropriate for organizations. Mayeno (2007) developed a table outlining the process of change for both individuals and organizations. One of the important steps in addressing and implementing cultural and linguistic competence is for the organization to assess its readiness for change and where it is in the stages of change process. Too often, organizations do not take the time to figure this out and develop interventions and strategies that are not appropriate for where they are. If the interventions and stages are mismatched, organizational change efforts can result in serious setbacks (Mayeno, 2007). Case Example: A social policy agency felt that it was time for the organization to address issues related to cultural competence and race equity at their staff retreat. They devoted a half-day at the retreat to showing a documentary about race and having a dialogue. They were surprised that many of the African American staff, who were primarily secretaries and administrative assistants were very unwelcoming and offended by these issues being raised. Bewildered by this response (they had expected more resistance from white staff), they hired a consultant to address this turn of events. In interviews with the staff, the consultant found that there were many “unspoken” racial tensions within the organization, and that the African American staff were “distrustful and suspicious” as well as “fearful” about why these issues were being brought up at this time. The organization had not adequately prepared their staff for this discussion and therefore, there were great feelings of being unsafe and distrust. The consultant had to go back and address this process and help the agency rebuild trust before additional activities could move forward. EXERCISE 2-1: Ask each staff person in your organization to assess where your agency is on the Cultural Competence Continuum and the Stages of Change. Determine how much consensus there is about the stages and have a discussion about why the organization is viewed as being at a certain stage. Have staff make suggestions about interventions or processes that may assist the organization in moving to the next level. |
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