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Cultural Awareness and Competence 1 Cultural Awareness and Competence with African-American Clients Leah Packard LSW/CDCA Capella University SWK5012(3): Cultural Competence and Social Work Practice with Diverse Populations Dr. Renanda Dear December 15, 2023

Cultural Awareness and Competence 2 Population Selection and Justification According to Appleby, et al. (2010) “The experience of African Americans in the United States is unique … No other groups entered the society as involuntary immigrants, and no other group was subsequently victimized by two centuries of slavery .... ” Unfortunately, the subjugation of African Americans continues to persist in modern American Culture. The beauty of the culture such as customs, dress, and even hair continue to be portrayed as unacceptable and are discriminated against in various settings (Martin, A., 2017). White people of all ages, socio- economic statuses, and religions have claimed in one sentence to not be prejudiced against African Americans yet, in the next sentence justify the police killing of an unarmed African American man (on multiple occasions) (Deversi, M., 2016). Discrimination continues to be a major problem bread into our culture since its inception and is often based on ethnicity or color (Appleby, et al. 2010). Workers need to have a deep knowledge understanding of how the legacy of slavery, racism, discrimination, and internalized oppression affect the social functioning and psychological well-being of African-American Clients (Appleby, et al., 2010). In Ohio, Black Ohioans make up 45% of the state prison population, but only 17% of treatment court participants are Black (Health Policy Institute 2021). I work with clients navigating the criminal justice system (facing charges, returning home from prison, or entering treatment instead of conviction) at The Oriana House Inc., in the Treatment Department. Many of my clients are African-American males. I have noticed an uptick in the number of African- American males entering treatment for substance use disorders (SUD) and mental health concerns. I have also noticed an undeniable disparity between the sentences of my white male clients when compared to my Black male clients. I want a better understanding of how to advocate for fair sentencing practices, equity, and other important issues for my African- American Clientele.

Cultural Awareness and Competence 3 While I have some knowledge of African-American culture and the history of racism, prejudice, discrimination, and oppression. I do not feel proficient enough to understand the unique challenges they face accessing services and would like to better understand and grow in my ability to provide culturally competent services to them. Our core values implore us to fight for social justice, enhance the dignity and worth of our clients, and enhance cultural competence (NASW, 2021). Given my clientele, it is my ethical responsibility as I see it to enhance my cultural sensitivity and cultural awareness of the African-American population I currently serve, to understand, provide competent services, and advocate for equality, equity, and develop treatment interventions that are inclusive of their unique cultural considerations. Culturally Relevant Research Conducted in the African-American Community The first study analyzed looked at suicide and protective factors among African Americans. This study, being culturally informed, focuses on the protective factors African Americans have against suicide, while also highlighting the lack of appropriate research and interventions for African Americans. This study also pointed out that suicide among African Americans has been a neglected topic while suicide rates are steadily increasing every year (Reed et al., 2021). They found that since 1998 suicide rates have increased by 24% for the public but rates have increased by 30% among African Americans; and raw numbers for suicide show a 57% increase in suicide for African Americans since 2013 (Reed et al., 2021). The authors used critical race theory to examine protective factors specific to African Americans that may mitigate suicide risk. They performed a literature review of social work research from 1980 to 2018 (which revealed the lack of contribution by the social work discipline as there were only 20 suicide-related studies) to examine social work’s contribution to research on suicide-specific studies and examine protective factors for African Americans (Reed et al., 2021).

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Cultural Awareness and Competence 4 Results showed that on a micro-level, private regard and strong African American identity were protective factors as well as aggression and impulsivity in response to discrimination causing outward violence which protects against suicide but could lead to criminality (Reed et al., 2021). At a Mezzo-level family support and the role of women are protective factors (Reed et al., 2021). Macro-level factors included social/peer support, poverty, and education/awareness in that poverty decreases suicidal ideation while education increases risk due to attainment not paying off, it also found that religion, access to care, and internal response to community violence are protective factors (Reed et al., 2021). They proposed that the use of Critical Race Theory, increasing minority-inclusive research, interventions, models, and theoretical approaches to suicide research are essential because generalizing all populations in suicide research ensures that “the needs and empowerment of suicidal African Americans will continue to be misunderstood, over-looked or ignored.” (Reed et al., 2021). The second study examined the relationship between Race-based traumatic stress symptoms (RBTS) and traditional trauma symptoms in Black Americans (Roberson & Carter, 2022). The study recruited 230 African American participants over half male. Findings promote a need for practitioners to understand that trauma symptoms may differ regarding racial discrimination experiences among African Americans (Roberson & Carter, 2022). They urge clinicians working with Black clients to look beyond instruments and interact with them to discern if they are exhibiting symptoms of trauma despite low hypervigilance scores and to focus more on self-esteem and anger symptoms (Roberson & Carter, 2022). I found this study highlights the need for developing culturally sensitive measurement tools to address symptom presentation which might vary between different cultures to assist in diagnoses. It also reinforces

Cultural Awareness and Competence 5 that clinicians must remain ever cognizant of how symptom presentation can differ based on one’s experiences and culture. The third study investigated the degree to which experiences of racial discrimination in African Americans are related to negative mental health outcomes (post-traumatic stress disorder (PTSD), depression, and anxiety) while controlling for the influence of negative affectivity (Mekawi et al., 2021). The study sampled 419 African American adults (56.1% women) from 18 to 78 years old, 22.2% had less than a high school education, 43.2% completed or earned a GED, and 33.9% completed additional education (Mekawi et al., 2021). Monthly income was as follows, 41.1% reported earning less than $500 per month, 25.3% less than $999, and 30.5% reported an income of $1,000 or more per month (Mekawi et al., 2021). They used various inventories to measure experiences of discrimination, to measure PTSD, depression, anxiety, and personality symptoms (Mekawi et al., 2021). They found that experiences of discrimination were associated with adverse mental health outcomes even when controlling for negative affectivity (Mekawi et al., 2021). They report that some researchers have attempted to criticize the notion that experiences of racism correlate to negative mental health outcomes and that rather negative affectivity or personality traits were more the blame (Mekawi et al., 2021). The study has relevant clinical implications in that clinicians need to be diligent in addressing how their racial ideologies interfere with their ability to provide culturally competent services (Mekawi et al., 2021). It was alarming that professionals in the field would to this day attempt to minimize the impact of racism, discrimination, and oppression and essentially attempt to shift blame to the victim. They call for clinicians to reconceptualize their client's race-related

Cultural Awareness and Competence 6 distress by recognizing all the interpersonal and structural factors that affect the client’s functioning instead of pathologizing the client’s lived experience (Mekawi et al., 2021). Theories and Methods When working with African American Clients I feel that using the empowerment theory and methods is a way to address not only the client but the larger environment and systems the client operates in. Empowerment theory in short links individual strengths/resilience, natural helping systems, and proactive behaviors to social policy and social change (Perkins & Zimmerman, 1995). Empowerment theory posits that we think in terms of wellness, competence, and strengths when it comes to clients and communities (Perkins & Zimmerman, 1995). African philosophy summarizes that no one can be self-sufficient and that interdependence is a reality for all people (Skene, K., 2022). The resilience of the individual is a combination of personal and environmental factors (Skene, K., 2022). Empowerment theory seeks to increase personal, interpersonal, and political power so that individuals and communities take the steps necessary to improve their lives and functioning (Perkins & Zimmerman, 1995). Appleby et al., (2010) suggest as well that social workers must practice from a theory that people of color are vulnerable to racism and victimization. It is also suggested to keep in the forefront power-conflict theory as this theory helps to establish a frame of reference putting the spotlight on the psychological and sociological effects of power and oppression (Appleby et al., 2010). Power-conflict theory enables social workers to understand certain behaviors and explains our clients who are discouraged or estranged (Appleby et al., 2010). Historical and Contemporary Antecedents of Discrimination

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Cultural Awareness and Competence 7 It has been more than 400 years since the first slave ship landed on American soil and more than 149 years since the end of the American Civil War and the passage of the Thirteenth Amendment, more than 50 since the passage of The Civil Rights Act of 1964 (Rucker, 2020). Slavery and post-slavery laws in this country were based on and justified by the belief that Black people were mentally and morally inferior to whites, which was a theory developed by Thomas Jefferson (Mangis, N., 1999). Following the Civil Rights Act, Jim Crow Laws remained in effect in some areas until around 1968 (Rucker 2020). It is said today that the U.S. prisons and courts are being used as a contemporary system of racial control masquerading under the guise of adhering to the principle of colorblindness, many refer to this as the New Jim Crow Era (Alexander, M., 2012). Alexander (2012) argues that race is no longer used to justify discrimination, exclusion, and social contempt. Officials use the criminal justice system to label persons of color as “criminals” and this label allows them to continue using old forms of discrimination such as employment discrimination, housing discrimination, denial of the right to vote, denial of educational opportunity, denial of food stamps and other public benefits as well as others to perpetuate the racial caste system targeting Black men and the decimation of communities of color (Alexander, M., 2012). Racism and discrimination have historical and contemporary roots in policing as well considering Slave Patrols originated as a mechanism to capture and brutalize escaped enslaved peoples (Hassett-Walker, C., 2021). The first deaths in America of Black men at the hands of law enforcement can be traced back as early as 1619, and today African African-American men continue to be profiled, unfairly arrested/convicted, and murdered at the hands of law enforcement (Hassett-Walker, C., 2021). In 2019, The Pew Research Center reported that Black

Cultural Awareness and Competence 8 adults are five times as likely as whites to say they have been unfairly stopped by police because of race or ethnicity (44% vs. 9%). Research consistently shows that Black citizens (especially those with darker skin tones) face more discrimination, lower socio-economic status, harsher penalties in the legal system, less access to education, and equity in healthcare (Adams et al., 2016). Influence of Culture on Attitudes, Values, Perceptions, Behaviors, and Interpersonal Relations African-American culture is often misinterpreted and unfortunately stereotyped in our society. The beauty of the culture such as customs, dress, and even hair continue to be portrayed as unacceptable and are discriminated against in various settings (Martin, A., 2017). The abhorrent stereotype that African Americans especially males are unintelligent, lazy, violent, and criminals has had long-lasting impacts on educational outcomes, employment opportunities, socioeconomic status, and the dismantling of African-American families and communities (Taylor et al., 2019). The US Constitution considered slaves to be three-fifths of a person, the adoption of Jim Crow Laws as discussed earlier, and most recently police brutality against unarmed African-American males has consistently reinforced the dehumanization of African- Americans (Taylor et al., 2019). When people are continually degraded and dehumanized, they internalize that oppression and unfortunately begin to believe the stereotypes about their group (Taylor et al., 2019). Another relational issue based on cultural belief stems from the historical abuses of Black communities by the “helping” professions as well as divergences in values, goals, and behaviors of professionals as compared to community members have been well documented, and Black people maintain a realistic distrust of those whose services and interventions have intruded into their private lives (Jordan et al., 2001).

Cultural Awareness and Competence 9 Social Justice Concerns When discussing race and justice we are looking at the ways discrimination, policing, prosecutions, and incarceration practices impact Black communities (National Association for the Advancement of Colored People [NAACP] n.d.). Black people are incarcerated at more than 5 times the rate of whites, and 65% of Black adults have felt targeted because of their race (NAACP, n.d.). It was found that 52% of African-American males who did not graduate high school had a prison record by the time they were 30 (Taylor et al., 2019). African Americans are found to make up only 12% of the US population but 40% of the total prison population (Taylor et al., 2019). Systemic racism plays a major role in educational outcomes, and employment opportunities in the Black community as well. African-American males are suspended more often, are half as likely to be placed in honors classes, and are 2.4 times more likely to be placed in remedial classes based on teachers' own biases and stereotypes (Taylor et al., 2019). This inequality in education plays a role in employment disparities as well on top of inherent systemic racism (Taylor et al., 2019). Stereotypes held by employers often result in covert racism in the hiring process (Taylor et al., 2019). They see disproportionate salaries to their white coworkers (up to 20% less) and are twice as likely to be unemployed (Taylor et al., 2019). These issues impacting African-American communities cause extreme amounts of emotional, mental, physical, and financial impacts on their community, and individuals. The cost of an unjust system is extremely high as reflected in the research discussed throughout this paper. Personal Competencies As far as personal competencies go, I feel like I have cultivated an even greater awareness of myself, and I strive to always remain open-minded and non-judgmental with my

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Cultural Awareness and Competence 10 clients. I am an active listener with my clients, and I always seek clarification if I do not understand, I try to never make assumptions. I show respect and empathy and come from a place of trauma-informed care as it pertains especially to the impact of historical trauma and systemic issues. I collaborate well with other agencies to address gaps in available resources or develop new resources for mutual clients. I advocate alongside my clients to address any barriers they face in our programs or re-entry to the community. I stay abreast of resources available in the community that could help my clients as well. I have creative problem-solving skills, and I can remain calm in most emergent or crises. Increasing my cultural competence is a life-long process of learning, self-reflection, and adaptation. Technological Considerations In social work and health care in general, technological communication considerations are becoming increasingly important. Technology can be extremely helpful and powerful in connecting us with clients who may lack the means to attend in-person meetings and assist us in providing services and addressing various needs. Every social worker should familiarize themselves with the Standards for Technology in Social Work Practice (NASW, 2016). When considering digital communication, Telehealth etc. with the African American culture, I came across a subject known as the ‘digital divide’ (Community Tech Network [CTN], 2023). Being successful in our society requires our citizens to have internet access. It has been found that 31% of African Americans do not have a home computer, and 38% lack high-speed internet access or broadband, so about one in three Black adults are offline (CTN, 2023). The price of internet in the United States is one of the highest in the world, and with systemic racism in our society, Black households earn around half as much as white counterparts making home internet costs too high (CTN, 2023). Given this information, it would be important to ensure that the use of

Cultural Awareness and Competence 11 technology in providing services does not inadvertently create or exacerbate disparities with my clients. I would likely lean towards tailoring communication methods based on my client’s preferences, technological literacy as well as access. I have Telehealth sessions with some of my Black clients and for some, it is extremely helpful if they struggle with transportation, childcare, or other resources needed for in-person visits. Action Plan The first place I would like to start is increasing my knowledge of culturally appropriate treatment interventions at the individual and group level with my client demographic (much of my work at this time is individual counseling and group therapy). Searching for evidence-based research on effective treatment modalities online will help me to sharpen and further develop my skills going forward. I will continue to seek out culturally centered services available in my community to address the unique needs of my African-American clients who are re-entering the community or continuing to navigate within the criminal justice system. I want to immerse myself in cultural events open to the public as well. I would like to research online and find advocacy groups focused on equity and social justice in African-American communities in my area and find a way to volunteer with them and get involved in their events in my community. Seeking out in-person or online CEU opportunities related to culturally competent practice in the African-American community will benefit me as well in my plan to continuously grow in cultural competence. I believe that this action plan is a good starting place for the next year, I will seek Supervision throughout this year to address my progress in cultural competence and ask for guidance in other ways I can continue to grow even beyond the next year and for the rest of my career in social work.

Cultural Awareness and Competence 12 When working with African-American clients culturally competent care is necessary to create positive treatment outcomes, empower clients, and build trusting relationships within the Black community. It takes consistent appraisal of biases, commitment to exploring culturally relevant research, and a deep understanding and education of Black history and their unique experiences (Appleby et al., 2010). A worker must have cultural humility, empathy, a knowledge of intersectionality, and active listening skills as well to honor the strengths and unique perspectives of African-American clients. Emphasis on culturally relevant research strategies and interventions is of import as well to ensure maximum benefit of the treatment provided. Integration of technology should be approached considering issues of digital disparities, access, and privacy to ensure African-American clients benefit from any virtual communication rendered during treatment. Cultural competence is a lifelong journey of education, advocacy, and collaboration.

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Cultural Awareness and Competence 13 References Alexander, M., (2012). The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: New Press. Appleby, G. A., Colon, E. A., & Hamilton, J. (2011). Diversity, oppression, and social functioning: Person-in-environment assessment and intervention (3rd ed.). Upper Saddle River, NJ. Pearson. Community Tech Network (2023). Digital Equity for Black Americans: A Racial Justice Issue. Retrieved from https://communitytechnetwork.org/blog/digital-equity-for-black- americans-a-racial-justice-issue/?gclid=Cj0KCQiAj_CrBhD- ARIsAIiMxT99uBw2vBvyIqlyN7YxFkqIMgWQbR8RaRJObncinResU3rWKnFY7hQa AuxBEALw_wcB Diversi, M. (2016). The Ever-Shifting Excuses for Demonizing Black People in America. Cultural Studies ↔ Critical Methodologies . 16 (3), 245-252. https://doi.org/10.1177/1532708616634769 . Facts and Figures. Connections between criminal justice and health: Insights on justice and race, Health Policy Institute of Ohio, 2021. Retrieved from https://www.healthpolicyohio.org/facts-figures-criminal-justice-and-health/ . Hassett-Walker, C. (2021, January 11). How You Start is How You Finish? The Slave Patrol and Jim Crow Origins of Policing. Human Rights Magazine , 46 (2). https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/ civil-rights-reimagining-policing/how-you-start-is-how-you-finish/

Cultural Awareness and Competence 14 Jordan, L. C., Bogat, G. A., & Smith, G. (2001). Collaborating for social change: The Black psychologist and the Black community . American Journal of Community Psychology, 29 (4), 599-620. https://doi.org/10.1023/A:1010474101801 Magnis, N. E., (1999). Thomas Jefferson and Slavery: An Analysis of His Racist Thinking as Revealed By His Writing and Political Behavior. Journal of Black Studies . 29 (4), 491- 509. Martin, A. (2017). The Hatred of Black Hair Goes Beyond Ignorance. TIME Magazine. Retrieved from https://time.com/4909898/black-hair-discrimination-ignorance/ . Mekawi, Y., Hyatt, C. S., Maples-Keller, J., Carter, S., Michopoulos, V., & Powers, A. (2021). Racial Discrimination Predicts Mental Health Outcomes Beyond the Role of Personality Traits in a Community Sample of African Americans. Clinical Psychological Science , 9(2), 183-196. https://doi-org.library.capella.edu/10.1177/2167702620957318 National Association of Social Workers. (2021). Code of ethics . Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics . Perkins, D. D., Zimmerman, M. A., (1995). Empowerment Theory, Research, and Application. American Journal of Community Psychology, 23(5), 569-579. National Association of Social Workers. (2015). Standards and indicators for cultural competence in social work practice . NASW Press. Reed, D. D., Stoeffler, S. W., & Joseph, R. (2021). Suicide, race, and social work: A systematic review of protective factors among African Americans. Journal of Evidence-Based Social Work, 18(4), 1-393. https://doi.org/10.1080/26408066.2020.1857317

Cultural Awareness and Competence 15 Roberson, K., & Carter, R. T. (2022). The relationship between race-based traumatic stress and the Trauma Symptom Checklist: Does racial trauma differ in symptom presentation? Traumatology, 28 (1), 120–128. https://doi.org/10.1037/trm0000306 Rucker, J. M. (2020). Thinking Structurally: The Antecedents and Consequences of a Structural Understanding of Discrimination (Order No. 28150538). Available from ProQuest Dissertations & Theses Global. (2572595344). http://library.capella.edu/login?qurl=https %3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Fthinking-structurally- antecedents-consequences%2Fdocview%2F2572595344%2Fse-2%3Faccountid %3D27965 Skene, K.R., (2022). What is the Unit of Empowerment? An Ecological Perspective. British Journal of Social Work . 52, 498-517. Doi 10.1093/bjsw/bcab012. https://web-s- ebscohost-com.library.capella.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=b6c04e7b- 9219-4bf2-9f00-87ab0ec51bdf%40redis Taylor, E., Guy-Walls, P., Wilkerson, P., & Addae, R. (2019). The Historical Perspectives of Stereotypes on African-American Males. Journal of Human Rights and Social Work, 4 (3), 213-225. https://doi.org/10.1007/s41134-019-00096-y

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