Introduction
A 35-year-old Hispanic mother walks into a community agency near her home with her two toddlers in tow. A neighbor told her that the agency has low-cost, high-quality child care services and she would like to learn about the program. The brochures she sees are in English so she approaches a receptionist, who asks her in English to complete some paperwork. Seeing that the mother doesn’t understand her, the receptionist immediately asks a service provider who learned basic Spanish in college to come speak with her. The service provider briefly explains the paperwork to the mother and offers to call in a translator. The mother, unsure about what was said and worried that the translator represents someone official who may ask her difficult questions, takes the paperwork and thanks the service provider warmly. She leaves the agency and doesn’t return.
Scenarios like this are common across the US. Social service agencies are experiencing pressures related to cultural and linguistic diversity, though the challenge itself is not new. In the late 1980s, Cross and colleagues called on systems of care for children and families to improve their competence in serving diverse cultural groups. The resulting cultural competence movement has been strengthened by a growing recognition of the striking disparities in health and social outcomes across ethnic and racial groups, and a commitment by many in the public and private sectors to reduce these disparities. Yet over the past 25 years, health and social disparities have remained intractable and in some cases widened, even as the US population has become more diverse.
Poor health outcomes among some ethnic and racial groups are attributable to poverty and other socioeconomic stressors as well as to limited access to health and social services, high rates of attrition from services, low rates of follow up, and poor quality of care. Current evidence strongly suggests that prevalent models of health and social service provision, which largely reflect white, middle class values, do not effectively meet the needs of ethnically and racially diverse groups. Failure to properly address cultural differences creates and maintains mistrust and other potential conflicts between service providers and potential clients, further contributing to low quality of care and poor health outcomes. Thus, delivering culturally competent services remains a goal and a highly promising approach to promoting positive outcomes among racially and ethnically diverse groups and to ultimately reducing health disparities.
This brief provides an overview of cultural competence for organizations serving children and families from diverse ethnic and racial backgrounds. In reviewing the evidence and offering considerations for services, we focus primarily on the Hispanic population, though the information presented is relevant to services with all minority groups. Hispanics are expected to represent over 30% of the US population by the year 2050 and while the majority (~64%) originates from Mexico, the larger population represents various Spanish-speaking countries of origin throughout the Americas. Diversity is also seen in race (e.g., black, white, mestizo), ethnicity, socioeconomic status, language (e.g., various indigenous languages such as Mixtec) and patterns of immigration and regional settlement. At the same time, Hispanics are unified by a common culture characterized by traditional values of interdependence, especially familismo (an emphasis on family), dignidad (dignity) and respeto (respect). As we aspire to cultural competence in serving Hispanic and other ethnically diverse populations, our understanding and appreciation of culture must be steeped in recognition of potential differences at the individual and subgroup levels.