January 16, 2019 | PRA Culture, PRA Work | Kristin Lupfer We all talk about cultural competence. It is part of our professional development and values. But what does it mean and how do we really put cultural competence into practice? One way to operationalize cultural competence is by modifying Evidence-based Practices (EBPs). I am reminded how cultural differences can have an impact across the spectrum of services and experiences. A friend of mine was sharing a story about her son who has autism and how he was being assessed for progress in his development. He was being asked to identify objects in pictures and there was a picture of an iron. They are a busy family with two working parents and countless appointments for therapy and school, so they do not iron. They use wrinkle spray or just go with it. In a joking, but also serious way, the mother asked that the photo of the iron not be included in the evaluation. Whether someone irons or not seems fairly innocuous, but there are significant cultural differences that can impact the effectiveness of EBPs. For example, some cultures might consider visions a spiritual experience and others consider that same experience a hallucination and symptom of mental illness. Our approach and response to that experience can have a significant impact on the therapeutic relationship. On a much larger scale, as organizations, we can consider whether the EBPs that we are implementing are culturally appropriate and identify the potential need for cultural modification. Modifications can be made at the point of initial engagement to intervention, evaluation, and aftercare. There is a great resource available that walks providers through the process and provides helpful case examples: The Toolkit for Modifying Evidence-based Practices to Increase Cultural Competence. A table within the toolkit (page 19) demonstrates cultural factors and cultural variations: Cultural Factor Cultural Variation View of Mental Illness Holistic health view Does the culture recognize mental illness or consider it part of a holistic view of mind/body? Attribution What is the source of the mental health problems? Are they biological, magical, psychosocial, or a form of punishment? Degree of stigma Stigma reduces access to mental health care. The way stigma is demonstrated and its intensity may vary by culture. Social Positioning Discrimination Discrimination occurs when one group is given preferential treatment over another based on certain characteristics. Discrimination often takes the form of intentional exclusion from a location or activity. How this is experienced can vary by culture. Equality People may have different roles in their culture. It is important to consider equal treatment of people vs. equal status in a community. Stereotypes It is important to consider both the provider’s and consumer’s preconceived notions about the other’s culture, particularly in situations where there is a mismatch. For a summary of this toolkit, download the Modifying Evidence-based Practices to Increase Cultural Competence: An Overview from the Identity and Wellness section of the PRA Well-Being Resources page. The goal is to achieve the best possible outcomes for individuals while maintaining fidelity to the models implemented. What about the SOAR model have you adapted to meet the cultural needs in your community?