38. Certainly this is a superficial conceit: there is much movement on the surface, but the mind is neither deeply moved nor affected. Still, gnosticism exercises a deceptive attraction for some people, since the gnostic approach is strict and allegedly pure, and can appear to possess a certain harmony or order that encompasses everything.
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.
the humble approach pdf 11
Eliminating Indigenous and ethnic health inequities requires addressing the social determinants of health inequities including institutional racism, in addition to ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care delivery. Some jurisdictions have included cultural competency in health professional licensing legislation [21], health professional accreditation standards, and pre-service and in-service training programmes [22,23,24,25]. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. This article reviews how concepts of cultural competency and cultural safety (and related terms such as cultural sensitivity, cultural humility etc) have been interpreted. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for why broader conceptualisation of these terms is needed to achieve health equity. A move to cultural safety is recommended, with a rationale for why this approach is necessary. We propose a definition for cultural safety and clarify the essential principles of this approach in healthcare organisations and workforce development.
This review was originally conducted to inform the Medical Council of New Zealand, in reviewing and updating its approach to cultural competency requirements for medical practitioners in New Zealand Aotearoa. The review and its recommendations are based on the following methods:
This review and analysis has been conducted from an Indigenous research positioning that draws from Kaupapa Māori theoretical and research approaches. Therefore, the positioning used to undertake this work aligns to effective Kaupapa Māori research practice that has been described by Curtis (2016) as: transformative; beneficial to Māori; under Māori control; informed by Māori knowledge; aligned with a structural determinants approach to critique issues of power, privilege and racism and promote social justice; non-victim-blaming and rejecting of cultural-deficit theories; emancipatory and supportive of decolonisation; accepting of diverse Māori realities and rejecting of cultural essentialism; an exemplar of excellence; and free to dream [28].
Cultural competency is a broad concept that has various definitions drawing from multiple frameworks. Overall, this concept has varying interpretations within and between countries (see Table 1 for specific examples). Introduced in the 1980s, cultural competency has been described as a recognised approach to improving the provision of healthcare to ethnic minority groups with the aim of reducing ethnic health disparities [31].
Cross et al. [29] contextualized cultural competency as part of a continuum ranging from the most negative end of cultural destructiveness (e.g. attitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the culture such as cultural genocide) to the most positive end of cultural proficiency (e.g. agencies that hold culture in high esteem, who seek to add to the knowledge base of culturally competent practice by conducting research and developing new therapeutic approaches based on culture). Other points along this continuum include: cultural incapacity, cultural blindness and cultural pre-competence (Table 1).
where the movement from cultural competence to cultural safety is not merely another step on a linear continuum, but rather a more dramatic change of approach. This conceptualization of cultural safety represents a more radical, politicized understanding of cultural consideration, effectively rejecting the more limited culturally competent approach for one based not on knowledge but rather on power [63]. (p.10).
Unfortunately, regulatory and educational health organisations have tended to frame their understanding of cultural competency towards individualised rather than organisational/systemic processes, and on the acquisition of cultural-knowledge rather than reflective self-assessment of power, priviledge and biases. There are a number of reasons why this approach can be harmful and undermine progress on reducing health inequities.
It is clear from reviewing the current evidence associated with cultural competency and cultural safety that a shift in approach is required. We recommend an approach to cultural safety that encompasses the following core principles:
In operationalising this approach to cultural safety, organisations (health professional training bodies, healthcare organisations etc) should begin with a self-review of the extent to which they meet expectations of cultural safety at a systemic and organizational level and identify an action plan for development. The following steps should also be considered by healthcare organisations and regulators to take a more comprehensive approach to cultural safety:
Cultural competency, cultural safety and related terms have been variably defined and applied. Unfortunately, regulatory and educational health organisations have tended to frame their understanding of cultural competency towards individualised rather than organisational/systemic processes, and on the acquisition of cultural-knowledge rather than reflective self-assessment of power, priviledge and biases. This positioning has limited the impact on improving health inequities. A shift is required to an approach based on a transformative concept of cultural safety, which involves a critique of power imbalances and critical self-reflection.
The world is constantly evolving. Without an intense curiosity and a desire to learn, you will be left behind and increasingly unable to converse, much less keep up, with your peers. Staying abreast of new learning opportunities requires a humble awareness that what you know is not enough and that you always have more to learn.
It is relatively easy to be humble when you are at the bottom of the tree, as it were: new in a job, or very junior. The more senior you get, however, the more likely you are to have people looking to you for answers, and the more you find yourself believing that you can help.
A key quality of humbleness is to value others and enable them to be heard. Spending time listening to others, and drawing out their feelings and values, enabling them to express themselves, is a very powerful way to start to understand this.
Like Jesus, we can approach each neighbor without fear and walk side by side during both difficult and joyful times. We can value their qualities, share material and spiritual goods, encourage, give hope and forgive.
Yet Jesus does not focus directly on these forms of abuse, but turns his attention to the human heart, the root from which they arise ... Our hearts must be transformed, if we are to acquire new attitudes and establish genuine and just relationships. To be humble does not only mean not being ambitious and dominant, it also means being aware of our own nothingness, feeling small before God and thus placing ourselves in his hands, like children.
Humble can be used to describe what is ranked low by others, as in "persons of humble origins." People also use the word of themselves and things associated with themselves; if you describe yourself as "but a humble editor" or refer to your home as your "humble abode," you are saying that neither you nor your home is very impressive.
The World Health Organization (WHO) has been creating and disseminating information about interprofessional collaboration for many years (e.g., Gilbert et al., 2010). Other health professions (i.e., nursing, public health, occupational therapy, speech-language pathology and audiology, and social work) quickly adopted their framework and competencies. As many behavior analysts practice within the health arena, it is prudent to acknowledge the guidance provided by the WHO and to build upon their well-established foundation. Several of our peers have started this conversation (e.g., Bowman et al., 2021; Slim & Reuter-Yuill, 2021), but our field has yet to adopt the WHO interprofessional practice (IPP) framework. Capitalizing on technology that already exists, we briefly outline the core competencies put forth by the Interprofessional Education Collaborative (IPEC, 2016) and discuss how they relate to humble behaviorists (see ABAI, 2020 for another source) in the following sections. The practice of humble behaviorism will require behavior analysts to successfully collaborate with other professionals. The practice of humble behaviorism will also demand that behavior analysts demonstrate competencies in four key areas: (a) Teams and Teamwork, (b) Roles and Responsibilities, (c) Values and Ethics, and (d) Communication (see Fig. 1).
The ethics of collaboration are central to the evidence-based practice of behavior analysis (Slocum et al., 2014). Humble behaviorists recognize that the practice of behavior analysis is founded on the same fundamental principles of ethics (e.g., benevolence and do no harm) as all other human service professionals (Contreras et al., 2021; Rosenberg & Schwartz, 2018). Likewise, behavior analysts believe that ethical decisions are made through the integration of the best available evidence, clinical expertise, and client and family preferences and context (BACB, 2020; Contreras et al., 2021; Rosenberg & Schwartz, 2018; Sackett et al., 1996; Slocum et al., 2014; Spencer et al., 2012). As all health professionals are charged with engaging in evidence-based practice (or medicine), it is the common ground upon which all team decisions are processed (Cox, 2012). Adopting the same definition of evidence-based practice as other health professions (Slocum et al., 2014) puts behavior analysts in a humble stance, and readies them for teaming. Being a part of an interprofessional team means that behavior analysts should strive to uphold the values, goals, and decisions made by the team, as is their ethical responsibility (BACB, 2020; Contreras et al., 2021; Cox, 2012). By honoring shared values and evidence-based processes, behavior analysts demonstrate their ability to be team players, which in turn promotes a favorable impression of behavior analysis. 2ff7e9595c
Comments