Moving Cultural Diversity toward Cultural Competence in Health Care. (Editorial)
Galambos, Colleen M., Health and Social Work
The United States is experiencing a shift in demographic trends, including an increase in cultural diversity. Demographers predict that the next two decades will bring racial and ethnic minority populations to a numerical majority in the United States (Sue & Sue, 1999). The reality is that, African Americans, American Indians, Alaska Natives, Asian Americans, Pacific Islanders, and Hispanic Americans accounted for 30 percent of the population in 2000 (U.S. Department of Health and Human Services, 2001). These population groups are projected to account for about 40 percent of the population by 2025 (U.S. Department of Health and Human Services, 2001). Recognizing these demographic changes, the social work profession has attempted to prepare for these population shifts. Through the years, there have been a number of initiatives and development of standards related to cultural diversity and practice. The professional responses have yielded mixed successes.
A RESPONSE FROM HIGHER EDUCATION
The academy has addressed cultural diversity in educational programs in social work through the creation of a series of policy statements that address the issue. The latest version of the Council on Social Work Education's (CSWE) Education Policy and Accreditation Standards (EPAS) states: "Social work programs integrate content that promotes understanding, affirmation, and respect for people from diverse backgrounds. The content emphasizes the interlocking and complex nature of culture and personal identity. It ensures that social services meet the needs of groups served and are culturally relevant. Programs educate students to recognize diversity within and between groups that may influence assessment, planning, intervention, and research. Students learn how to define, design, and implement strategies for effective practice with persons from diverse backgrounds" (2001, p. 10).
The latest standard moves beyond earlier versions of the EPAS that required schools and programs of social work to provide content related to cultural diversity throughout the curriculum. The new standard also requires that programs provide educational experiences in which the students develop practice skills for working with a culturally diverse population.
In response to the older versions of the EPAS, foundation textbooks and supplemental texts began to include content related to cultural diversity. However, a past content analysis of the professional literature found that the majority of the social work literature on cultural diversity was inadequate (McMahon & Allen-Meares, 1992).
On the other hand, Lum (1996) and Devore and Schlesinger, (1996), among a few, have attempted to help shape a professional practice response through writing about social work practice with culturally diverse populations. Pointing out that cultural groups have unique characteristics and needs and these factors should be taken into consideration in the assessment and intervention phases of social work practice, their scholarship contributed to the professional knowledge base in this area.
A RESPONSE FROM PROFESSIONAL PRACTICE
In an attempt to reinforce the importance of integrating cultural diversity in social work practice, the National Association of Social Workers (NASW) developed standards and policy statements that provide direction in this area. Under the direction of the National Committee on Racial and Ethnic Diversity, standards for practice from a cultural competence perspective were developed and adopted by the NASW Board of Directors in 2001 (NASW, 2001). These standards provide comprehensive definitions of culture, competence, and cultural competence and may be used as a foundation for professional practice.
The NASW Code of Ethics (2000) also provides guidance on multicultural practice. The Code states: "Social workers should understand culture and its function in human behavior, recognizing the strengths that exist in all cultures. …