You're Doing It Wrong: The evolution of cultural competence | Raquel Martin | TEDxRutgersCamden

Summary

The speaker passionately critiques the ineffectiveness of current diversity and cultural competency trainings, which they argue often reinforce stereotypes rather than combat biases. They highlight the importance of experiential learning and continuous engagement with diverse communities to truly understand and address racism and prejudice. The speaker shares personal experiences as a black woman and professional in academia and healthcare, emphasizing the need for trainings to address the root causes of discrimination and to promote a more inclusive and understanding society.

Takeaways

• 😔 The speaker expresses frustration with diversity trainings that reinforce stereotypes rather than fostering anti-racism and cultural competency.
• 🌟 Cultural competency is not an achievable goal but a continuous journey that requires experiential learning and engagement with diverse groups.
• 📈 The speaker highlights the negative impacts of poor cultural understanding in various professional roles, including academia, healthcare, and mental health.
• 🔍 The historical context of 'cultural competence' is important, emphasizing the need for ongoing learning and interaction with different cultures, not just academic knowledge.
• 🏥 In healthcare, biases can lead to misdiagnoses and unequal treatment, with black patients experiencing higher mortality rates and less access to standard treatments.
• 👨‍⚕️ The speaker recounts an incident where a training session for black youths inappropriately used a scene of police brutality, illustrating a lack of cultural sensitivity.
• 📚 Data is shared to humanize the experiences of black individuals, showing how poor cultural confidence can lead to disparities in education and healthcare.
• 🚫 The speaker criticizes the tokenistic approach to diversity trainings, which often occur once a year and lack follow-up or meaningful engagement.
• 🌱 The roots of racism and oppression need to be addressed in trainings, not just the symptoms, to truly improve the human experience.
• 🌈 A comprehensive approach to diversity training should include discussions on intersecting identities and involve a variety of resources and formats to foster understanding.

Q & A

What is the speaker's main concern about the diversity trainings they have attended?

The speaker is concerned that the diversity trainings they have attended often reinforce stereotypes rather than providing effective ways to address biases and practice anti-racism, cultural competency, and diversity.

Why does the speaker feel that the current approach to diversity training is a waste of time?

The speaker feels that the current approach is a waste of time because it lacks experiential learning, follow-up, and meaningful engagement, instead focusing on one-time, mandatory trainings that do not lead to tangible improvements in cultural understanding or behavior.

What does the speaker believe is the true meaning of cultural competence as proposed by Dr. Daryl Wing Sue?

According to the speaker, Dr. Daryl Wing Sue proposed that cultural competence is not about being fully versed in a group of people but rather about engaging in experiential learning and interacting with people from different walks of life as human beings.

How does the speaker describe the impact of poor cultural competence on their various roles?

The speaker describes the impact of poor cultural competence as significant across their roles as a professor, scientist, licensed clinical psychologist, and a black woman in America, where they witness the effects of racism, bias, and lack of cultural understanding in academia, healthcare, and personal experiences.

What is the significance of the movie 'Crash' scene in the context of the training session mentioned by the speaker?

The speaker highlights the movie 'Crash' scene as an example of poor cultural competence in a training session aimed at teaching distress tolerance to black youths. The scene's depiction of police brutality reinforces negative stereotypes and is inappropriately used to induce stress.

Why does the speaker argue that cultural competence should not be treated as an achievable goal?

The speaker argues that treating cultural competence as an achievable goal is misguided because it implies a finish line, whereas it should be an ongoing journey of learning and engagement with diverse cultures and experiences.

What are some of the disparities the speaker mentions in the healthcare system affecting black patients?

The speaker mentions several disparities in healthcare, including higher mortality rates for black patients with heart disease, cancer, and HIV/AIDS, less likelihood of receiving gold standard treatments, and the ineffectiveness of medical devices like pulse oximeters for individuals with dark skin pigmentation.

How does the speaker connect the patient's experience of imposter syndrome to broader societal issues?

The speaker connects the patient's experience of imposter syndrome to broader societal issues by suggesting that it could be a result of stereotype threat, which is stress and anxiety that arises from the fear of conforming to negative stereotypes attributed to one's racial or ethnic group.

What does the speaker suggest as a way to improve cultural competence trainings?

The speaker suggests improving cultural competence trainings by including a variety of information sources, addressing intersecting identities, engaging in meaningful conversations, setting tangible goals, and focusing on the roots of racism and bias rather than just the symptoms.

Why does the speaker emphasize the importance of authenticity and how is it connected to cultural competence?

The speaker emphasizes the importance of authenticity because it is a privilege that can be perceived as a threat due to racial bias. Authenticity is connected to cultural competence as it involves understanding and respecting individuals' true selves, which includes their racial and cultural identities.

Outlines

00:00

📚 The Frustration with Ineffective Trainings

The speaker expresses exhaustion and frustration after attending a training session, which they feel has reinforced stereotypes rather than addressing biases and promoting anti-racism. They lament that such trainings, despite being prevalent, often fail to provide practical ways to improve the human experience. The speaker's personal offense stems from witnessing the negative impact of poor cultural understanding in various roles they hold, including as a professor, scientist, and licensed clinical psychologist. They highlight the importance of experiential learning over academic training and criticize the tokenistic approach to diversity trainings that occur annually, often in February, without any follow-up or meaningful engagement.

05:00

🚑 The Consequences of Cultural Incompetence

This paragraph delves into the detrimental effects of cultural incompetence, particularly in the fields of education and healthcare. The speaker shares data showing that black students are more likely to be suspended from school and black patients are at a higher risk of mortality due to disparities in treatment. They also discuss the bias in medical device effectiveness, such as pulse oximeters, and the historical roots of racial disparities in medicine. A therapeutic scenario is presented where a black woman's struggle with imposter syndrome is mishandled due to the clinician's lack of understanding of the patient's cultural context and experiences.

10:00

💔 The Impact of Racism and Stereotype Threat

The speaker emphasizes the importance of addressing the root causes of racial stress and difficulties, using the metaphor of a tree to illustrate the concept. They discuss the idea of stereotype threat, which affects the performance of individuals from stereotyped groups, and how it can lead to increased mistakes and stress. The paragraph also touches on the broader implications of racism, including the weaponization of black individuals' appearances and the need for legislation to protect against hair discrimination. The speaker calls for a deeper, more uncomfortable examination of the roots of these issues rather than focusing solely on the symptoms.

15:02

🌟 Cultivating Cultural Competence and Tangible Change

In the final paragraph, the speaker calls for a shift in the approach to cultural competence training, advocating for a more engaged and ongoing process rather than a one-time event. They stress the need for varied forms of information and narratives to foster a deeper understanding. The speaker also discusses the importance of addressing discomfort and challenging biases, and the necessity of setting tangible goals and metrics for creating a less oppressive environment. They conclude by emphasizing that cultural competence is not a finish line but a lifelong journey, and that improving the human experience requires understanding and addressing the roots of racism.

Keywords

💡Cultural Competence

Cultural competence refers to the ability to interact effectively with people from different cultural backgrounds. In the video, it is discussed as an essential skill that is often misunderstood or inadequately addressed in diversity trainings. The speaker criticizes the superficial approach to cultural competence, emphasizing the need for experiential learning and genuine engagement with diverse communities, rather than just academic or cognitive understanding.

💡Stereotypes

Stereotypes are generalized and often oversimplified ideas about a particular group of people. The video script highlights the speaker's frustration with trainings that reinforce stereotypes instead of challenging them. Stereotypes are depicted as harmful constructs that can lead to biases and discrimination, affecting areas such as education, healthcare, and the workplace.

💡Bias

Bias refers to a prejudice or inclination, often unconscious, that favors or discriminates against a particular person or group. The script discusses how biases can significantly impact various aspects of life, such as patient care in healthcare and the experiences of students in academia. The speaker argues for the necessity of addressing and mitigating biases to improve cultural understanding and inclusivity.

💡Racism

Racism is the discrimination and prejudice against people based on their race or ethnicity. The video script uses personal and professional experiences to illustrate the pervasive impact of racism. It is highlighted as a root cause of many of the issues discussed, such as the over-suspension of black students in schools and the misdiagnosis of black patients in healthcare.

💡Oppression

Oppression is the unjust or cruel exercise of authority or power. The speaker in the video uses the term to describe the systemic and societal forces that marginalize certain groups, leading to stress and anxiety. The concept is explored in the context of healthcare, where black patients may experience less empathetic treatment, and in the workplace, where black individuals may face discrimination.

💡Cultural Humility

Cultural humility is an approach to engaging with people from different cultures that acknowledges one's own limitations and biases. It is contrasted with cultural competence in the video, where the speaker argues for a more humble and ongoing learning process rather than a fixed state of being competent. Cultural humility involves recognizing and addressing power imbalances and being open to learning from others.

💡Experiential Learning

Experiential learning is a process through which knowledge is created through experience and reflection. The video script advocates for experiential learning as a more effective way to achieve cultural competence than traditional training methods. It is suggested that engaging with diverse communities and reflecting on those experiences can lead to deeper understanding and personal growth.

💡Diversity Training

Diversity training refers to educational programs designed to promote understanding and respect for diversity in the workplace and other settings. The script critiques the effectiveness of such trainings, suggesting that they often fail to produce meaningful change. The speaker calls for a reevaluation of these trainings to ensure they address the root causes of discrimination and偏见.

💡Stereotype Threat

Stereotype threat is the anxiety or fear of confirming negative stereotypes about one's group. The video discusses how stereotype threat can lead to stress and underperformance, particularly for black individuals who may feel they need to constantly disprove stereotypes about their intelligence or abilities. The speaker uses this concept to explain the challenges faced by black patients and professionals in various settings.

💡Authenticity

Authenticity in the context of the video refers to the genuine expression of one's identity, including aspects such as skin color, hair, and cultural practices. The speaker argues that authenticity is a privilege for marginalized groups, as their natural expressions can be perceived as threats or subjected to discrimination, such as through hair-based bias in the workplace and schools.

💡Intersectionality

Intersectionality is the interconnected nature of social categorizations such as race, class, and gender, and how these interact to create specific modes of discrimination and privilege. The video script touches on the importance of considering intersecting identities in diversity trainings to fully address the complexities of individuals' experiences and the various forms of oppression they may face.

Highlights

Feeling of exhaustion and frustration after diversity trainings that fail to address biases effectively.

The prevalence of trainings that double down on stereotypes rather than fostering anti-racism and cultural competency.

The importance of acknowledging and addressing the impact of power, prejudice, and privilege in society.

Personal offense taken to subpar cultural understanding and its impact on various roles, including professor and scientist.

The role of cultural competence in healthcare and its failure to improve patient outcomes for black patients.

The historical context of cultural competence and its true meaning as coined by Dr. Daryl Wing Sue.

The inadequacy of mandatory trainings that lack follow-up and experiential learning.

The harmful decision-making in mental health practices due to poor cultural competence.

Data on the disproportionate impact of poor cultural confidence on black boys and girls in schools.

The 'unequal treatment' report revealing higher mortality rates for black patients due to racial disparities in healthcare.

The medical device disparity affecting the accuracy of pulse oximeters for black patients.

The dominance of certain communication styles by doctors with black patients, limiting their treatment options.

The historical roots of medical practices, such as J Marion Sims' unethical experiments on enslaved women.

The therapeutic process failure due to not addressing the roots of racism-related stress.

The concept of stereotype threat and its impact on the performance of black individuals.

The need to address the roots of racism in diversity trainings rather than just the symptoms.

The importance of varying the forms of information and narratives in cultural competence trainings.

The necessity of tangible goals and metrics for achieving cultural competence in organizations.

The myth of colorblindness and its implications for addressing racism effectively.

The lifelong journey of cultural competence and the need for continuous improvement in understanding and practice.

Transcripts

last week I walked out of a training

from my colleagues feeling a sense of

exhaustion and frustration

and this is not the first time I have

felt this way

when I leave these trainings I typically

feel like they have doubled down on

stereotypes rather than providing me

with ways to address my biases and

practice anti-racism

cultural competency and diversity

trainings are so prevalent these days

and they should be as we venture to a

space of acknowledging addressing and

understanding the impact that power

Prejudice and privilege has on this

world and all those that reside in it

however the truth is

typically when I attend these trainings

I find them to be a waste of my time

and that is heartbreaking to me because

we are worse off due to these poor

trainings that do not provide us with

ways to improve The Human Experience

I take personal offense to these

lackluster trainings because in the many

roles that I hold I see the impact that

subpar cultural understanding

limited cultural humility

and outdated cultural knowledge has on

the world

I see the impact as a professor

when my students come to me and share

that once again they have been Val

invalidated and the victims of racism by

my colleagues in Academia

I see the impact as a scientist when I

look at statistic after statistic

regarding the number of black patients

and patients of the global majority that

feel seen when they visit their doctors

these patients are significantly more

likely to be misdiagnosed because the

biases that their doctors hold impact

their ability to do an appropriate

assessment and do their job

I see the impact as a licensed clinical

psychologist when I work with patient

after patient after patient

regarding ways to deal with the impact

of Oppression that they experience

in the workplace

in their neighborhoods

and sometimes in their own families

and I see the impact as a black woman in

America who often has to convince others

that I am not a threat simply because of

the color of my skin

or the fact that my hair defies gravity

I see the impact every day

you know so many people attempt to teach

about cultural competence and the role

of cultural competence without

understanding the history behind the

term

did you know that when professor in

psychologist Dr Daryl Wing Sue coined

the phrase cultural competence he stated

that it is not possible to be fully

versed on a group of people in your

lifetime

it's true he actually stated that it is

more important to have experiential

learning to engage with people that

don't look like you who from different

walks of life as human beings than it is

to focus on

the academic trainings the cognitive

understanding that so many of these

diversity trainings seek to embody

but that's not really how we're taught

cultural competence is it

every year we are mandated to go to at

least one mandatory training most of the

time it is in February

we all know why it is typically in

February

and then we see a speaker

we watch a webinar we check off a box we

get the certificate and too often the

education ends there

no afterthought no follow-up no

experiential learning

and that was never how it was meant to

be

when we treat cultural competence like

an achievable goal like a Finish Line to

be crossed we completely missed the mark

and we do Injustice to all those that

will be significantly impacted by our

ignorance

by our insensitivity

and by our inconsideration

I unfortunately have witnessed many

incidents of poor cultural competence

but one that always sticks with me

was during a panel a planning session

between licensed clinical psychologists

the purpose of the session was to

identify ways to teach distress

tolerance to a group of black youths

we typically do this by stimulating some

form of stress that is deemed reasonable

and then allowing the children to

practice their coping skills in a safe

environment this is typically done by

showing a scary movie clip but this year

a psychologist proposed that they

changed the scene to a scene from the

movie Crash

which depicted beliefs police brutality

the offenders were European American

police officers and the victims were a

black couple

I want you to think of how abominable a

decision it was

for licensed mental health professionals

whose job it is to contribute to the

mental healing of youths

to decide that showing

of seeing that depicted police brutality

would create what is deemed as a

reasonable amount of distress

and black youths

I often wonder what contributes to these

poor decision making especially among

licensed mental health professionals

I believe it happens because the way we

seek to understand and learn more about

individuals from diverse backgrounds and

cultures is limited to zoom meetings

and workshops

and webinars

I want to share some data with you so I

can fully help you understand and

humanize the experience

of what poor cultural confidence

contributes to

black boys and girls are respectively

three and six times more likely

to be suspended from school

then their European American peers for

displaying the same behaviors

in 2003 The Institute of medicine

published a 700 page document entitled

unequal treatment

this revealed that

black patients have a higher mortality

rate

when it comes to heart disease

cancer and HIV and AIDS than any other

U.S racial or ethnic group and this

disparity is not due to differences in

access to care in fact at equivalent

levels of access to care Black and

Hispanic patients are significantly less

likely to receive gold standard

treatments

that are known to treat medical

disorders including heart attacks

there's even disparity in the

effectiveness level of medical apparati

pulse oximeters are used every single

day and hospitals to measure the level

of oxygen in the blood

they are used with disorders such as

pneumonia lung cancer and asthma

however a study in 2022 revealed that

they are less effective in individuals

with dark skin pigmentation

like black patients

the inability to appropriately measure

the level of oxygen in the blood

can contribute to a number of medical

difficulties and possibly death

a study of over 4 700 participants

revealed that black patients are more

likely to be subjected to dominant

communication styles from their doctors

less likely to be provided with all the

treatment options and less likely to be

engaged in participatory decision making

for their own Medical Care

and if we go back to the development of

the field of medicine we will come

across J Marion Sims

a man who is lionized as the father of

modern gynecology

and who perfected his technique by

operating on enslaved African women

without anesthesia and certainly without

their consent

I often see these things

therapeutic care as well

I want to put you in the driver's seat

so you can understand how this can

manifest in the therapeutic process

a patient comes to your office a black

woman comes in and she is seeking mental

health care

after you do an assessment you identify

the fact that she is having difficulty

identifying her strengths and abilities

she often feels like a fraud in her

environment

and she is having such difficulty

meeting her goals

so you collaborate together to identify

a plan

you decide to start with assertiveness

training it is an effective treatment

when it comes to anxiety and stress but

it doesn't work

during the next appointment she shares

that she is having difficulty

identifying any positives in her life

when she thinks about goals when she

thinks about what she can achieve she

can't identify one

so you propose the use of a gratitude

Journal

but it doesn't work

during the next session you do more

digging

and she shares that she has never

experienced this form of feeling like an

imposter before typically she thrives in

all her environments and that is when

you decide to empower her you share that

she simply needs to be authentic in her

space and people will welcome her

obvious intellect

in her vivacious personality

and that is where you lost her she goes

you and she does not come back for

another session now as the clinician in

the room you do what anyone does when

they are ghosted personally or

professionally you ask yourself why what

happened you walk yourself through the

steps

you utilize patient-centered care

because your training taught you that so

often black patients aren't even engaged

in treatment options they're just given

to them

you empowered her and used a

strength-based perspective because you

learned in your training so often black

patients are treated from a framework of

deficits which is also harmful

you did everything that you were taught

to do

but what you missed is what wasn't

included in the training and what so

often is not included in the trainings

because they seem to make others

uncomfortable

and that is the fact that

when your skin is weaponized

everything is a privilege authenticity

is a privilege

because everything can be perceived as a

threat

from the tone of your voice

to the way that you wear your hair

did you know that black women were one

and a half times more likely to know

someone

who was sent home for their hairstyle or

to be sent home for their hairstyle

and this isn't limited to the workplace

hair discrimination has been found in

youths as young as five years old

they're creating a respectful and open

world for natural hair is a piece of

legislation that was created by four

phenomenal women who felt that black

individuals should not be held back and

discriminated against in the workplace

and in school because of the way that

they wore their hair

however not even 50 percent of states in

the United States have enacted this

piece of legislation in fact although it

passed the house in March 2022 it was

blocked in the senate in December in

2022.

I want you to think about that for a

second how many times when you think of

privileges do you think about

authenticity

when you take a step to ruminate on that

I want you to ask yourself

has legislation ever had to be passed so

that you were not retaliated against

for the way that you wore your hair the

way that it came out of your head

what's more authentic than that

that stress that anxiety that your

patient felt could likely have been a

result of stereotype threat this is a

form of Stress and Anxiety that presents

itself when you have a fear of

conforming to a stereotype that is

attributed to your group now there are

many egregious stereotypes when it comes

to black people but a very common One

deals with the lack of intellect

if I am working and stereotype threat

presents itself and it often does I will

create so much mental energy combating

that stereotype I'm not stupid I'm smart

I can do this let me check triple check

and double check that I won't even

divert the right amount of energy to

perform the task that is well within my

ability to do

which will contribute to significantly

more mistakes

everyone has stress when it comes to

performing tasks but stereotype threat

gets in the way of you doing things that

you can even have the ability to do

overall

when you think about the integration of

all the symptoms and what contributes to

racism related stress and and

difficulties within the environment I

want you to think about a tree

that stress that hesitance that fear

that imposter syndrome that your patient

was experiencing that was a branch

but the things that are contributing to

those the maintenance of those branches

thriving and whistling in the wind every

day

is racism

those are the roots

if we ever want to improve The Human

Experience of individuals overall

through all of these trainings they must

address the roots

when you walk out of a training with the

same way of thinking the same

information that you walked into the

training with the problem is the

training

we need to vary the forms of information

that we Herald so many times we focus on

peer-reviewed journals and those are a

good start but publication bias also

exists it is easier for a research study

that focuses on European Americans to be

published and one that focuses solely on

black people or black people or people

of the global majority and not in

comparison one that focuses solely on

these individuals and the intricacies of

the experience in the diaspora

we also need to look at the way we do

these trainings are we looking at

intersecting identities

age

ability level

sexual orientation

it seems like a lot to include in one

training and it is and the goal is not

to include it in one training the whole

purpose of this is to be an experience

and understanding that it is a journey

when it comes to cultural competence

we need to focus on engagement

a three-hour talk with 15 minutes of q a

is not enough time

you need to look at books and break them

down you need to listen to podcasts and

break it down we need to really vary the

information that we share the narratives

that are experienced and the way that

people choose to share them

and have a conversation

do you have difficulties having the

conversation are you uncomfortable let's

start there

where is the discomfort coming from

are you afraid of being wrong

that's okay

I would trust someone who admits to

being wrong way before I trust someone

who says that they're right all the time

are you feeling oppressed in the

environment that the the training is

happening let's start there

what form of Oppression are you

experiencing is it internalized

is it institutional is it cultural all

of these have different treatment plants

but they can all be accomplished

we need to come back with tangible goals

and metrics for achieving those goals

it's not enough to say that we want the

environment to be less oppressive we

need to say that we are going to look at

our policies and come back in two months

and three months yes your policy May

state that it is against discrimination

when it comes to skin color but what

about hair

what about hairstyles or hair lengths or

protective styles that are attributed to

certain individuals of racial or ethnic

Origins

how diverse is your company is your

organization really when you go up

different levels of the hierarchy do you

notice that individuals start to look

the same

that's not diversity

and it's just important to look at these

things from day to day it didn't take

one day to build that bias

it's not going to take one day or what

training to break it down

there is no such thing as being

colorblind when you say you don't see my

color you don't see me

and it also places emphasis on the wrong

thing

color is not the issue race is not the

issue

racism is

when we focus on what is really

important

we can work towards improving The Human

Experience overall

and the many roles that I hold

scientists psychologists person

Professor I'm here to tell you therapy

is not going to fix it all

my office should not be the only safe

space that someone holds

I should not have to manage the fear of

individuals who took a Hippocratic oath

to protect me those who decided to Serve

and Protect others the world should feel

like a safe space

and if we are going to address that we

have to look at the roots we have to be

okay with being wrong and we have to

improve The Human Experience overall by

understanding

my cultural competence is not a Finish

Line

we're going to work on this our whole

lives

thank you