WEBVTT
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Step two is an awareness
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and acceptance of difference.
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To be able to say
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that it's okay to be different.
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To look at difference with curiosity and openness
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and not make value judgements.
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A person who likes diversity, who values it,
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who is intrigued by it,
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and wants to, you know, make sense out of it.
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Being very, probably flexible, very adaptable,
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very open to concepts
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and ways of being that might be very different
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from their own,
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I think is probably the most critical.
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Being aware and being constantly pushing yourself
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to constantly have that thirst like a sponge
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to know more is critical and key.
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At the same time,
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making sure that we're not stereotyping.
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One of the major ways
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that cultures differ from one another
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is in their focus on either the individual or the group.
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Independent cultures like ours in the United States,
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tend to emphasize individual needs and autonomy.
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Interdependent cultures like those in many Asian
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and South American countries,
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emphasize the needs of the group.
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They value group harmony above personal interests.
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Another difference is how members
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of the cultural group define family.
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Family could mean nuclear family,
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mother, father and children,
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or it might mean extended family
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including relatives and non-blood kin.
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The word family may include ancestors
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or even generations to come.
(children reading)
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It could refer to the whole community.
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Communication is another factor that varies
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from culture to culture,
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body language, eye contact,
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physical distance, silence.
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Even certain words may mean one thing to you
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and something very different to another person.
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For the next few minutes,
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we will watch three dramatizations
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that show the interaction between a practitioner
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and patient clients during an intake interview.
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These fictional scenarios
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feature Latino, African-American,
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and Native American consumers
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to demonstrate how an awareness and acceptance of difference
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can help a practitioner engage with patients and clients.
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Wait a minute, are you listening to yourself?
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Because I'm listening
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and what I'm hearing is
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that unless your grandfather gives his consent,
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you feel you'll be unable to make a decision
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that could affect the rest of your life.
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Maria, whose life is it anyway?
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Mine.
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Are you asking me or telling me?
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Telling you.
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In this dramatization,
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the worker imposed her own individualistic perspective
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on her client.
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She dismissed Maria's strong family ties,
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and her sense of responsibility to the group.
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Not only has she ignored a potential source
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of strength and support for Maria,
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she's also alienated the person she wants to help.
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Here's how the worker might have handled the encounter
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if she'd been more skilled in the art and science
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of cross-cultural communication.
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As in all social work and healthcare,
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effective cross-cultural work requires us
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to start where the patient or client is.
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Listen with an open mind.
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Acknowledge your patient client's values
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and life experiences.
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This is your opportunity to understand the world
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through someone else's eyes.
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It sounds like your grandfather
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plays a very important role in your family.
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Yes.
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In your family,
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who gets involved in the decision making
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when there's a major decision to be made?
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I didn't ask that right, did I?
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I guess what I'm trying to find out is
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how your family works.
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Because in order for me to help you,
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I need you to help me understand
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how your family makes decisions.
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And when you're in a situation
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that you don't understand what's going on,
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cultural competence means you just simply ask.
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And I'd ask you, is it okay if I ask you a question,
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and tell me, you can tell me if I'm wrong,
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I'm going to ask it in such a way that I hope
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allows you to give me the most information,
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but if I'm off-base, would you correct me?
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By asking questions about someone's culture
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and being authentic,
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what we do for a brief moment
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is we invert the balance of power.
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Typically as a social worker,
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I have the authority
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and you, as a client or customer, don't.
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But when I reverse that and ask you,
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well explain that to me.
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James Lee called that the ethnographic interview,
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but I ask you to explain what you mean
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by that term or that concept
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or that behavior. What we do for a brief moment
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is we invert the balance of power.
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Don't be afraid to ask questions
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and they don't have to be personal.
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They don't have to be you know,
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well, you know tell me your life history.
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But you know, I noticed that you know,
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many, I went to the temple and this took place.
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They had a tree there with this ribbon around it.
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What did it mean?
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Well, this is what I saw and this is what I saw.
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And what does this mean?
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In other words, if we see something we don't understand,
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we can either go back and analyze it
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and maybe make a mistake,
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or we can just use plain old common sense
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and ask the people, what am I observing?
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What does this mean?
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And give up thereby a little bit of the power
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and authority and control by doing it.
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So I would appreciate anything you could share with me
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that would help me understand your family.
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Well, when you said my family,
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I didn't know if you met my mom and dad or familiaris.
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Can you explain that word?
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How did you pronounce it?
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Familiaris.
I tried to learn a few words
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of every language of every new patient
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so that I can better relate to them and build their trust.
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'cause not everyone speaks English here in Hawaii.
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Familiaris.
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Did I spell that right?
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Not even close.
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You learn 10 words from that patient
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so that you may communicate with them better
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and it really makes a difference.
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Now I become the customer, the client,
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the recipient of your knowledge
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and it validates you as being having some expertise.
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If for nothing else, your own reality.
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Familiaris, it's like our group, our whole group,
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not just the people who live in my house,
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but my aunts, my uncles, my cousins, patrino, madrina.
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Oh, wait a sec.
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What, what was that?
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Padrino and-
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Madrina.
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Madrina, sorry.
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What's-
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It's godfather and godmother.
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Padrino is godfather and madrina is godmother.
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Thank you.
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Yes.
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And those type of relationships
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are ones that tend to last,
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that are much more reciprocal,
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as opposed to one way.
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Often people are very willing to share with you
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their own cultural insights,
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and they may take you on a cultural journey
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that you otherwise wouldn't get.
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Now, the worker has an opportunity
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to understand how her client's world operates.
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To observe how this young woman's strong connection
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to her family may be a source of support.
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Let me ask you,
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who would you like from your familiaris
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at this table with us?
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Who would, who would make you feel comfortable
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and give you the support you need?
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Mi tia Ladi.
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My aunt.
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Ladi, yeah.
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She's always there for me.
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Their whole outlook changes
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when you speak to them in their own language
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and you you know, bow your head or you,
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you avert your eyes or you gaze into their eyes,
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or you use the therapeutic touch
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that they are familiar with.
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So it's very, very important.
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Not even here in Hawaii,
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I'm sure in all the other states
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to really just ask the patient what they would like.
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Is there anyone else?
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How many can I have?
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How many do you need?
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And people really resonate with the fact
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that while this person doesn't know,
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is willing to learn and recognize me
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as having something to share.
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Which members of your family are you close to?
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Well, in my nation, we follow the clan of our mother.
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So that means if my mother belongs to the alligator clan,
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then I belong to the alligator clan.
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And anyone who belongs to the alligator clan
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would be considered part of my family
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because we have a matriarchal link.
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But then I also have many cousins
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who belong to the raccoon clan
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because their mother and their grandmother
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are raccoon clan.
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Now during festival time-
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Etiquette, when you don't know the cultural values,
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it's very easy to misread behavior.
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Making direct eye contact in one culture shows respect
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and another culture is disrespectful.
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The way that I was trained as a therapist,
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I was trained to know that
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when people won't look me directly in the eye,
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they're not being very truthful.
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Along the way, I learned that they're being very respectful
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and very honest.
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Don't be afraid to admit when you don't know something.
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When you acknowledge your own ignorance, you lose nothing.
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And your patient/client gains the opportunity
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to teach you something.
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I think just the idea of being really honest
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about it and saying
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I really wanna learn more about your culture
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and I feel embarrassed that I don't know.
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And so you ask your permission to almost ask for help.
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It's okay to tell the person
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I don't know anything about your culture.
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And then the person will like you,
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because they, if I'm from Mexico,
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somebody asked me from Mexico, I feel proud.
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And I wanna share.
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I would be very open,
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very explicit that I am not native American.
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It's obvious.
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You can see that.
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I know very little about your culture.
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Probably what I do know about your culture,
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may be stereotypes or something I've read.
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And I'm not sure if that's even true.
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That's fascinating.
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You know, I've heard of clans,
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but I never understood how it works.
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How far back in history can you trace your clan?
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The alligator clan?
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Oh we go back over a thousand years.
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That's amazing.
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What a beautiful legacy for your children too.
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Yeah.
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I really want them to feel connected to our heritage.
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I want them to be proud.
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Let the patient client control the flow of information.
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I wouldn't try to push the conversation
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more than you were giving me permission to.
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I'm watching you for cues.
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I think too, knowing that it's okay
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if there's silence.
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I think in Western society we've gotten used to
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not being silent or waiting for a response from people.
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And sometimes people just need time to think.
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Is there anyone within your clan
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or even outside of your clan
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that you feel very close to on a personal level?
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For example, if you had a personal problem,
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or an emergency in your home,
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who would you call for help?
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That's easy because we have a phone tree.
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Well, that sounds smart.
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How does it work?
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Well, first I call three people on the phone tree,
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and then they in turn have the responsibility
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of contacting three people of their own
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until before you know it,
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the word is reached every corner of Indian country.
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One of the most important differences
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from culture to culture is how we define family.
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Okay, where are you in the birth order?
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Oldest or youngest?
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Well, actually you could say
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I'm the second of four sisters.
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Okay, okay.
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You said sisters.
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I thought you had one sister.
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Well, growing up there was my older sister then me,
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and my sister's daughter, and a cousin
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that was close in age.
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So actually I grew up with three sisters.
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For many African American families, strong kinship ties,
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flexible family roles,
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and informal adoption are time honored cultural traditions.
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These values and practices can be regarded as strengths.
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So you grew up with your sister,
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along with your niece and your cousin, correct?
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Technically correct.
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My mother took in her other sister's two boys for a time,
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my cousins.
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Oh, but not legally?
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It wasn't illegal.
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No, no, no, no, no.
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What I met is she didn't adopt them legally?
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Why should she adopt them?
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In this scenario,
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the worker approached the encounter
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from her own nuclear family bias.
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She's passed up a chance to see her client
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in a cultural context.
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And now she's offended the woman.
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If you're gonna work with someone different,
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it isn't unusual for you to do something
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or say something that doesn't sit well with them.
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So it isn't a bad idea to actually apologize
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in advance early on in the relationship
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just to get it out of the way.
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If I offend you, that's my dumbness, not my meanness.
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And if you would be so kind
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just take me in a cultural journey, I'd be so appreciative.
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And I think that they'll get a better sense
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of how to help people by looking at their strengths
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using their strengths and looking at how their culture
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can be used as a resource
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rather than discounting the culture
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or asking people directly or indirectly
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to change their culture.
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You know, many of the African American people
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that I've met have described the same family structure
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that you've described,
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especially about taking the children in.
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One woman explained it to me in terms
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of how families had to survive during slavery.
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That's correct.
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Absolutely correct.
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Our family had to look out for each other.
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Would you say that's one of your family's strengths,
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strong family ties, flexible family roles.
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Yes, absolutely.
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Okay.
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Are there any other values in your family
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that you would consider African American values?
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What do you mean?
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Okay for example, if I were to come to your house
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or let's say that I were to stay with you
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for a couple weeks,
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what would I observe about the way that you live,
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the way you raise your children,
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the meals you cook, whatever
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that I could identify as African American
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without stereotyping of course.
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Okay.
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We know that the majority of communication
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is also nonverbal.
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And so we have to be aware
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that the things that are being spoken verbally,
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but also looking at our non-verbal cues.
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And being humble enough to know
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that we don't know at all.
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That we need to be in a position
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that we can say to those that we're with,
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you know, I don't know it all.
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And can you help me to understand better?
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I think what ultimately comes in is
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that people are gonna pick up whether you're sincere.
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And I think that's the issue,
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because if you're sincere in your effort
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and you're willing to look at their culture,
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I think most people are open and forgiving.
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If you're, if you don't do the quote on quote correct thing,
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but they're not going to be forgiving
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if you're not sincere.