PSYC FPX 4900 Assessment 1 A Cultural Crisis with a Lack of Professional Competency

PSYC FPX 4900 Assessment 1 A Cultural Crisis with a Lack of Professional Competency

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Capella University

PSYC FPX 4900 Psychology Capstone Project

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Date

A Cultural Crisis with a Lack of Professional Competency: A Case Study

Lucia Cordova, a 32-year-old Hispanic woman, serves as the primary caretaker for her grandmother, Elena Cordova. Elena moved in with Lucia and her husband Martin about five years ago after the passing of her own husband. Recently, Elena has exhibited signs of potential memory issues, such as getting lost on her way home from the park. In one instance, the police found her and returned her home after Lucia and Martin became concerned when they couldn’t locate her in the neighborhood. On another occasion, they found her two miles away in a supermarket parking lot. Lucia expressed her concerns about her grandmother possibly having Alzheimer’s disease to her friend, Hannah Kennard, a school counselor at Cargill Academy.

The conversation took place while they were volunteering at Habitat for Humanity. Hannah referred Lucia to Dr. Bhandari, a specialist in memory and aging. However, Elena was upset that Lucia had arranged the referral without discussing it with her first, as Elena believed her issues were simply due to a lack of sleep. Despite her grandmother’s objections, Lucia took Elena to see Dr. Bhandari. During the visit, a nurse took Elena’s vital signs without explanation, and Dr. Bhandari, of Indian descent, only realized that Elena did not understand English very well after entering the room. Consequently, Dr. Bhandari directed her communication to Lucia instead. However, Lucia struggled to fully understand the doctor due to her thick accent. Lucia believed she understood the doctor’s request for some tests for her grandmother, but she did not explain the details to Elena, leading to Elena’s anger upon returning home, possibly due to the treatment she received from both Lucia and Dr. Bhandari.

Addressing Cultural Differences and Competency

This case study highlights significant gaps in cultural competency, particularly in the interactions involving Hannah, the school counselor, and Dr. Bhandari’s medical practice. It also reflects the complexities of identity at the intersection of multiculturalism, familism, and cultural contextualism within the Cordova family (Comas-Díaz, 2012a; Anzaldúa, 1987; Moya, 2001). Lucia exhibits what is known as a “crossroads identity,” where she navigates between her Hispanic culture and the dominant American culture. However, Elena may embody a different aspect of racial identity development, possibly showing a lack of tolerance for those outside her ethnic group. Familism, which emphasizes strong family bonds and interdependence throughout life stages, is evident in both Elena and Lucia.

In contrast, the dominant culture often prioritizes independence depending on an individual’s stage of life. Hannah and Dr. Bhandari failed to demonstrate cultural awareness and sensitivity, leading to a lack of cultural contextualism and syncretistic spirituality in their interactions with Elena and Lucia. These shortcomings in cultural competency can have detrimental effects on professional conduct, particularly in clinical practices like medicine and therapy, where understanding and respecting cultural differences are crucial for providing effective care. Without adequate training in cultural competency, healthcare professionals risk causing harm to clients, particularly in a multicultural society like the United States (Hays, 2016; Capella University, n.d.).

An Analysis of the Issues

Hannah and Dr. Bhandari’s interactions with Lucia and Elena revealed a lack of cultural competence, impacting the quality of care and support provided. These cultural differences not only created ethical dilemmas but also highlighted the potential for similar issues to arise in the care of other Hispanic Americans or individuals from different ethnic backgrounds if cultural competency is not adequately addressed through training and skill development.

Cultural Issues

Hannah and Dr. Bhandari did not appropriately consider Lucia’s role as a middle-aged Hispanic American woman and caretaker or Elena’s status as an elderly, recently widowed Hispanic woman before making referrals for dementia testing. This oversight aligns with Hays’s (2016) model of addressing cultural differences, which emphasizes the importance of considering factors like age, gender, assumed diagnosis, ethnicity, religiosity, and socioeconomic status (Capella University, n.d.). Neither Lucia nor Elena’s age was adequately considered in a culturally relevant manner, reflecting a broader issue in how non-Hispanic Americans may approach these factors. Hannah could have provided Lucia and Martin with evidence-based coping strategies and asked more detailed questions about Elena’s history, including her religious beliefs, spiritual practices, familism, and potential experiences of depression or anxiety following her husband’s death. Similarly, Dr. Bhandari could have ensured that her medical practice was trained in cultural competency, which might have prevented the negative experience Elena had during the visit. Addressing the language barrier with an interpreter from the outset would have been a crucial step in providing culturally competent care. Without such interventions, Hispanic individuals, particularly middle-aged women and elderly individuals, may continue to face challenges due to professional bias and a lack of cultural competence.

Theoretical Issues: Cultural Identity Theories

The cultural issues in this case can be further understood through the lens of cultural identity development theories, such as the cross-identity approach and familism, as well as cultural competency models that emphasize ethical contextualism and syncretistic spirituality within a late-stage adulthood developmental framework. These psychological theories help explain the cultural dynamics at play. The cultural identity development theories of multiculturalism and familism highlight the importance of cultural analysis, which Hannah failed to apply when interacting with Lucia and Elena. For instance, Lucia may need healthier coping strategies as her grandmother’s caretaker, but stress management techniques tailored to Latina Americans were not considered or discussed. Lucia might be navigating her role as a caretaker while balancing her identity within both American and Hispanic cultures, whereas Elena may be more rooted in familism, which emphasizes the responsibilities family members have towards one another, especially in caring for elders. This cultural misalignment likely contributed to Elena feeling disrespected by Lucia’s decisions. The failure to address these cultural factors, such as cross-identity and familism, potentially caused harm to both Lucia and Elena.

Cultural Competency Approach

In light of the need for greater cultural competency in healthcare, a client-oriented model is essential. Stefano et al. (2019) suggested that integrating various perspectives on cultural competency could enhance healthcare delivery from staff interactions to patient care. For example, ethical contextualism, syncretism, and an understanding of developmental stages are interconnected through professional training, skill development, and attitudes toward diversity. Comas-Díaz (2012a) emphasized that ethical contextualism is crucial for maintaining healthy and productive clinical relationships, reducing ethical dilemmas, and adhering to the American Psychological Association (APA, 2016) standards, including guidelines for cultural diversity competency. This approach requires professionals to be not only trained in cultural competency but also respectful of multicultural contexts, proficient in problem-solving, and committed to valuing human dignity, liberty, and justice (Comas-Díaz, 2012a; Fisher, 2009). However, Dr. Bhandari and Hannah struggled with applying ethical contextualism and did not consider syncretistic spirituality, focusing only on Elena’s late-stage adulthood.

Professional Behaviors

As a result, both professionals failed to demonstrate competency in referring and treating Elena and Lucia. In addition to their lack of diversity training, they did not address Elena and Lucia’s ethnicity or nationality. Both are Latina, and further issues may involve familism, multiculturalism, religiosity, and grief. Hannah did not explore primary cultural identity issues or coping strategies with Lucia, nor did she address potential grief and traditional healing opportunities for Elena before making referrals. Her actions did not align with the APA (2017) suggested guidelines for cultural diversity. Similarly, Dr. Bhandari may have assumed that Lucia and Elena spoke English and could clearly understand her accent. Once she realized that Elena did not speak English well, she ignored her and spoke directly to Lucia. This oversight in healthcare cultural competency suggests that Dr. Bhandari and her medical team lacked proper training, even though diversity training is recommended but not mandatory for licensed practitioners within the American Medical Association (AMA, 2018). The AMA initiated a plan to improve equity in 2018, but more progress is needed.

Global Attitudes and Political Ethics

Attitudes related to diversity, ethnicity, and culture have been persistent issues globally. Unfortunately, differences from the perceived authority of the majority have often been viewed as separate and inferior, a negative aspect of humanity throughout history. For example, the first murder recorded, recognized by Abrahamic religions like Judaism, Islam, and Christianity, was committed by Cain against his brother Abel (Wikipedia, n.d.). Various interpretations of this act have been debated over centuries, with many agreeing that greed and jealousy were the primary motives. Thomas Hobbes (1588—1679), a well-known philosopher, is recognized for his work on social and political regulation, particularly the development of social contracts. He concluded that humanity is inherently selfish, self-centered, and fearful (Williams, n.d.). However, Jean-Jacques Rousseau (1712—1788) argued that while society may sometimes act on these negative traits, people are also capable of compassion, empathy, authenticity, and growth without projecting responsibility onto others (Bertram, 2017).

Adversity on Diverse Cultures

Female Latinas, whether religious or not, in various socioeconomic conditions and at different ages, may avoid seeking psychological or medical help due to a lack of cultural competency. Lucia, who cares for her elderly grandmother, may need a range of referral options not only for Elena but also for herself. Elena may be experiencing something other than dementia, possibly related to the loss of her husband five years ago. Therefore, further research is necessary to explore other possibilities and alternative solutions.

Research Findings

This section presents research methods and findings from two studies, along with an analysis, to offer potential solutions and future prevention strategies for the issues highlighted in the case study.

Ostir et al. (2004)

While this study is not recent, it directly relates to the case study and offers relevant insights. Ostir and colleagues conducted a clinical case study involving older Mexican-American women to understand the effects of positive emotions and functioning. It aimed to determine whether attitudes and emotions influenced daily activities among elderly Mexican-American women. The authors argued that aging involves biological, psychological, and social processes, and maintaining a positive outlook can improve mental and physical functioning, even for those in their 80s. Positive emotions are correlated with longer, healthier lives and may even reduce the risk of heart attacks and strokes.

The study found that although positive emotions declined as people aged, those who maintained them were more likely to lead healthier lives. These findings have important implications for Hispanic women like Elena. Given that she has experienced several adverse events in the past five years, exploring positive emotions as part of her care could be beneficial. Additionally, cultural competence on the part of Hannah and Dr. Bhandari could have prevented some of the negative experiences she encountered.

Comas-Díaz (2012b)

Comas-Díaz’s study aimed to determine how positive psychology could help Latina women navigate spiritual and emotional adversity. She argued that traditional healing practices, when combined with positive psychology, could be more effective than solely using Western psychological theories. Comas-Díaz found that positive psychology could enhance emotional and spiritual healing among Latina women by integrating traditional practices. These findings have significant implications for healthcare providers like Dr. Bhandari, who may not be familiar with traditional healing practices. If Dr. Bhandari had been culturally competent and had knowledge of these practices, Elena’s experience might have been more positive. Furthermore, Comas-Díaz’s work suggests that positive psychology and traditional healing practices can work synergistically, providing Latina women with a more holistic approach to health and well-being.

Analysis

While Ostir et al.’s (2004) study focused on Mexican-American women, and Comas-Díaz’s (2012b) work targeted Latina women in general, both offer valuable insights into the cultural issues highlighted in the case study. Both studies emphasize the importance of positive emotions and cultural competence in providing effective care to Hispanic women. The findings suggest that healthcare providers should be trained in cultural competency and be open to incorporating traditional healing practices into their treatment plans. This approach could help prevent some of the issues that Elena and Lucia encountered and provide a more holistic and culturally sensitive approach to care.

Analysis of the Case Study: Strengths and Weaknesses

Lucia’s character is portrayed as a “good caretaker” who took her grandmother to a memory specialist. However, she did not consider using a translator during the doctor’s visit and struggled to understand Dr. Bhandari’s thick accent. Lucia was uncomfortable when Dr. Bhandari bypassed her grandmother and only spoke to her, without understanding the cultural implications of her actions. Additionally, Lucia did not explain the doctor’s recommendations to Elena, which resulted in further tension.

Strengths

Lucia demonstrated strength in her willingness to care for her grandmother, despite the challenges she faced. She also showed resilience in navigating her dual cultural identity as both a Hispanic woman and an American. However, her lack of cultural competence in the medical setting highlights the need for greater awareness and training in this area.

Weaknesses

The case study reveals weaknesses in the healthcare system’s ability to address cultural differences. Dr. Bhandari’s lack of cultural competence and failure to consider Elena’s language barriers and cultural background resulted in a negative experience for both Elena and Lucia. Similarly, Hannah’s lack of cultural awareness in her referral process contributed to the challenges Lucia and Elena faced.

Future Prevention and Solutions

The case study suggests several potential solutions for preventing similar issues in the future. First, healthcare providers should receive training in cultural competency, with a focus on understanding the unique cultural and linguistic needs of Hispanic patients. This training should include practical strategies for overcoming language barriers, such as using translators or culturally appropriate communication techniques. Additionally, healthcare providers should be open to incorporating traditional healing practices into their treatment plans, recognizing the value of these practices in promoting emotional and spiritual well-being. Finally, the healthcare system should prioritize diversity and inclusivity, ensuring that all patients receive care that respects their cultural background and meets their unique needs. By implementing these strategies, the healthcare system can better serve Hispanic patients and other diverse populations, ultimately improving patient outcomes and promoting health equity.

Monserud (2019) conducted a contemporary, mixed-method cohort study to explore potential solutions for Hispanic marriage, aging, widowhood, and depressive patterns. The study involved 1,452 noninstitutionalized Mexican Americans aged 65 and older, using data from the H-EPESE across seven stages between 1993 and 2011. The longitudinal analysis offered comprehensive insights into aging, the significance of marriage, and the effects of widowhood on the psychological health of elderly individuals. Unlike Ostir (2004), Monserud (2019) extended the research by introducing specific interventions post-widowhood aimed at supporting the mental and physical health of Mexican Americans. The study measured outcomes based on various factors, with sex and immigration status treated as time-invariant variables calculated in stages 1 or 2, while the remaining variables were considered time-varying throughout the study.

All variables were centered at zero to aid interpretation, and missing values were addressed using a Stata command, with most variables having less than 2 percent missing data. Depressive symptoms were assessed at each stage using the Center for Epidemiologic Studies Depression Scale (Radloff, 1997), and age was measured at each location, centered at 65 years old in the growth curve model. Marital status was divided into three categories: recently widowed, continuously widowed, and married, to capture variations over time across each stage. Chronic conditions were documented to identify any health issues participants experienced during each phase. Financial strain, social support, and religious service attendance were measured at each stage based on risk factors, resources, and the availability of family and religiosity. The findings revealed that women, particularly those recently or continuously widowed, experienced more depressive symptoms than men, with symptoms increasing with age. However, physical health, social support, financial challenges, and church attendance were significant factors that influenced depressive symptoms and marital status longevity for both genders.

Case Study’s Relation and Potential Intervention

This research is pertinent to the case study as it evaluates depressive symptoms, widowhood, stress factors, and interventions among older Hispanic Americans, which could be relevant to Elena’s situation. For instance, losing her husband within five years places her between recently and continuously widowed, potentially explaining some of her forgetful symptoms. Additional stressors like financial and social support issues may have affected Elena after her husband’s death, as she now lives with her granddaughter. Interventions to improve her physical and psychological health could include attending more religious services and participating in programs focused on physical and emotional well-being. Rabinowitz et al. (2009) found that increased religious service attendance positively impacts older Latina females’ overall well-being, particularly those with dementia, depression, anxiety, and their Latina caregivers. Therefore, coping strategies like syncretistic spirituality, psychotherapy, and increased religiosity for Lucia and Elena could improve their conditions.

Proposed Cultural Guidelines and Competencies

Cultural competency training should be mandatory for professionals working with diverse cultures, especially in fields like medicine and school counseling, where such contact is frequent. Training ensures that professionals possess the necessary knowledge, skills, and attitudes to demonstrate cultural competence. However, the APA (2017) and AMA (2018) have shortcomings in their training programs, as not all graduate or doctoral programs include these trainings. While the APA (2017) has expanded its guidelines since 2002 and offers training, some research suggests these programs may not be effective. For instance, Kleinman and Benson (2006) argued that cultural competency training might be perceived as intrusive by patients and could even contribute to stigma. Similarly, a systematic review by Lie et al. (2011) found limited evidence of a positive relationship between cultural competency training and improved patient outcomes (see also Renzaho et al., 2013). Despite these criticisms, some institutions claim the training is effective because they offer it, such as universities and licensing bodies. Recent research, however, suggests that it may reduce the negative mental, emotional, and behavioral impacts during healthcare encounters, as seen in Lucia and Elena’s case (Flynn et al., 2020). More research and possibly standardizing training methods could help, as noted by Jernigan et al. (2016).

Competency Skills with Apprenticeship

Psychologists today can practice the ten guidelines set by the APA (2017) through not only formal education but also an unpaid apprenticeship with diverse therapists for 10 hours every two years for re-licensure. This apprenticeship is separate from the internship hours required for initial licensure and would apply to all mental health professionals, regardless of ethnicity or nationality. Competency in cultural sensitivity, awareness, professionalism, contextual intervention, and appropriate prevention is essential for all mental health professionals. For example, addiction counselors are required to complete 10 hours of continuing education units in ethics every two years, along with 40 to 60 hours of professional and personal growth to renew their licensure or certification. An apprenticeship offers invaluable learning, as some of history’s greatest minds, like Patrick Henry, were self-taught through such methods. Henry, a self-trained attorney, passed the Virginia Bar to practice law despite his lack of formal education. Although most people now learn through formal education, trade schools and apprenticeships remain valuable avenues for acquiring practical knowledge and wisdom.

Internships

Internships, however, have sometimes been misused for tasks like office cleaning or secretarial work. These hours are intended to provide hands-on experience with clients, but without appropriate supervision, interns may develop bad habits, such as egotism. As a former owner of a small college in California, I have heard many stories from interns about their experiences, both positive and negative, during their internships. Therefore, a solution lies in an action that must be completed before licensure renewal, ensuring that training is eventually completed, but the apprenticeship remains ongoing.

Additional Guidelines

Potential guidelines could combine the APA’s (2016) ten guidelines with a traditional apprenticeship and additional insights, especially concerning language. Professionals who do not speak the language of their clients should have an interpreter to facilitate communication, ensuring fluidity during appointments. However, this could also create a sense of being singled out. A possible solution could be to have cultural, social representatives (e.g., bilingual social workers) for each culture to act as liaisons between professionals and clients. This approach could prevent clients from feeling spotlighted due to their ethnicity or creed. For example, a White female English speaker might also have a cultural, social representative when working with a diverse psychologist whose first language is not English, as in the case of Lucia, Elena, and Dr. Bhandari.

The Client-Oriented Model

To further explore cultural competency models, Di Stefano et al. (2019) proposed the client-oriented model, which emphasizes a client-centered approach. This model includes measurable dimensions that define a culturally competent organization, but it can also be adapted for individual psychologists. The model’s six dimensions include: 1) having a formal written mission, vision, and values that reflect the importance of cultural competence; 2) providing services to a diverse population with culturally competent referral sources; 3) taking care of oneself and other staff to avoid burnout; 4) having the knowledge, skills, and awareness of clients’ cultural characteristics; 5) maintaining active community alliances to communicate effectively with those served; and 6) conducting continuous self-assessment to review potential biases and pursue professional growth in multicultural awareness. This client-oriented model offers a comprehensive framework for cultural competency.

Application of Cultural Competencies in Case Study

To apply cultural competency skills and guidelines to the case study involving Hannah and Dr. Bhandari, adherence to these guidelines, skills, and attitudes is essential. Using the client-oriented model will improve outcomes for Lucia, Elena, and others from diverse cultures. By employing the revised guidelines and an enhanced cultural competency model with reliability and validity, professionals can effectively address culture-related issues.

Conclusion Statement on Culture

Personal Plan of Cultural Sensitivity

Currently, I am actively enhancing my cultural sensitivity by continuing my education, in line with the suggestions I have made. As an addiction professional, I stay current with all required continuing education units needed for license renewal every two years. Additionally, I provide continuing education to other professionals, staying up to date with diversity training while incorporating my unique approach. For example, I use horses in professional growth workshops to bridge cultural gaps, as horses communicate in a way that resonates universally with humans. As a provider of continuing education, I prepare in advance by researching the cultural backgrounds of the individuals or groups I will work with. After nearly 30 years in the field, I have learned to be adaptable in all situations, understanding that individuals from any culture do not want to be singled out for their differences. I strive to treat everyone equally and to be well-prepared for each professional engagement. In my private practice, I refer clients to colleagues of the same culture if appropriate, ensuring they receive the best possible treatment, which I believe demonstrates true competence.

Guidelines as a Professional Moving Forward

The procedures I have developed will help me remain aware of what I need to do as I continue working with clients in the future. Expanding my knowledge, skills, and attitudes will enhance my cultural competence. Although I am currently semi-retired, I look forward to potentially writing a book one day. Nevertheless, I will continue to improve my cultural awareness to increase objectivity in my practice and writing. The guidelines have opened my eyes to aspects of communication and reasoning I had taken for granted, and I am committed to furthering my education, both academically and in life.

References

American Medical Association. (2018). AMA annual house delegates meeting: Board report 33, A-18, a “Plan for continued progress toward health equity D-180.981. [PDF]. https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justiceand-advance-health-equity

American Psychological Association. (2016). Ethical principles of psychologists and code of conduct. http://www.apa.org/ethics/code/

American Psychological Association. (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. Retrieved from https://www.apa.org/about/policy/multicultural-guidelines

American Psychological Association. (2019). APA style manual (7th ed.). https://apastyle.apa.org

Di Stefano, G., Scrima, F., & Parry, E. (2019). The role of organizational culture in the relationship between high-performance work systems and work-related stress. Journal of Business Research, 119, 420-430.

PSYC FPX 4900 Assessment 1 A Cultural Crisis with a Lack of Professional Competency

Flynn, A., & Perry, B. (2020). What is required to be culturally competent? Why some training programs are better than others. Counseling Today, 63(1), 16-23.

Jernigan, M. M., Williams, M. T., Skinta, M. D., Lyons, H. C., & Henze, K. T. (2016). Strategies to improve diversity and inclusion in psychology. The Behavior Therapist, 39(7), 235-241.

Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Medicine, 3(10), e294.

Lie, D., Lee-Rey, E., Gomez, A., Bereknyei, S., & Braddock, C. H. (2011). Does cultural competency training improve patient outcomes? A systematic review and proposed algorithm for future research. Journal of General Internal Medicine, 26(3), 317-325.

Monserud, M. A. (2019). Widowhood and depressive symptoms among older Mexican Americans: The role of financial strain, social support, and church attendance. Journal of Aging and Health, 31(10), 1879-1902.

Ostir, G. V., Ottenbacher, K. J., & Markides, K. S. (2004). Onset of frailty in older adults and the protective role of positive affect. Psychology and Aging, 19(3), 402-408.

Rabinowitz, Y. G., Hartlaub, M. G., Saenz, E. C., Thompson, L. W., & Gallagher-Thompson, D. (2009). Is religious attendance associated with less depressive symptomatology among older adults? Journal of Aging and Health, 21(6), 730-748.

Radloff, L. S. (1997). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.

Renzaho, A. M., Romios, P., Crock, C., & Sønderlund, A. L. (2013). The effectiveness of cultural competence programs in ethnic minority patient-centered health care—A systematic review of the literature. International Journal for Quality in Health Care, 25(3), 261-269.