The Elements of Cultural Competence

Cross et al.'s (1989) definition of cultural competence emphasizes three crucial issues for professionals who want to become culturally competent: 

• Cultural competence includes knowledge, behaviour and attitudes - not simply knowledge
• Cultural competence is a skill which needs to be expressed in behaviour as the capacity to function effectively in inter-cultural contexts - not simply knowledge and awareness
• Cultural competence extends beyond individual professional behaviours and includes organisations and systems - a culturally incompetent system can undermine the work of culturally competent professionals

Weaver (1999:218) argues that: 'most models of cultural competence consist of qualities that fall under the general components of knowledge, skills, and values... The three components of cultural competence are interactive, and none is sufficient in and of itself to bring about appropriate practice. Striving for cultural competence is a long-term, on-going process of development'.

Because of this dynamic interaction, to try to break down cultural competence into its elements is largely an artificial exercise. It follows, then, that developing cultural competence is more complex than completing a series of training sessions, ticking a series of boxes and claiming at the end that one is culturally competent. Nevertheless, it is useful to unpack the elements and place them in a systematic sequence to provide a guiding structure for the development of cultural competence. The following depiction of cultural competence in relation to Indigenous Australians is based on that published in by McConnochie and Nolan (2008:192-193).

There is widespread agreement within the literature that the development of cultural competence is a continuous process, not a single event. As Campinha-Bacote (2005:1) notes: 'Competence is a process, not an event; a journey, not a destination; dynamic, not static; and involves the paradox of knowing'.

Marcia Wells (2000:192) developed a model based on Cross et al.'s (1989) conception of cultural competence as a continuum. Her model places the elements of cultural competence (knowledge, attitudes and skills) in a developmental framework with the following sequence of stages along a continuum from cultural incompetence to cultural proficiency:

• Cultural incompetence: Lack of knowledge of the cultural implications of health behaviour
• Cultural knowledge: Learning the elements of culture and their role in shaping and defining health behaviour
• Cultural awareness: Recognizing and understanding the cultural implications of behaviour
• Cultural sensitivity: The integration of cultural knowledge and awareness into individual and institutional behaviour
• Cultural competence: The routine application of culturally appropriate health care interventions and practices.
• Cultural proficiency: The integration of cultural competence into one's repertoire for scholarship (e.g., practice, teaching, and research). At the organizational level, cultural proficiency is an extension of cultural competence into the organizational culture. For the individual and the institution, it is mastery of the [five preceding] phases of cultural competence development."

Indigenous Australian Studies provides contextual foundation for integrated discipline specific Indigenous content in remainder of program.

Developmental model of cultural competence

click on the image to view a larger version of the model

Suggested guidelines for the inclusion of Indigenous content across courses

Developed by Ranzijn, R., McConnochie, K., & Nolan, W. (2007)

Combining the six steps below with the six stages of Wells's (2000) cultural competence continuum produces a matrix which can be used to guide the development of cultural competence. The matrix encompasses many levels of experience, from beginning higher education studies through to practitioners who may have been working in the field for many years. The model outlines a process or journey which commonly (but not necessarily, depending on experience) begins at the bottom left hand corner (in the case of people who are culturally incompetent), and progresses towards the upper right hand corner (however, note the earlier comments about the need to re-visit the basics).

Any particular person could be located at any point in the matrix, or indeed at a number of points simultaneously, not necessarily on the arrow. In fact, it is unlikely that someone would be located right on the arrow, since people are likely to be at different levels of cultural competence depending on which content area they are proficient in. For instance, someone may be high on cultural proficiency in their generic understanding of culture while at the same time being culturally incompetent in the area of critically examining their profession.

This model has some important implications:

1. The process is sequential and cumulative – each stage builds on the previous stage as individuals move through this sequence. Developing cultural competence needs to build on a solid foundation of knowledge and understanding of culture, including one's own culture, and this then provides the framework for understanding Indigenous cultures.
2. This sequence is unlikely to be a single straight line for any particular individual, since everyone is likely to be at a different stage in knowledge, understanding and skills.
3. One-off case studies or lectures are unlikely to cover this range of understandings and skills. The process necessarily needs to extend over time, both in order to cover the range of understandings needed, but also to allow time for individual reflection and review.

click on the image to view a larger version of the model

Toward an Inclusive Curriculum:
Incorporating Indigenous Australian Content in Undergraduate Programs

"[T]he AVCC accept[s] the principle that all Australian higher education students [should] receive some understanding of Indigenous knowledge systems, cultures and values as an integral part of their studies. There are tangible benefits to be obtained in greater numbers of students gaining an understanding of Indigenous issues. The implementation of this principle will provide a sound basis for equipping all students with some generic skills for living in our society"

Australian Vice Chancellor's Submission to the Higher Education Review (2002:38).

Universities in Australia have been educating professionals for over 100 years. The education provided by Universities has shaped the thinking and practices of generations of professionals who have played a significant role in structuring relationships between Indigenous Australians and the broader society, including advising colonial and contemporary governments, authorities and professional bodies on policy and practice, constructing and legitimating societal values and attitudes, and providing professional services to Indigenous peoples.

The National Best Practice Framework provides a guide to the implementation of Indigenous Cultural Competency in the Australian higher education sector.

As the institution responsible for educating the next generation of professionals across a range of disciplines, Charles Sturt University has a significant role in shaping the culture, paradigms and practices of those professions. Charles Sturt has a major responsibility to provide the next generation of professionals with knowledge and understanding of Indigenous cultures, histories and contemporary contexts and equip graduates with culturally appropriate skills and strategies to prepare them for working effectively with Indigenous clients and/or communities. This education should engage students in a critical inquiry into the nature of their profession - its history, assumptions and characteristics, its role in structuring Australian society,  and its historical and contemporary engagement with Indigenous communities and Indigenous people. These professional characteristics need to be examined and understood if professionals are to develop an understanding of the social and political contexts of Indigenous people's lives and communities and the roles of the professions in shaping those contexts to become agents of change.

The inclusion of Indigenous content into all Charles Sturt undergraduate programs offered by Charles Sturt University has the power to change the nature of Australian society and the quality of service provision provided to Indigenous Australians. The systematic and systemic inclusion of Indigenous Studies provides Charles Sturt with the opportunity to define itself as a leading institution in Indigenous Education and a significant agent for social change and ethical practice in contemporary Australian society. The implementation of policy ensuring that all graduates are provided with the opportunity to develop knowledge, skills, motivation and confidence to be able to work professionally with Indigenous people and communities provides Charles Sturt with the foundation upon which to set this higher education institution apart from other universities, being second only to the University of South Australia in implementing such policy.

Content of cultural competence training

What should be included in cultural competence training? A focus group convened to identify the skills and attributes that Indigenous Australians and various employer groups argued should attain provided detailed suggestions for the content of training.

Mapping the Development of Cultural Competence

The main issues arising from the focus group were:

• The lack of awareness amongst professionals about Indigenous clients, cultures and contexts,
• The absence of specific skills and strategies for working in Indigenous contexts
• The culturally specific nature of the assumptions and practices of professions and agencies
• The failure of the professions to engage in broader issues of justice and human rights - including an advocacy role and a role for the professions in developing understanding of, and strategies for challenging prejudice, ethnocentrism and racism
• 'The need for individuals to be aware of their own values, assumptions and expectancies, and how these impact on their interaction with Indigenous clients and communities' {Ranzijn, 2007:25)

In the area of understanding Indigenous cultures, histories and communities, the group thought that the content should include:

• The basis of Indigenous spirituality and belief systems
• The sources and contemporary characteristics of families and family structures.
• Relationships with land and the interconnectedness of land, family and spirituality.
• The diversity of concepts of identity - different concepts of identity across cultures
• The importance of understanding the impact of historical processes
• The impact of historical processes on identity (colonialism, institutionalization, discrimination, stolen generations etc.)
• Community and individual responses to colonialism
• The broad characteristics of contemporary Indigenous communities,
• An awareness of relevant social indicators
• Relevant national and international legislation and obligations 

Finally, the group felt that exploring the nature of the profession should include:

• Critically exploring the major paradigms of professions and the impact of these paradigms on how the profession impacts on clients from diverse backgrounds.
• Analysing the extent to which professional activities are structured around un-recognised assumptions which are culture specific and recognise the need for the profession to identify and question these assumptions
• Exploring issues of power relations within a range of contexts, including researcher/researched contexts, client/practitioner contexts and more general issues about cultural dominance
• Examining the extent (or lack) of engagement of their professions in broader social/political issues as a significant issue
• Examining personal values and belief systems within a context which is both supportive and challenging

These points can be grouped into six categories, two for each of the three main attributes of cultural competence, namely, knowledge (steps 1 and 2 below), values (steps 3 and 4), and skills (steps 5 and 6). Developing cultural competence in relation to Indigenous Australians in a thorough and comprehensive manner involves progressing more or less in the following sequence from basic knowledge through to professionally specific skills:

1. Obtaining a generic understanding of the nature and significance of culture
2. Obtaining a general understanding of Indigenous cultures, histories, contemporary societies and issues
3. Exploring individual and societal values and attitudes (Individual, institutional and cultural racism).
4. Critically examining the nature of one's profession or occupation
5. Developing generic skills for working in Indigenous contexts
6. Developing professionally specific skills for working in Indigenous contexts
   

Brief literature review of pedagogy in Indigenous cultural competence

http://www.indigenousculturalcompetency.edu.au/downloads/LiteratureReview.pdf
http://www.indigenousculturalcompetency.edu.au/html/Resources.html#lit

There are many possible definitions of cultural competence. Tracy Westerman, an Aboriginal psychologist from Western Australia who is working to raise awareness about the need to be culturally competent when working with Indigenous Australians, comments that, 'cultural competence is about the ability of practitioners to identify, intervene and treat mental health complaints in ways that recognise the central role that culture plays in mental illness' (Westerman, 2004, p. 2).

The Australian literature on cultural competence and the incorporation of Indigenous Australian content into university degree programs does not have a long history. There was a steady trickle of literature discussing Indigenous content in University courses from the 1970s to the mid-1990s focusing on two linked issues: how to improve the enrolment and retention of Indigenous students in university courses, (e.g. see Schwas, 1995) and the inclusion of Indigenous content in teacher education programs, with the specific intent of developing the awareness and skills to enable teachers to teach Indigenous Studies in primary and secondary schools  (Craven, 1997). 

In general this earlier literature does not specifically address the inclusion of Indigenous Studies for non-Indigenous students across professional areas. By the mid-1990s the literature began developing, with some identifiable new threads emerging. Staff within a few universities began exploring the position of Indigenous knowledge systems and possible strategies to improve the representation of these knowledge systems across their universities (Anderson, Singh, Stehbens, & Tyerson 1998; Collard, Walker, & Dudgeon 1998; Lampert, 1996; Lampert & Lilley, 1996; Harris & Malin, 1997; Morris, 1999).

At the same time academics began reporting on their experiences of attempting to incorporate Indigenous content within specific disciplines and professions, including education (Craven, 1997); law (Clarke & Orford, 1998; Carpenter, Fields & Barnes, 2004) ; health and nursing (Hardy, Miller, Stewart, & Lewin, 1998; Harkin, Newbury, Henneberg, & Hudson, 2000; Morris, 1999; Phillips, 2004a); and psychology (Altman, 1996; Riggs, 2004; Sonn, 2004; Sonn, Garvey, Bishop, & Smith, 2000).

From 2000 onwards the literature began elaborating, exploring the emergence of a debate around theoretical frameworks concerning relationships between Indigenous and western knowledge systems (Dodson, 2000; Forrest, 2000; McConaghy, 2000; Nakata, 2002, 2004) and the pedagogical difficulties associated with teaching required Indigenous content to non-Indigenous students, particularly exploring issues of  resistance and hostility, and strategies to overcome these issues (Altman, 1996; Bin-Sallik, 2003; McConaghy, 2003; Nomikoudis, 2002;  Sonn, 2004; papers from Tertiary Aboriginal Studies Conference 2000). The establishment of policy statements by universities, professional bodies and accrediting agencies requiring the inclusion of Indigenous content within professional programs has been a feature of this literature over the last few years.

Within this literature a number of issues are apparent. The ongoing success of initiatives to introduce required Indigenous Studies content in Australian university programs has been significantly reduced by:

• A lack of serious institutional commitment, either at a policy level or to the commitment of adequate resources to achieve the goals established;
• A dependence on the good-will and motivation of individual staff, rather than a commitment to appointing staff with specific expertise in these areas;
• A dependence on Indigenous units within universities to carry responsibility for the development and teaching of this Indigenous content-responsibilities for which Indigenous units may not be adequately resourced or staffed  to undertake;
• A lack of commitment by many academic staff (and in some cases resistance from staff) across professions and disciplines to the development and incorporation of Indigenous content; and
• A lack of well-established curriculum and pedagogical guidelines.

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Previously Charles Sturt University led Cultural Immersion experiences to Ngiyeempaa country in Menindee in western NSW, to advance an institution-wide transition from Indigenous cultural awareness to cultural competence.

The objective of this journey was to give staff the experience of being connected to Country, of learning about First Nations culture from First Nations people and of reflecting upon their professional practice in light of this. On this four-day camp, participants would sit with Ngiyeempaa Elder Aunty Beryl Yungh a dhu Philip-Carmichael, to listen and learn cultural ways and forms of respect. Dr Barbara Hill, the previous Academic Lead (First Nations Curriculum) said,

"The experience of participants at Menindee affirms that social justice and reconciliation are at the heart of efforts by the University to produce an institution-wide transition that will foster and ensure increasing Indigenous student recruitment, retention and completion of its courses."

Since its inception in 2010, more than 100 academic, executive and senior University staff have traveled on this journey. These included former Vice-Chancellor, Professor Andrew Vann, early in his tenure in 2012, and before him, former Vice-Chancellor, Emeritus Professor Ian Goulter, in 2011.

A final word

Writing of his Menindee experience, former Charles Sturt Vice-Chancellor Professor Andrew Vann gratefully acknowledged Aunty Beryl and her family's hospitality, and looked forward to returning. He noted the Ngiyeempa tradition of story telling to transmit law and expectations, and reflected on what universities can draw from that at a time of significant change.

'It seems to me that in the contemporary university we have a critical need to nurture a sense of shared culture owned by all parties and to retain a sense of agency in the face of what is admittedly a very competitive environment,' he wrote. 'I think there might be things to learn from Indigenous cultures.'

Author: Bruce Andrews

Read more about the Menindee cultural immersion experience in:

Barbara Hill and Jane Mills (2012), 'Situating the 'beyond': Adventure-learning and Indigenous cultural competence', in Discourse: Studies in the Cultural Politics of Education, DOI:10.1080/01596306.2012.698864