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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
[email protected]
206-398-4010
• 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
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Knowledge
Geography
Belief
Art
Law
Class
Race
Income
Education
Morals
Sexual orientation
Gender
Customs
Capabilities, and
Habits.
The Iceberg theory of culture – those
things that are most deeply
held are beneath the service
Culture
Visible
• Style of dress
• Holiday customs
• Music
• Arts
• Gestures
• Foods
• Rituals
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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
https://www.aamc.org/download/54338/data/culturalcomped.pdf
Knowledge
• Has the student learned the key core crosscultural 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 natural
Group 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 Avoid direct conflict and focus
face is less important
on face
Monochronic
Time
Orientation
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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
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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
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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
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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
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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 nondiagnostic, 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 HASTINGS RACE & POVERTY L.J. 131 (2006)
Test your own bias at
https://implicit.harvard.edu/implicit/
• 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 consciousunconscious divergences
• Called the Implicit Association Test, or IAT
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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
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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!