A Cultural Competence Instrument for use by Social Work and Mental Health Workers: ASK

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A Cultural Competence Instrument for use by
Social Work and Mental Health Workers ASK

• A Paper Presented at
• 14th Robert Lee Sutherland Seminar
• Hogg Foundation for Mental Health
• by
• Patrick Leung, Ph.D.
• Professor of Social Work
• University of Houston
• Graduate College of Social Work
• December 1, 2006

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Cultural Competence Training

• Formal training
• How to apply competencies, utilize professional
  resources, perceive their work positively, and
  develop confidence in service delivery
• Short-term training
• Does not lead to effective, enduring results
• Long-term training
• Self-assessment
• Continued commitment

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How to Achieve Cultural Competence?

• To accept and agree to a lifelong commitment of
  developing ones skills
• To be cognizant of own values and beliefs
  regarding own culture and the cultures of others

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Three Distinct Areas in Most Self-Assessment
Tools

• Awareness/Attitude/Value Individuals knowledge
  about beliefs and attitudes of a culture
• Skills The creation and implementation of
  culturally appropriate interventions
• Knowledge Individuals ability to understand
  distinct cultural views

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Purpose of This Research

• To report the testing results of these
  questioning items tested on practitioners and
  social work graduate students
• To identify an efficient way to apply this scale
  in practice, education, and training
• To consolidate major factors involved in this
  evaluative model
• To identify curricular needs/gaps in culturally
  competent assessment.

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Method

• ASK Survey 97 questions were extracted from the
  articles written by Leung et al. in 1994 and
  Stevenson et al. in 1992
• Importance Scale A 5-point, Likert-type scale
  format was used (with 1 being the least important
  and 5 being the most important)
• Surveys sent to students and practitioners with
  anonymous participation

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Instrument ASK Self-assessment Scale

• Focus on 3 major practice areas
• Attitude
• Skill
• Knowledge
• Explain the ultimate goal
• To provide an opportunity for self-assessment
• To promote further development of culturally
  sensitive practice
• To identify areas for improvement

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Seven phases of the casework process

• Contact 18 items
• Problem identification 16 items
• Assessment 14 items
• Case planning 14 items
• Intervention 13 items
• Termination 11 items
• Evaluation 11 items

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Practice Components
Attitude items (30) Skill items (40)
Knowledge items (27)
gtgt

• Previous research found that
• Knowledge
• Successfully attained immediately after training
• Attitude Skill
• Requires ongoing supervision, training, and
  self-learning in practical situations

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Sample

• Group 1
• Graduate social work students
• n119

• Group 2
• CPS practitioners
• n171

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Comparing the Two Groups

• GROUP 1
• Target
• 170 MSW students from two graduate schools of
  social work
• advanced curriculum
• enrolled in research courses
• Sample
• 119 students
• 70 response rate

• GROUP 2
• Target
• 590 CPS practitioners
• Caseworkers or Supervisors
• Sample
• 171 respondents
• 29 response rate

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Group 1 and Group 2Who Are They?
Group 1 n119
Group 2 n171
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Demographics

• GROUP 2
• n171
• Gender
• 80.7 female
• 28.0 male
• Age 23 63 years
• Mean 39 years

• GROUP 1
• n119
• Gender
• 70.6 female
• 29.4 male
• Age 22 62 years
• Mean 36 years

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Ethnicity
Group 1 Students n119
Group 2 Practitioners n171
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Education Focus of Group 1

• Concentration in MSW Studies (n119)
• 31.9 Children and Families
• 15.1 Mental Health
• 15.1 Health Care
• 12.6 Political Social Work
• 9.2 Gerontology
• 1.7 Substance Abuse

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Work Experience

• Group 1
• n119
• 0 - 13 years
• Average lt1 year
• Mean0.93 year
• Modeno experience
• 77 (n82) with no prior experience

• Group 2
• n171
• 3 months 26 years
• Average 8 years

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Findings

• A Cronbach alpha of .97 for both groups
• Reliability
• .90 - .95 for students
• .91 - .95 for practitioners
• ? A high degree of internal consistency
• Using the principal component method with varimax
  rotation
• Differences between the groups in terms of the
  number of factors loaded under each of the three
  ASK areas

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Factor Analysis
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Factor Analysis
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Factor Analysis
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Attitude Items (30) Group 1

• Students, 7 factors (64.8 total variances)
• The value of clients inputs
• Receptivity to cultural differences
• Search for meanings
• Positive attitudes
• Value of professional attributes
• Value of experience
• No assumptions

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Attitude Items (30) Group 2

• Practitioners, 8 factors (67.5 total
  variances)
• Attitude toward case planning
• Value of understanding
• Attitude toward other peoples ideas
• Attitude toward problem identification
• Value of professional attributes
• Attitude toward termination
• Value of listening
• Attitude during contact

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Attitude Both Groups

• Similarities
• Professional Attitude
• Acceptance
• Understanding

• Differences
• Group 1
• Client-Focused
• Group 2
• Skills-Oriented

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Skill Items (40) Group 1

• Students, 10 factors (71.5 total variances)
• Skill in identifying culturally specific
  resources barriers
• Skills in working with external resources
• Skills in using culturally specific language and
  examples
• Skills in connecting to clients meanings
• Skills in accessing to clients resources
• Skills in identifying the perspective of being a
  client
• Skills in encouraging familys participation
• Skills in identifying cultural definitions
• Skills in clarifying cultural meanings
• Skills in confronting inappropriate behaviors

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Skill Items (40) Group 2

• Practitioners, 9 factors (69.3 total variances)
• Skills in intervention
• Skills in case planning
• Skills in using culturally specific language and
  examples
• Skills in termination
• Skills in assessment
• Skills in contacting clients
• Skills in engaging clients
• Skills in identifying cultural appropriate
  resources
• Skills in demonstrating respect

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Skill Both Groups

• Differences
• Group 1
• Participation
• Connection
• Confrontation
• Group 2
• Intervention Stages
• Respect

• Similarities
• Resources
• Language

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Knowledge Items (27) Group 1

• Students, 7 factors (67.3 total variances)
• Knowledge about culturally specific approaches
• Knowledge about culturally relevant information
• Knowledge about clients cultural characteristics
• Knowledge about cultural barriers
• Knowledge about cultural greetings
• Knowledge about culturally-based behaviors
• Knowledge about cultural assessment

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Knowledge Items (27) Group 2

• Practitioners, 7 factors (67.74 total
  variances)
• Knowledge about culturally specific interventions
• Knowledge about termination
• Knowledge about assessment
• Knowledge about clients problem definitions
• Knowledge about case planning
• Knowledge about culturally-based behaviors
• Knowledge about cultural expectations

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Knowledge Both Groups

• Similarities
• Cultural Specificity
• Assessment
• Problem Definition
• Behavior

• Differences
• Group 1
• Information-Based
• Group 2
• Intervention Stages

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Discussions

• Validity
• The results have reached the purpose
• Assessing the viability and readiness of using
  the ASK in education and practice

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Finding 1 Differences in factorizing the items
in the ASK areas in terms of perceived importance

• Students
• Stress the important of cultural meanings and
  values
• Emphasize the evaluation of barriers and resources

• Practitioners
• Stress the development of concrete skills and
  ideas in working with clients
• Emphasize the evaluation of professional
  attributes and skills across intervention stages

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Explanations

• Students responses may not be based on actual
  practices
• The perceived importance level of each of these
  items may be a function of practice experiences

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Suggestion 1

• Discussion of practitioners responses among
  social work students as a means to address
  cultural competence from a practical perspective

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Finding 2 Excessive number of items in this
instrument

• Reflected in the extreme high score of the
  reliability coefficient (.97)
• The optimal alpha coefficient value for a scale
  .80 - .90
• ? excessive items
• ? overlapping dimensions
• ? general redundancy within the variable
  domains

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Suggestion 2

• Items with low loadings and overlapping contents
  be considered initial targets for removal or
  consolidation
• By using the factor loading of .50 as a cut-off
  point, further examine the following variables
  for possible consolidation
• Five attitude variables (31, 32, 45, 48, 75)
• Six skill variables (09, 29, 40, 41, 42, 82)
• Three knowledge variables (04, 49, 76)

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• These variables represent greetings, information
  sharing, clients perspectives and meanings,
  cultural learning, and outcome evaluation
• In five of the seven phases
• Two Contact items
• Three Problem identification items
• Five Assessment items
• One Intervention item
• Two Evaluation items

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Recommendations

• Original design
• A self-assessment tool in practice training
• Facilitating work with clients
• Factor analysis results differ between students
  and practitioners
• Social work educators be sensitive and design
  curriculum that will help students understand the
  importance of including certain multicultural
  aspects from practitioners view before assessing
  their own cultural competence

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Recommendations

• Not an outcome evaluation tool or
  performance-based measure for the purposes of
  recruitment or promotion
• Use of all items with caution at this point
• Further tested with inputs from workers and
  supervisors
• Identify educational areas for students
  potential caseworkers

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Short Version of ASK Based on Practitioners

• Attitude
• Openness
• Clients Willingness
• Learning from Clients
• Previous Experiences as a Guide Only
• Skill
• Openness
• Clients Meaning Reflections
• Clients Strengths
• Goal-Oriented Assessment of Clients Behavior
• Knowledge
• Alternatives
• Goal-Oriented Learning of Clients Culture
• Outcome Evaluation

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Cultural Competence Self-Assessment Tools

• The self assessment results can help
  practitioners identify their strengths and
  weaknesses
• The continuous use will result in
• An enhanced cultural sensitivity for both
  caseworkers and supervisors
• A heightened sense of awareness
• An ability to better serve the needs of diverse
  clients

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Q A

• Dr. Patrick Leung pleung_at_uh.edu
• Professor of Social Work
• Graduate College of Social Work
• University of Houston
• 713-743-8111