The Behaviorist Diaries

One question I was recently asked, which I am sorry to say made me pause was, “Do you ascribe more to the theory of cultural competence or cultural humility?” My response, after the pause, was to say that I ascribe more to cultural humility in that we must strive towards cultural competence, but cultural humility requires that we are humble, self-reflective, and assume that we don’t know everything. Admittedly, I played this exchange over and over in my head and wondered if my answer was “correct” and wondered if this is what the person was asking. Unfortunately, I also wondered what they themselves thought, about their political affiliations, and how they would perceive me and my political affiliations after I provided that answer. This overthinking is a common occurrence for me, but in this instance it was beneficial in that it led me to dig a little more into the terminology used when discussing diversity, equity, and inclusion.

The Behavior Analyst Certification Board (BACB), the certifying agency for Board Certified Behavior Analysts (BCBA) has published a new ethical code which goes into effect as of January 1, 2022. For me, one of the exciting new areas of emphasis is a focus on ensuring that BCBAs are gaining skills related to cultural diversity. As someone who continues to have much to learn, but also prides themselves on being culturally aware, I look forward to learning more through continuing education on this topic, which is sure to come now that this is included in our code. Given this upcoming change, one of the first places I looked was our new Ethics Code for Behavior Analysts (BACB, 2021) and found yet another term – cultural responsiveness (1.07 Cultural Responsiveness and Diversity). Oh no, now I knew I had to learn the origin of cultural competence and cultural humility and what each truly meant.

Let’s start with cultural competence. This term was first used to discuss the impacts of a client’s culture on medical treatment (Cross, T., Bazron, B., Dennis, K., & Isaacs, M., 1989).  It’s used when discussing practitioner-client interactions and to ensure that patients of differing backgrounds are treated equitably. At first glance, this term seems great in that as a practitioner you should be competent and aware of variations in culture, especially the culture of those that you serve such as clients or supervisees/trainees. However, as I dug further into the origin of this term, one of the identified issues is that it assumes that the norm is white and that being competent is learning the culture of anyone that differs from the norm. It also assumes that the practitioner can demonstrate behaviors that are determined to be competency measures of another person’s culture. Could this lead to overgeneralizations of how a person may interact given their physical presentation? Is it possible to be competent in every cultural variation? 

Next I moved onto the term cultural humility. This term was coined in 1998 by Tervalon and Murray-Garcia and describes an ongoing process of self-reflection and continued investigation of your own internal biases (Tervalon, M. & Murray-Garcia, J., 1998). There is no end point to this investigation and there is an acknowledgement that multiple cultural identities may cross paths (intersectionality). This reminds me of a term we use in behavior analysis – contextual control in which multiple variables come together to exert control on behavior. After learning this term, I was happy with my answer to the question. I can’t imagine describing myself as culturally competent in every culture in the world and would be surprised if anyone could achieve that feat. 

Finally, the BACB Code of Ethics for Behavior Analysts has multiple standards addressing issues of cultural diversity, equity, and inclusion, but I would like to focus on standard 1.07 – Cultural Responsiveness and Diversity. Standard 1.07 requires that we acquire skills related to cultural responsiveness, that we evaluate our personal biases, and those of our supervisees and trainees. This statement seems to ascribe to the theory of cultural humility to me. However, in conducting a brief review of related research, it appears that cultural responsiveness is a term often used by educators, in that a culturally responsive curriculum is developed to ensure and address cultural competence. 

Yikes, this is confusing – I think I still have some things to learn, but maybe we all do.  Although some of these terms have been around since the late 80s, there are newer terms and more research being conducted now that helps to refine our terminology. I look forward to this ongoing unfolding of terms and am just relieved that my immediate community, BCBAs, now have an obligation to discuss and to push ourselves to learn more. 

Let’s keep the conversation going – what can you teach The Behaviorist Diaries Community about this topic? Do you agree or disagree? Comment below. 

Happy Holidays,

Chrissy 

References

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO:  Author. 

https://www.bacb.com/wp-content/uploads/2020/11/Ethics-Code-for-Behavior Analysts-2102010.pdf 

Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care (Vol. 1). Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. 

Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117-125. https://doi.org/10.1353/hpu.2010.0233