Cultural Competence and Implicit Bias WASCLA May,3, 2013 Wenatchee Gillian Dutton Assoc. Prof. of Lawyering Skills, Dir. Externship Program Seattle University School of Law

What is Culture? What is Cultural Competence? How Does Implicit Bias Affect Cultural Competence? How Can We Use Knowledge of Bias and Culture in Language Access Work?

Some Examples of Culture’s Impact on Legal and Medical Communication Approach to documentation Views of mental illness and disability Description of trauma Style of communication Definition of family relationships

Definition of Culture Shared by a Social Group The Iceberg theory of culture – those things that are most deeply held are beneath the service Knowledge Geography Belief Art Law Class Race Income Education Morals Sexual orientation Gender Customs Capabilities, and Habits.

Culture Visible Style of dress Holiday customs Music Arts Gestures Foods Rituals Invisible Concept of self – individual or collective Obligations Relationships Status Power – hierarchical or egalitarian Harmony/Face Directness Non-verbal communication

Identify Your Own Culture Think about the culture you identify with the most. List five adjectives that describe your culture. Consider how this might impact your work in language access.

What is My Culture? Which Culture? How many had trouble choosing a culture? Have there been times in the past when you could easily identify a culture? How many chose positive attributes in your list? How many had negative attributes?

Why Is Culture Important? We draw conclusions about individuals through our own cultural lens Based on the actions of others, we create a story, which leads to motive, and then to judgment For effective cross cultural communication, we may need to educate participants about cultural misconceptions and the potential for miscommunication

How Can We Teach Cultural Competence? A Comparison with Medical Student Training Curriculum covers –Attitudes, Knowledge and Skills Attitudes Has the student learned the particular importance of curiosity, empathy, and respect in cross-cultural encounters? Does the student exhibit these attitudes as corroborated by evaluation? Measured by survey, self-awareness assessment, structured interviewing, presentation of clinical case, videotaped encounter Association of American Medical Colleges- Cultural Competence Education

Knowledge Has the student learned the key core cross- cultural issues, such as the styles of communication, mistrust/prejudice, autonomy vs. family decision making, the role of biomedicine for the patient, traditions and customs relevant to health care, sexual/gender issues, and so on? Does the student make an assessment of the key core cross-cultural issues, as corroborated by evaluation? Measured by pretest-posttest, unknown clinical cases, presentation of cases, objective structured clinical exams

Skills Has the student learned how to explore core cross-cultural issues and the explanatory model? Has the student learned how to effectively negotiate with a patient? Does the student explore the explanatory model and negotiate with a patient, as corroborated by evaluation? Measured by presentation of clinical cases, objective structured clinical exam, videotaped clinical encounter

Cultural Competence How might acquire cultural competence attitudes, knowledge and skills? (seeing below the iceberg) ►Acceptance and respect for differences ►Ongoing assessment of your own, and your group’s culture ►Understanding of and attention to difference dynamics ►Continued curiosity and expansion of cultural knowledge and resources ►Adaptation of one’s values and behaviors as well as the group’s demonstrated practices

Individualistic and Collective Cultures Individualistic –Individual gain, more independent –Self protective or more ego-invested –More competitive Examples: United States, Great Britain, Canada, Netherlands, and New Zealand Collective –Focused on problem solving –More collaborative –Saving face may be a goal Examples: Venezuela, Colombia, Pakistan, Peru, Taiwan, Thailand, and Singapore

Different Cultural Perspectives: Dealing With Conflict Individualistic Cultures:Interdependent Cultures: Conflicts are naturalGroup harmony is extremely valued Address conflict and move on Shame and honor are important People associate freely with any group Societies are hierarchical and traditional Confront conflict, managing face is less important Avoid direct conflict and focus on face

Monochronic Time Orientation Time is scheduled, arranged and managed Linear, sequential, and ordered Tangible Time is money and can be wasted Value of schedules, tasks, getting the job done View of polychronic – disrespectful Examples: German, British, Canadian and US cultures

Polychronic Time Orientation Informal perception of time Time is flexible, several things can be done at once Fluid approach to time and scheduling Global, broad, multi-layered, interconnected Focus is on relationships, not watching the clock Ok to be late View of monochronic-disrespectful Examples: African, Middle Eastern, and Latin American cultures

Other Dimensions of Culture Universalism/ Particularism High context/ Low context Power distance Uncertainty avoidance Locus of control

Relationship Between Implicit Bias and Cultural Competence Approach to bias –Understand the biases of your own culture (race, gender, sexual orientation, etc.) –Recognize how culture and bias impact ability to understand a person’s story –Understand how both cultural competence and bias might affect you and the parties

One Up and One-Down Groups One-Up Perspective Sees individual acts Does not see “group-ness” Advantage or privilege is invisible Systems are created from this vantage point (your own beliefs, viewpoints, values) ► Focus is on intent; how far we have come; don’t be a victim One-Down Perspective Patterns of behavior seen Keenly aware of “group-ness” Disadvantage is well-known and often internalized May use one-up group’s standards to judge themselves Need to collude to survive, not stand out ►Focus is on effect/outcome; understanding the system; how far we have to go

Studies Show Bias Affects All of Us Asian American women subconsciously primed to emphasize their Asian identity do better on a hard math test, and those primed to focus on their female identity do worse, than those who receive neither priming. African Americans told that a challenging test they are taking is ability diagnostic do significantly worse than equally talented White students, a performance drop that disappears when the test is described as a non- diagnostic, problem-solving exercise. (Emphasis added and cites omitted) p. 173 “Cross-Cultural Lawyering by the Book: The Latest Clinical Texts and A Sketch Of a Future Agenda, 4 H ASTINGS R ACE & P OVERTY L.J. 131 (2006)

Test your own bias at It is well known that people don't always ‘speak their minds’ New research shows that people don’t always ‘know their minds’ Role of implicit or automatic bias This method demonstrates the conscious- unconscious divergences Called the Implicit Association Test, or IAT

Implicit Association Testing – Sample Topics Weapons Native American Weight Sexuality (Gay-Straight) Asian American Arab-Muslim Race (Black-White) Gender-Career Age (Young-Old) Disability

EXPLICIT VS. IMPLICIT (AUTOMATIC) BIAS ‘ Prejudiced' = endorse or approve of negative attitudes and discriminatory behavior toward various out-groups. IAT test showing automatic White preference does not mean approval of this preference. Biases registered on IAT may not be consciously endorsed, or may be contradictory to intentional attitudes and beliefs. Individuals may function in a non-prejudiced fashion with active effort to prevent discriminatory behavior. Relaxing these active efforts, people may be likely to show discrimination in thought or behavior.

Do Automatic Racial or Ethnic Preferences Occur in other Countries, in Regard to other Groups ? Demonstrated in various Asian, European, and Australian groups, very likely universal –Automatic White preference due to deep learning of negative associations to the group Black High levels of negative references to Black Americans in American culture and mass media may contribute to this learning Negative references may be residue of long history of racial discrimination rather than result of deliberate efforts to discriminate

Responding to Automatic Bias Embark on consciously planned actions that can compensate for known unconscious preferences and beliefs. This may involve acting in ways that you may not naturally act – for example, smiling at people who are elderly if you know you have an implicit preference for the young. Identifying effective mechanisms for managing and changing unwanted automatic preferences is an active research question in psychology. The good news is that automatic preferences, automatic as they are, are also malleable!

Southern Poverty Law Center Data on Bias 30% of workers heard colleagues use racial/ethnic slurs in past 12 months 30% report sexist comments in same time 21% of workers overheard age-related ridicule 20% report comments about sexual orientation 1 in 10 students report derogatory term re race, religion, disability, gender or sexual orientation in past 6 months

Exercise -- Reflecting on Your Own Experience Think of an experience you (or a family member) have had with bias (also referred to as micro-aggressions) –How might the incident affect people involved? (target, perpetrator, witnesses) –How might the incident affect the health of the community? –What are the emotional, social, physical and financial costs of incidents like these? –Why do we often not respond? We all face difficulty in responding to bias –Barriers include power, familiarity, emotional connection

Response to Bias in Legal, Medical and Social Services –What language will you use? –Meet with parties separately or together? Separate out intent Focus on empathy Appeal to principles Describe impact Acknowledge your own bias Find an ally, be an ally Set limits

Examples of How to Start I don’t know if you know how that sounded, but the way it sounded to me is that you think... (identify hurtful bias). I used to think I was able to put biases aside, but then I realized that many of these behaviors are unconscious … (describe your own experience similar to the behavior witnessed) Help me to understand what you meant by… (insert statement)

Practice Tips For Addressing Culture and Bias in Response Language Settings Explore prior miscommunication due to culture/bias Identify cultural preferences in communication Educate about role of implicit bias in communication/ goals Consider exercise on impact of micro-aggressions Provide experiences that could undo or reverse the experience that created the unwanted preference –Read/view material that opposes the implicit preference. –Interact to provide experiences to counter preference. Remain alert to the existence of undesired preference –Recognize that it may intrude into judgments/actions.

Good Luck! ( This is important work.) Questions? –Thank you!