The Cultural Competence Continuum

Among the most useful tools developed to help one understand and assess cultural proficiency is the cultural competence continuum by Terry Cross (Cross, Bazron, Dennis, & Issacs, 1989), which can be applied to institutions as well as individuals. This paradigm defines six positions along a continuum, ranging from cultural destructiveness on the negative end, to cultural incapacity, cultural blindness, cultural precompetence, cultural competence, and finally cultural proficiency on the positive end. It should be noted that these six levels are not discrete steps. Each level can have many substeps that comprise numerous positions along the continuum. The six levels are just convenient labels describing the major positions along this continuum. Here we will discuss the application of this model to individuals.

Cultural destructiveness is on the most negative end of this scale. It is represented by attitudes, beliefs, and behaviors that are inherently damaging to targeted cultures and to the individuals within those cultures. Individuals in this position are typically those espousing racism, believing that a dominant race and culture is superior and seeking to suppress or eradicate other "lesser" cultures. They act to favor the dominant group while denigrating and discriminating against others. Although individuals who consciously and blatantly endorse racism are unlikely to enroll in a cultural proficiency course, there may be some who enter a mental health training program without realizing that cultural proficiency is an integral component of clinical skills. The more common situation, though, are individuals who are not consciously aware of the cultural destructive implications of their views and attitudes. Indeed, we often come across students who acknowledged that they did not realize they were on this end of the scale until they applied the continuum to themselves. In this regard, the cultural competence continuum is a valuable tool for self-examination in a training program.

Cultural incapacity is the next position on the continuum. It is manifested by individuals who do not intentionally seek to be culturally destructive, but still demonstrate an extremely biased position, believing in the inherent superiority of the dominant group, and often holding a paternalistic or patronizing attitude over minority groups. For example, they may uphold discriminatory policies and practices or communicate subtle messages to minority people that they are not valued or welcomed. They commonly hold lower expectations for people from minority backgrounds. Occasionally, these individuals may consider themselves "open-minded" and "ready" to work with minority clients, without realizing their patronizing attitude. In this regard, it is sometimes quite difficult for an individual to realize that one is on the cultural incapacity level of the cultural competence continuum. Careful self-reflection along with constructive and supportive feedback from others, will be helpful for individuals at this level to recognize their position.

Cultural blindness is the level most often submitted as the socially desirable position by well-intentioned but uninformed individuals who profess that "people are the same" and should therefore just be treated equally. What is significant here is the lack of knowledge displayed by culturally blind individuals who know little or nothing about the importance of culture, ethnicity, language, and traditions as significant elements in one's personal and social development. Often couched with humanistic terms like "human being," "person," or similar words, the culturally blind position advises one to ignore color and ethnicity, and merely see "people as people." Also important is the ethnocentric perception that values and behaviors of the dominant culture are universal and shared by all. This leads to clinical practices in which the traditional approaches designed for the mainstream cultural group are assumed to be applicable across the board to all other cultural and socioeconomic groups. Based on our own experience, cultural blindness and cultural precompetence, the next level on the continuum, are commonly found among students and trainees in mental health training programs.

Cultural precompetence is significant in that, at this level, individuals become aware of their own personal limitations in cross-cultural communication and relationships. These individuals desire to provide fair and equitable treatment to everyone, but find themselves frustrated at not knowing exactly what is possible or how to proceed. Individuals at this level sometimes may engage in a single act of cultural responsiveness, and assuming this to be sufficient, develop a false sense of accomplishment. Conversely, they may be discouraged by a single failed attempt to reach out to clients of other ethnic backgrounds and feel reluctant to try again. In working with students and trainees at this level, the faculty or trainers should be sensitive to their good intentions and be supportive both in directing them to take a more comprehensive view of cultural responsiveness and in encouraging those who have experienced failures in their past attempts to be culturally responsive. Care should be taken to approach their concerns in a positive and constructive manner, ensuring that they do not feel belittled or criticized for what they have achieved or failed to achieve so far in their attempts.

Cultural competence is exemplified by individuals who value cultural diversity and whose acceptance and respect of differences propel them to continue their own personal self-assessment and self-development regarding cultural knowledge. The level of sophistication and awareness of the dynamics of difference are continuously developing, with the individual beginning to accumulate a critical mass of rewarding cross-cultural encounters where he or she successfully managed the dynamics of difference. Culturally competent mental health professionals are cognizant of the need for cultural adaptations in their beliefs, attitudes, policies, and practices in order to provide effective service to diverse communities. They are sensitive to the needs of culturally diverse clients and continuously seek to expand their cultural knowledge and skills. This is the level for which mental health training programs should aim, in preparing their students and trainees to work in the multicultural society of the United States.

Cultural proficiency is the most positive end of the scale and the most advanced stage of competence. This level is demonstrated by persons who hold culture in high esteem and are committed to continue to learn and contribute to the knowledge base of culturally competent practice. Mental health professionals at this level are knowledgeable about cultural issues and seek to conduct research, develop new approaches based on diverse cultures, and disseminate new information on culturally responsive services. They engage in, and also seek to promote, culturally appropriate services to clients. For them, cultural proficiency is not an end point. Rather, it is a lifelong journey of professional and personal development. Cultural proficiency involves valuing lifelong learning, and training programs should inspire in their graduates.

In sum, the cultural competence continuum is a useful framework for training programs to gauge the needs of their students and trainees and to define realistic learning goals, guiding and encouraging students and trainees to move forward onto the more advanced levels. A training program can also apply this framework for self-evaluation to determine to what extent it is culturally responsive on the institutional level. Finally, we also want to encourage students and trainees to utilize this model as a means of self-exploration and development. It is important to remember that cultural proficiency does not stop with graduation from a training program or with the attainment of professional licensure. It is a lifelong learning process that a responsible mental health professional will pursue.

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