Ethics Alive! Cultural Competence, Awareness, Sensitivity, Humility, and Responsiveness: What's the Difference?

by Allan Barsky, J.D., MSW, Ph.D.

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     When the NASW Code of Ethics was revised (effective January 1, 2018), one change was to the title of Standard 1.05. The original title for this standard was “Cultural Competence and Social Diversity.” The revised title is “Cultural Awareness and Social Diversity.” So, one might ask, what is the import of this particular change in wording?         When speaking or writing about issues related to culture and social diversity, different social workers have favored different terms: cultural competence, cultural awareness, cultural sensitivity, cultural humility, and cultural responsiveness. This article compares and contrasts these terms, showing how each may provide useful guidance in determining how to work with diverse clients and communities in an ethical manner. Although I chaired the task force that proposed revisions for the NASW Code of Ethics, I am not speaking on behalf of the NASW or the task force. This article reflects my own opinions and suggestions. I hope others will continue the conversation by submitting comments and engaging colleagues in further discussion.

Cultural Competence

    Within the field of social work, cultural competence refers to the ability to practice social work “in a manner that recognizes, affirms, and values the worth of individuals, families, communities, and protects and preserves the dignity of each” (National Association of Social Workers, 2015, p. 13). More generally, the term competence suggests that social workers should possess a certain set of knowledge, skills, and values. Standard 1.05(b) of the NASW Code of Ethics suggests:

Social workers should have a knowledge base of their clients’ cultures and be able to demonstrate competence in the provision of services that are sensitive to clients’ cultures and to differences among people and cultural groups.

    Building on the Code of Ethics, Standard 3 of the NASW’s (2015) Standards and Indicators for Cultural Competence in Social Work Practice suggests that social workers should have and develop ongoing knowledge about

...the history, traditions, values, family systems, and artistic expressions such as race and ethnicity; immigration and refugee status; tribal groups; religion and spirituality; sexual orientation; gender identity or expression; social class; and mental or physical abilities of various cultural groups.

    For some people, the notion of cultural competence may come across as arrogant. How could I be fully competent in another person’s culture? Does reading a textbook or taking a course on a client’s culture make me competent? For others, competence is seen as a process rather than an outcome. I continuously strive to develop the knowledge and skills that I need to work effectively with people from a particular culture. When working with clients, I can further develop my competence by learning from them.

Cultural Awareness

    Cultural awareness refers to being mindful or conscious of similarities and differences between people from different groups. Cultural awareness includes being aware of issues related to power, privilege, and oppression. To employ cultural awareness in practice, social workers need to be aware of their own cultural characteristics (values, worldviews, language, belief systems, traditions, norms), as well as those of the people they are serving. Without self-awareness, social workers risk imposing their values, beliefs, and judgments on clients (Maschi & Leibowitz, 2018). Social workers should be particularly aware of the interplay between culture and the concerns for which clients are seeking help. If a client is experiencing depression, for instance, social workers should be aware of the cultural meaning of depression, what types of interventions are culturally appropriate, and what types of support are culturally appropriate.

    On its face, the term cultural awareness does not seem to require social workers to act in a particular manner, but rather to merely to be aware of cultural issues. The concept of awareness is used in Standard 1.05(d) of the Code of Ethics:

Social workers who provide electronic social work services should be aware of cultural and socioeconomic differences among clients and how they may use technology.

    When social workers use the term cultural awareness, they are often referring to practicing with cultural awareness. Accordingly, cultural awareness is not just about being aware, but incorporating this awareness in the way social workers engage, assess, and work with clients, organizations, communities, and policy processes.

Cultural Sensitivity

    Cultural sensitivity is similar to cultural awareness in that both terms require consciousness of cultural issues affecting practice. The term sensitivity is used in Standard 1.05(b), quoted earlier. Some might argue that cultural sensitivity goes beyond awareness, requiring a deeper understanding and ability to apply this understanding to one’s practice. For example, I am not only aware of discrimination against the African American community; I also understand how discrimination may be affecting the community, and I adjust the way I work to take these effects into account. Being culturally sensitive implies that social workers are not only aware of differences, but they are respectful and accepting of the difference. They do not judge differences as good or bad. They strive to understand differences from an emic, within culture, perspective. Accordingly, if I am working with a woman who wears a hijab or headscarf, I strive to consider the meaning of the hijab or headscarf from my client’s cultural and individual perspectives, rather than from an outsider’s perspective.

Cultural Humility

    Cultural humility suggests that social workers should not view themselves as experts in other people’s cultures but as learners. By acknowledging that I do not know everything about another person’s culture, I am showing respect and I am opening my heart and mind to learning. When I am working with Blind clients, for instance, I treat these clients as experts in their own lives, including their experiences in and perspectives about Blind culture. I acknowledge that I do not understand Blind culture in the same sense as my clients, and I value the opportunity to learn from them (National Association of Social Workers, 2015). Similar to cultural awareness and cultural sensitivity, cultural humility requires reflection and self-awareness. To avoid making assumptions about another person’s culture, I need to be aware of ways in which that culture affects my own language, beliefs, values, and so on.

Cultural Responsiveness

    Cultural responsiveness means being aware of cultural factors and responding to them in an appropriate manner. Culturally responsive social workers include culture as part of their biopsychosocial assessments. They also tailor their interventions to take the client’s culture into account. As with the other approaches to culture, cultural responsiveness suggests that social workers demonstrate respect, build on the strengths of the culture, and attend to clients in the contexts of their social environments, including culture.

Which One?

    So, which term is the best one to guide social work practice? I’m not so sure that we have to choose between terms. Rather, we can seek to understand these terms in a manner that highlights the strengths of each. As social construction theory notes, the meanings that we attach to particular words are socially constructed. We could define cultural competence, for instance, in a manner that suggests social workers can be all-knowing and can know more than their clients about what is good for them. Alternatively, we could define cultural competence as having values, knowledge, and skills that embrace cultural humility, awareness, sensitivity, and responsiveness.

    Using this construction of cultural competence, social workers should strive to develop their knowledge and skills, so they can work effectively with people from diverse cultures. Although they may gain knowledge and skills from taking courses and reading books and articles, they also gain knowledge and skills from working directly with clients.

    Integrating cultural competence and cultural humility, social workers acknowledge that each client’s experience of culture is unique. Social workers can have some knowledge about a client’s culture and treat the client as the expert in the helping relationship. Similarly, social workers can integrate cultural awareness, sensitivity, and responsiveness by raising self-awareness, attending to cultural differences and similarities, and ensuring that their assessments and interventions respond to the cultural strengths and needs of the people they are serving.

    Social workers and clients work together as partners in the helping process. Social workers focus on helping clients achieve their own goals, including goals that are culturally informed.

    Many books and articles have been written about cultural competence, awareness, sensitivity, responsiveness, and humility. Different scholars and practitioners are proponents of different terms and ways of approaching culture in practice. I suspect the vigorous debate over which terms and approaches are preferable will continue. Despite the controversies, the profession of social work can unite around its core principles: service, respect for the dignity and worth of all people, social justice, competence, integrity, and human relationships. Regardless of what we call our approach to working with and for people of different cultures, we can fulfill our mission by implementing these values throughout our work.

    As Shakespeare wrote in Romeo and Juliet, “A rose by any other name would smell as sweet.”

References

Maschi, R., & Leibowitz, G. S. (Eds.). (2018). Forensic social work: Psychosocial and legal issues across diverse populations and settings. New York, NY: Springer.

National Association of Social Workers (NASW). (2015). Standards and indicators for cultural competence in social work practice. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=PonPTDEBrn4%3D&portalid=0

National Association of Social Workers (NASW). (2018). Code of ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Allan Barsky, Ph.D., J.D., MSW, is Professor of Social Work at Florida Atlantic University and author of Social Work Values and Ethics (Oxford University Press).

The views expressed in this article do not necessarily represent the views of any of the organizations to which the author is affiliated, or the views of The New Social Worker magazine or White Hat Communications.