#AmIQualified: Let’s talk about moving from cultural competence to cultural humility

​By: Dr. Kyomi Gregory, PhD, CCC-SLP
With: AC Goldberg, PhD, CCC-SLP & Vivian Tisi, MA, CCC-SLP
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Special thanks to Vivian for proposing the concept of #AmIQualified. We can ask ourselves this as SLPs who treat a broad range of individuals, as we push toward and through cultural humility.

What does culture mean to you?

Tell me what is most central to your identity:
 
Is it your age?
Disability?
Ethnicity?
Gender?
Sex?
Sexual orientation?
National origin?
Language?
Race?
Religion?
Veteran status?
… or something else?
 
If you had a hard time choosing one you probably, like most people, fit into more than one category. Oftentimes culture operates at a place of intersectionality. One box does not fit all areas of your cultural identity. Culture is the fabric that makes you who you are and is always evolving. But importantly, our assumptions about culture shape our interactions with our clients. These are the invisible biases that can prevent a clinician from being qualified to practice.

Traditionally as a field, we have focused on reaching cultural competence. But competence is just the first step toward a process of lifelong learning about culture. Cultural competence suggests that clinicians can complete a course or class to achieve competence, that learning could mostly end there, and/or that cultures are finite (which mostly just risks stereotyping individuals). This definition is problematic in our ability to serve diverse populations in this profession. A more encompassing term that involves self-reflection/self-critique, learning from others, partnership building, and the lifelong process of learning is “cultural humility.”
 
Tervalon & Murray-Garcia (1998) define cultural humility as a lifelong commitment to self-evaluation and self-critique that addresses the power imbalances in the patient–physician dynamic and focuses on developing mutually beneficial and non-paternalistic clinical and advocacy partnerships within communities. This model applies equally well to the profession of Communication Sciences and Disorders (CSD). We use models of caregiving that are often based on medical models in a variety of settings. The concept of cultural humility differs from the expectation of certified CSD professionals, which is that most will demonstrate cultural competency based on the standards of the American Speech–Language–Hearing Association (ASHA), our professional organization and certifying body. We now know that cultural competence is not a finite skill but should be considered an ongoing process that would be coupled with cultural humility known as “cultural competemility” .
 
As clinicians aim to achieve cultural humility, we must address the conscious and unconscious beliefs that shape our perspective of a particular culture. No one is part of a monolithic culture. In fact, our clients hold multiple identities that make them who they are. For next steps on this topic, please see the article “Moving forward as a profession in a time of uncertainty,” as well as future articles from us and contributors using the hashtag #AmIQualified.
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We welcome other bloggers, thought leaders, and anyone interested in joining this discussion to use the hashtag #AmIQualified along with us to connect our conversations with one another.