Cultural Awareness and Competence of Jamie R. Gervais Department

African Americans and the Healthcare System, Culturally Relevant Research Approaches, and Culturally Competent Strategies for Recruitment and Retention of African American Populations into Clinical Trials are some of the topics that will be covered in the document that is provided below, which is based on the Cultural Awareness and Competence. Additionally included in the paper are some practical principles, culturally sensitive research methodologies, social justice issues, and theories and methodologies. Below is also a discussion of technological communications and action plans.

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Cultural Awareness and Competence
Jamie R. Gervais
Department of Social Work, Capella University
SWK5012: Cultural Competence and Social Work Practice with Diverse Populations
Dr. Aldison Middleton-Hinton
December 17th, 2021

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Cultural Awareness and Competence
African Americans are one of the largest of many ethnic groups in the United States.
They are largely the descendants of enslaved people who were brought from Africa by force to
work in the New World and their rights were severely limited, in addition to being denied a
rightful share in the economic, social, and political progress of the United States. Despite all
challenges faced, African Americans have made basic and lasting contributions to American
history and culture. During and after the reconstruction period, African Americans in cities
organized historical, literacy, and musical societies. The blossoming of African American
creative talent in literature, music, and the arts in the 1920’s was focused in New York City and
known as the Harlem Renaissance. Similar to the Garvey Movement, it was based on a rise in
“race consciousness”. In addition, the black cultural movement of the 1920s was greatly
stimulated by African American journals, which published short pieces by promising writers.
While African Americans have made political progress through leaders such as Martin Luther
King Jr., movements such as the civil rights movement, and activist groups such as the NAACP,
many continue to face deep rooted, difficult social and economic challenges, especially in the
inner cities (Lynch, 2021).
I currently live and work in Little Rock, Arkansas, where African Americans make up
42.04% of the population and of that number, 24.72% live in poverty (Little Rock Arkansas
Population, 2021). Working on an inpatient behavioral health unit at a local hospital, most of our
patients are on Medicaid and live in poverty. Little Rock can be described as a city of two halves.
One side is to the east of I-30 and to the south of I-630, where it is predominately black and poor.
The other is to the west of I-430 and to the north of I-630,where it is predominately white and
more affluent. The city’s current geographically segregated housing patterns have been

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consciously created by public policy, with private sector collusion, and have been going on since
the 1950’s. The Federal Housing Act of 1949 began an aggressive racial redistricting of the city
in addition to private sector practices supporting public policy in creating a geographically
segregated city. In 1971, busing threatened to overturn the purpose of residential segregation by
forcing cross-city transportation of students to ensure integrated public schools but instead,
caused Little Rock to begin to see a sprouting of new private schools. Their locations once again
largely mirrored the city’s segregated housing patterns. This can be viewed as another wave in
the ongoing school building program in the city that has sought to reflect and reinforce
segregated neighborhoods. Other urban planning devices have also added to the creation of a
divided city, for example the construction of I-630, which drew a hard line across an already
segregated city (Kirk, 2014).
Differentiation in Diversity
The Black population of the United States is diverse. Its members have varied histories in
the nation as well as nuanced ethnic and racial identities reflecting intermarriage and
international migration. The result of this is key distinctions in demographic and economic
characteristics between different parts of the national Black population, highlighting its diverse
multitude of backgrounds. The Black population’s racial self-identification is also changing.
Among those who self-identify as “Black or African American”, the total number of individuals
who say it is their only racial or ethnic identification has declined over the past two decades. The
nation’s Black population is changing in other ways too. A growing number are foreign born, the
population is aging, and a significant number are college graduates (Tamir, 2021).

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African Americans and the Healthcare System
Working in healthcare, specifically behavioral health, I have witnessed the
socioeconomic factors that often make treatment options for African Americans less available. In
2018, it was reported that 11.5% of Black adults in the U.S. had no form of health insurance at
all (NAMI, n.d.). African Americans are also disproportionately more likely to experience mental
health issues and social stigma. Historical adversity has translated into socioeconomic disparities
experienced by African Americans today. African American mental health statistics show that
socioeconomic status is linked to mental health because people who are impoverished, homeless,
incarcerated or have substance abuse problems are at higher risk for poor mental health. Ongoing
stigma and lack of access to health care act as barriers for anyone with a mental health condition,
but research shows a particular disparity when it comes to minorities, especially African
Americans, which can contribute to individuals not receiving proper support or treatment to feel
better (Discovery Mood & Anxiety Program, 2019). In addition, Black people have historically
been negatively affected by prejudice and discrimination in the health care system in the US.
Provider bias, both conscious and unconscious, and a lack of cultural competency can result in
misdiagnosis and inadequate treatment which can ultimately lead to mistrust of mental health
professionals and create a barrier for many to engage in treatment (NAMI, n.d.).
Culturally Relevant Research Approaches
Research in social work involves conducting an investigation in accordance with the
scientific method with the objective to build the social work knowledge base in order to solve
practical problems in social work practice and social policy. Investigating phenomena in
accordance with the scientific method requires ultimate adherence to empirical principles, for

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example, basing conclusions on observations that have been gathered in a systematic,
comprehensive, and objective fashion (Rubin, 2009).
Traditional research consists of qualitative, quantitative, and experimental methods.
Although quantitative research has dominated the research conducted in counseling and other
helping professions, there is increasing recognition of the importance of qualitative research and
its fit with the values of the counseling profession, in general, and evidence-based practice, in
particular. There are clear values being used by clinical consumers of counseling research when
evaluating the importance of the research being done including fidelity, openness and
transparency, care for the research participants, competence, and beneficence, as well as
statistical, practical, and clinical significance, which are already strongly rooted in Western moral
philosophy. It is proposed that all research projects should provide evidence that the values of
fidelity, openness and transparency, care for the research participants, competence, beneficence,
and statistical, practical, and clinical significance be demonstrated in addition to researchers
having the obligation to clearly address these values in each stage of the research process. The
clinical significance of this research is related to practical significance, however, it is a more
narrow understanding of significance that is related to how helpful and how useful the research
findings are for clinicians. An example of this would be can counselors working with boys who
have been diagnosed with a conduct disorder make important level of care treatment decisions on
the basis of the research of Enebrink, Andershed, and Langstrom (2005)? According to their
research, boys presenting with lack of empathy, lack of emotionality, and callousness had more
severe and aggressive symptoms of conduct disorder than did boys diagnosed with conduct
disorder but who did not present with such symptoms (Duffy & Chenail, 2009).

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Due to statistical significance being such an important determinant of the value of
quantitative research findings, it is important for the researcher to understand the meaning,
appropriate uses, and limitations of the tests of statistical significance that are used in a study.
There is a long and important history of both empirical research and commentary in the
counseling field suggesting that researchers do not understand the purpose of limitations of the
statistical tests used in their research (Duffy & Chenail, 2009). To date, the use of the concept of
cultural competence in the context of research, compared to its use in the context of health care
providers in health care settings has been limited. Increasing demographic shifts require that
researchers better understand the potential role of racial and cultural differences among
population groups, how such differences may impact their research study design, analysis and
interpretation, and consequently how best to engage diverse populations in research. Overall,
cultural competence describes how researchers can be culturally prepared to consider the
aforementioned topics (Atim et al., 2009).
Cultural competence in research is the ability of researchers and research staff to provide
high quality research that takes into account the culture and diversity of a population when
developing research ideas, conducting research, and exploring applicability of research findings.
It plays a critical role in study design and implementation processes, including the development
of research questions and hypotheses, outreach and recruitment strategies, consent activities, data
collection protocols, analyzing and interpreting research findings, drawing conclusions and
presenting the results. Altogether, cultural congruence through these processes helps ensure the
research is applicable to diverse populations and can be adapted to meet the target population’s
social, cultural, and linguistic needs as necessary. Cultural competence in research is an all-
inclusive principle encompassing traditional nodes of scientific research including basic science

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research, clinical research, community-based participatory research, and community
engagement. For example, community-based participatory research starts with a research topic
that is of importance to a specific community with the goal to combine knowledge and action for
social change to improve community health and eliminate health disparities. A core element of
any research related to this is community engagement, which requires academic members to
become part of the community and community members to become part of the research team,
creatingre a unique working and learning environment. This concludes that an understanding of
cultural competence in research is not only required for successful and culturally safe
community-based participatory research and community engagement, but also for effective
research design, implementation, and recruitment of research participants (Atim et al., 2009).
Culturally Competent Strategies for Recruitment and Retention of African American
Populations into Clinical Trials
In the past, African Americans have suffered medical experimentation as well as poor
medical treatment which has resulted in hesitation when it comes to participating in research
activities. Barriers to African Americans’ participation in clinical trials include a lack of
awareness about trials, low socioeconomic status, mistrust, poor communication skills, and a
lack of disease education. Otado et al. (2015) proposed that these barriers could be overcome by
using appropriate and culturally sensitive strategies with regard to recruitment. It was also
emphasized that adequate minority representation is important if differential effects among
diverse groups are to be assessed and for the results to be generalized. The primary focus of this
research was to identify successful recruitment strategies, challenges, and best practices for
researchers to engage African American communities in clinical studies when taking into
consideration a target participants’ culture and context. The significance of this study was to

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conduct research on culturally competent recruitment strategies for African Americans in order to
better understand ways that can help researchers improve current strategies in order to increase
minority participation in clinical trials. This study examined (1) both successful recruitment
strategies and challenges in working with African American populations in general, and (2)
successful recruitment strategies utilized at an inner-city medical campus of a historical black
university (Otado et al., 2015).
Putting Principles into Practice: Addressing Historical Trauma, Mistrust, and
Apprehension in Research Methods Courses
Social work has stressed the importance of scientific inquiry and research since its
professional identity formation and there has been a continuation of attempts to ensure that the
research-based knowledge aspect of professional education was actualized through training,
practice, and scholarship. Due to student ambivalence toward research, some educators have
been encouraged to seek innovative approaches to ensure that student anxiety and reluctance
toward research courses are reduced. Ironically, given the profession’s insistence on giving
consideration to cultural competence, the educational literature often falls short on moving past
addressing generalized student research anxiety to explicitly discussing how schools develop and
implement culturally relevant research pedagogy that takes into consideration students who
represent diverse backgrounds and identities. Henderson et al. (2016) used historical trauma
theory to provide a framework for understanding the possible cultural context of anxiety in social
work research courses for African American students at Howard University. This provided a lens
for considering how pedagogical strategies might facilitate a supportive and affirming learning
environment that acknowledges the role of scientific research in the oppression and
marginalization of groups that social work students may belong to. This research analyzed

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guiding principles for constructing classroom exercises and activities that helped directly address
forms of student resistance and anxiety while offering students’ positive models and alternative
narratives about research that helps build student interest and course-related self-efficacy. This
approach to curriculum content development may offer greater insights into how institutions and
instructors intentionally develop and implement plans for learning environments that (a) support
diversity and difference, (b) consider the impact of oppression on the human experience, and (c)
nurture professionals who can critically engage, evaluate, and conduct research that promotes
social justice and improvement of quality of life for all. Henderson et al. (2016) identified that
educators designing courses that solely focus on achieving competency in practice behaviors that
are traditionally linked to research may risk missing an important opportunity to address and
integrate engaging ideologies for student learners that are also considered valuable to the
profession.
Culturally Sensitive Research Approaches: An African-American Perspective
Tillman (2002) explains that the purpose of this article was to contribute to current
discussions about the use of culturally sensitive research approaches within the field of
qualitative research. More importantly, was the use of culturally sensitive research approaches in
research focusing on African Americans by using cultural standpoints of both the researcher and
the researched as a framework for research design, data collection, and data interpretation.
Tillman (2002) states that culturally sensitive research approaches can lead to the development of
theories and practices that are intended to address the culturally specific circumstances of the
lives of African Americans because researchers rely on participants’ perspectives and cultural
understandings of the phenomena under study to establish connections between espoused theory
and reality and then go on to generate theories based on these endarkened perspectives.

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Antecedents of Discrimination
Racism is still common in today’s society and skin tone is a visible cue that activates
culturally embedded prejudices and stereotypes that can lead to race-based discrimination
(Adams et al., 2016). Slavery and post-slavery discriminatory laws and policies in the United
States were justified by the belief that Blacks were mentally and morally inferior than Whites.
The residual of those beliefs remains, more than two centuries after slavery was abolished, in
cultural stereotypes that depict Black Americans in a poor manner. It has been hypothesized that
the phenotypic appearance that makes Black racial heritage salient is particularly likely to
activate stereotypes, meaning individuals with darker skin are expected to experience more
discrimination than those who are light-skinned. Studies suggest that skin tone continues to have
consequences for the well-being of African Americans (Adams et al., 2016). Adams et al. (2016)
explains that research consistently shows evidence of skin tone bias with darker-skinned Blacks
facing more discrimination, lower socioeconomic attainment, and harsher penalties within the
legal system. Skin tone bias operates through an important mechanism referred to as stereotype
activation, which can lead to discrimination and prejudice and research results suggest that
educational attainment and racial identity may be mechanisms that Blacks can mitigate potential
negative effects of skin tone bias (Adams et al., 2016).
Influence of Culture on Attitudes, Values, Perceptions, Behaviors, and Interpersonal
Relations
Taylor et al. (2019) explains stereotypes as being ingrained in the fabric of the United
States and coinciding with the institution of slavery. These deeply held beliefs stem from White
racist attitudes that were sustained through oppressive and discriminating actions that idealized
how slaves should think and behave. The behaviors that are expected from African-Americans

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are exacerbated by stereotypes that are maintained by the status quo. African American
stereotypes are seen throughout US history and have had a negative impact on African-American
families and communities. Taylor et al. (2019) provides an example of this with the belief that
African Americans are unintelligent, lazy, violent, and criminals, which has affected educational
outcomes, employment opportunities, socioeconomic status, and the dismantling of African
American families and communities. The belief of these stereotypes from educators,
businessmen, and law enforcement influences the treatment received by African Americans.
Social Justice Concerns
Stereotypes are linked to biases, prejudiceness, and systemic discrimination, which play a
major role in educational outcomes, employment opportunities, disproportional incarceration
rates, and the brutal treatment of African Americans. Stereotypes tend to limit opportunities for
specific groups and this is correlated with poverty and a host of other negative outcomes in the
African American community. Systemic racism in schools, the workforce, and the justice system
perpetuates the negative stereotypes of African-American males, particularly, resulting in fewer
opportunities, lower educational and employment outcomes, and higher incarceration rates. This
all leads to a self-fulfilling prophecy. Throughout history African-Americans have consistently
been dehumanized, which is evidenced by the US constitution considering a slave three-fifths a
person, the legalization of slave lynching, the adoption of Jim Crow Laws, and most recently,
police brutality against unarmed African-American males (Taylor et al., 2019). When individuals
are degraded and dehumanized, over time, they begin to believe the stereotypes about their group
and internalize the oppression being experienced. By adopting the dominant group ideology, the
subordinate group accepts the status as deserved, natural, and inevitable. This can cause
individuals to suffer from identity threat, where they believe the stereotypes and identity

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contingencies assigned to them by the dominant culture. This is often seen in Black children who
are exposed to negative stereotypes about their culture, resulting in negative racial identities
(Taylor et al., 2019). Taylor et al. (2019) explains when students believe these stereotypes about
themselves, it affects their school performance which will impact the types of jobs they attain as
adults, their socioeconomic status, the communities they live in, as well as their family life.
Theories and Methods
Assisting African Americans with the stress they face through oppressive and racist
environments requires social workers to be willing to support them in coping with and
confronting the environmental factors and the consequential lack of resources. Social workers
can assist African Americans in addressing these psychosocial stressors and their sources by
using integrated treatment approaches that include the empowerment, ego psychological, and
Afrocentric theoretical perspectives (Manning et al., 2004). By integrating these theoretical
perspectives, social workers are capable of expanding their conceptual knowledge base as well as
their understanding of problems experienced by this population of people. These theories allow a
closer examination of both the internal and external factors that impact the lives of African
Americans and result in a more accurate assessment of the needs and relevant environmental
influences. These theories share similarities by emphasizing the strengths of African Americans
and the impact of the environment on their functioning, as well as providing a helpful and broad
framework for intervention practices. These theories and methods prepare social workers to
address more personal issues, like the impact of racism on an individual’s self-esteem, while
confronting broader issues of social injustice and inconsistencies in the environment. These
methods also encourage African Americans to advocate for themselves and build on their own
strengths (Manning et al., 2004).

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When considering the racism and oppression African American experience, it is
important for social workers to employ intervention strategies that prevent stress and strengthen
general health as well as mental health. By using an integrative approach when working with
African Americans, social workers support the development of a strong cultural and racial
identity through the enhancement of ego development. Using ego psychology as a theoretical
framework can easily incorporate empowerment, Afrocentric, and spiritual concepts. Through
the therapeutic process, the client is able to develop a more stable identity with his or her culture
and race while developing new coping strategies for dealing with oppressive environments
(Manning et al., 2004)
Technological Communications
When it comes to the integration of technology and client services, Smith (2014) explains
that African Americans are less likely than whites to use the internet and to have high speed
broadband access at home. This causes an overall 7% point gap between whites and blacks.
While internet use is fairly universal among young adults, the college educated, and those with
relatively high incomes, regardless of race, research shows that older Blacks are significantly
less likely to go online, with only 45% of African Americans 65 years and older reporting use of
the internet. This is the same among Blacks who have not attended college, compared to whites
who have a similar level of education. Smartphones have had an effect on bridging this gap,
while around 10% of African American adults indicate that they do not have a traditional
broadband internet connection, they do report owning a smartphone, narrowing the “high speed
access gap” observed between whites and blacks. This means that 72% of African Americans
have either a home broadband connection or a smartphone (Smith, 2014). With that being said it
is safe to assume the use of technology could be a beneficial way to communicate with

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individuals in the African American community, especially for those who struggle with limited
transportation, childcare, and other available resources.
Action Plan
Striving to eliminate oppression, discrimination, poverty, social injustices, and violations
of human rights continues to be an important goal for social workers. The NASW Code of Ethics
states that the primary mission of the profession is to enhance human well-being and help meet
the basic human needs of all people while focusing on those who are vulnerable, oppressed, or
living in poverty. Social Justice is a core value of the profession and coincides with the
importance of practicing from a human rights perspective to seek to understand the nature of
oppression that is experienced by African Americans, especially males, and address these
problems by advocating on their behalf, while providing culturally competent services that
ensure individuals receive basic human rights that have been identified by the Universal
Declaration of Human Rights. It is the responsibility of the social worker to understand the
client, despite differences in beliefs, values, or choices, as well as empower them to make the
best decisions for themselves (Taylor et al., 2019).
References

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