Sample Healthcare Paper on Intersectionality, Cultural Humility, and Mental Health Treatment

Cultural awareness is a fundamental clinical practice standard within the social work profession and it is usually reinforced by the personal-centered approach of profession (Zeitlin, Altschul, & Samuels, 2016). Even though the engagement of social workers is guided by person-centered theory with unconditional positive regard in helping to have an understanding of the client’s worldview, the prevalent problem common to the social work practice is the failure to integrate cultural awareness in the mental health settings (Rogers, 2006). The code of ethics of NASW (2015) requires that it is mandatory for social workers to have an understanding of the functions of culture in both the society and lives of clients.

The provisions of NASW (2015) also bestow the obligatory responsibility of social workers to develop skills needed in facilitating the process of working effectively with diversity and obtaining knowledge of other cultures. In 2018, the standards of cultural competency were revised by NASW, a situation that led to the consequent development of the indicators and standards for cultural competence in the practice of social work. Intersectionality and cultural humility were identified by these revised standards as the indicators of social work practice (NASW, 2018). This qualitative study will use an action research approach to examine the clinical behaviors that help in demonstrating intersectionality and cultural humility in mental health treatment.

The study will seek to promote social change by advancing its contribution to the literature regarding cultural awareness in matters concerning social work practice. In this capstone project, the paper will be divided into two main sections. The first section will seek to describe the problem inhibiting the integration of cultural awareness within the settings of mental health, the description of the purpose, nature, and significance of the study followed with the theoretical framework that acted as the guidance for the study. The literature review describes the historical context, summary of current clinical applications, and the rationale supporting this study on intersectionality and cultural humility in mental health treatment. The second section offers description of research design and data collection process to explain the methodology adopted in conducting the study. The methodology section includes a description of the participants, procedures of recruitment, rationale for using zoom or telephone interviews for data collection, participants of the study, design of the study for obtaining informed consent and protecting participants, instrumentation, description of the data analysis process, and the study’s ethical procedure for ensuring that the study’s participants are protected.

Problem Statement

            In mental health treatment, considering that there continues to be growth of diversity in the United States, for clinical social work to be effective, it is necessary for the practice to incorporate cultural awareness. It is unclear how cultural humility and intersectionality are specifically integrated into in social work practice in Washington, and this will be problem that this study seeks to address.  The study will more specifically examine the clinical behaviors that the social workers use in demonstrating cultural humility and intersectionality when offering mental health treatment to patients. Cultural humility is the awareness of the privilege and power present in self-monitoring process and relationships to help in addressing any existing power imbalances. Cultural humility bestows the obligation upon social workers to recognize their distinctive positions of power so that they can actively be involved in mediating the imbalances in their relationships when working with diverse groups of clients. Cultural humility thus infers to the process by which social workers are effectively and respectfully responding to people of all diversity factors such as sexuality, races, cultures, languages, classes, ethnic backgrounds, and religions in ways communicating and protecting the worth and dignity of all individuals (Kohn-Wood & Hooper, 2014). Intersectionality is a concept that focuses on examining the prevalence of gender inequalities within the structures of power and confines of social relations (Ratts, 2017). Cultural awareness is regarded as the process by which social workers are effectively and respectfully responding to people of all diversity factors such as sexuality, races, cultures, languages, classes, ethnic backgrounds, and religions in ways communicating and protecting the worth and dignity of all individuals. Cultural awareness bestows the requirement on social workers in building positive working alliances with clients for the purpose of achieving positive treatment outcomes (Worthington Jr. & Utsey, 2013). Lee and Horvath (2014) conducted a study where they examined the adverse outcomes of treatment when there is lack of cultural awareness on the therapists’ dialog. The study found out that responses of the therapist helped minimize the cultural factors such as the moral values, beliefs, language, and traditions that are involved in the process of decision-making for the client. The actions of the therapist strained the working alliances consequently leading to the less engagement of the client in the treatment.

The problem pertaining to the ignorance of integration of cultural humility and intersectionality in the clinical social workers practice has been exhibited through the issues of implicit and explicit power differentials and acceptance and fostered therapy (Tourse, 206). An argument floated by Tourse (2016) is that the existence of explicit and implicit power differentials embedded within cultures is usually taken for granted. Social workers have ignored and continue to overlook cultural power dynamics and clients have progressively been disempowered in the process of treatment by identifying the behaviors that are culturally specific and imposing interventions that are culturally sensitive (Edwards, 2016). However, Edwards (2016) informed that the recognition of the client’s culture in treatment planning and mental health interventions is associated with an increase in the participation of client. The increase in participation of client in treatment consequently led to an increase in positive outcomes on mental health. Hook et al. (2013), support that there is occurrence of positive outcomes in mental health in strong therapist-client working alliances. Hook and his colleagues replicated four studies in their research to demonstrate how the existence of strong working alliances serves a significant role in predicting the improvement in functioning that the clients reported. The perception by the clients that the therapists have respect for their culture developed strong working alliances that served to demonstrate cultural humility (Hook et al., 2013).

According to Rogers (1957), there is the occurrence of effective therapy through the alliances of acceptance and fostered therapy. In unconditionally accepting environments, clients have the ability of exploring their states of incongruence. The states of incongruence are the discrepancies between the perceptions of the clients of self and the life situations, and these perceptions make the clients to experience emotional and mental distress (Rogers, 1979). The occurrence of internal conflicts is a contributing factor to the symptoms related to depression and anxiety. The existence of positive working alliances facilitates the provision of environments that allow clients to become involved in the change process. The purpose of mental health treatment is to serve in assisting clients through this change process tailored towards helping in the alleviation of associated symptoms, and this is the problem that this study will primarily seek to advocate for its solution in the delivery of treatment by ckinical social workers for the diverse population in Washington State. Understanding the culture of the client assist in building strong working alliances, but this also creates the possibility of causing power imbalances that can influence the working alliances (Berg, 2014). The revised standards of cultural competency have incorporated the concepts of cultural humility and intersectionality that facilitate the recognition of power dynamics (Tourse, 2016). Cultural humility and intersectionality are concepts responsible for examining oppression, privilege, and power present in societies and existing within the context of interpersonal relationships (Azzopardi& McNeill, 2016). Cultural humility and intersectionality are concepts responsible for examining oppression, privilege, and power present in societies and within the context of interpersonal, and have specifically bestowed their emphasis on the principles of social justice and the advocacy skills implementation (Danso, 2016).

In Washington State, cultural competence is an imperative requirement for clinical social work practice owing to the diversity of its population to ensure that every person’s unique needs are considered in the provision of mental health treatment services. The population consists of African Americans, Native Americans, Cuban Americans, Vietnamese Americans, Caucasians, Hispanics, LGBT (Lesbian, Gay, Bisexual, and Transgender persons), and large number of people living in poverty (U.S. Census Bureau, 2016). Washington State is unique from other States in America since it has the highest percentage of Hispanics approximated at a 48% of its total population (World Population Review, 2017). Of the total Hispanics population, 17% are immigrants from Latin America and 83% are native-born. Washington is third to Alaska and New Mexico in terms of having large population of Native Americans, estimated at around 16% of its total population (U.S. Census Bureau’s, 2016). Washington is one of the four States in America to have an ethically minority-majority population. Besides, about 10% of the residents of Washington live in poverty, and it is ranked 53rd as the poorest states in the U.S. (Center for America Progress, 2017). In addition, Washington is ranked as one of the top 5 States for the LGBT people (The Daily Best, 2018). Considering that Washington is culturally diverse with a considerable population still living in poverty, the needs of the community require service providers who are culturally competent.

In 2013, Washington suffered from mental health services across the State being abruptly terminated, and the situation made the grassroots community organizers to seek for having a holistic understanding of the mental health needs of the residents. The community organizer recorded 84 interviews and documented that Washington residents were experiencing long waiting lists to see mental health therapists, constant increased turnover rate of the mental health providers, and mental health services lacking cultural sensitivity. Washington houses high percentage of people living in poverty and homeless and its population is ethnically and culturally diverse, open to mixed sexual orientations (U.S. Census Bureau, 2016). Therefore, to adequately and effectively address the mental health needs of Washington’s population, the integration of cultural humility and intersectionality is necessary.

The practice that entails integrating cultural humility and intersectionality has been determined to be an imperative necessity to adequately address the mental health needs of the population in Washington State. The study will seek to explore how the integration of cultural humility and intersectionality helps social workers understand the client’s worldview during mental health assessment. It has been determined that there exists a gap between social oppression and power dynamics knowledge and their integration into clinical practice (Bubar, Cespedes, & Bundy-Fazioli, 2016). Therefore, based on this gap, when it comes to mental health treatment, it is still evident that there continues to be lack of effective clinical social work practice that incorporates cultural awareness, cultural humility, and intersectionality to address the needs of the ethnically and culturally diverse population. In this regard, the principal focus of this study will be tailored towards supporting the current efforts at the grassroots level seeking to improve mental health services in Washington by extensively researching the clinical behaviors in mental health treatment.

Purpose Statement and Research Questions

            The purpose of the research study will be to examine the clinical behaviors used in demonstrating cultural humility and intersectionality in the mental health in Washington State. The focus will thus be to determine how the integration of cultural humility and intersectionality help the social workers acquire knowledge and skills that enable them to exhibit suitable clinical behaviors needed to provide quality mental health treatments to clients from culturally diverse backgrounds. Person-centered theory will guide the research to facilitate the process of examining how the integration of cultural humility and intersectionality can be help to the social workers in understanding the worldview of the clients and their respective incongruence state.

Research Questions

            The study will focus on the following research questions:

  1. What clinical behaviors do social workers use in the different stages of mental health treatment (i.e., engagement, assessment, intervention, and evaluation) to convey cultural humility and address intersectionality?
  2. How does the training of social workers help in integration of cultural humility and intersectionality that enable them to acquire the appropriate knowledge and skills to understand the client’s worldview from diverse backgrounds needed to promote mental health assessment?

The study will contribute to the advancing of the professional practice of social workers in three distinct ways. The study will support the grassroots efforts that have been started in Washington State with the goal of helping improve services of mental health treatment. The study will examine the cultural awareness of social workers. The clinical social workers will provide examples of the successful interventions specific to the clients in Washington State. The study findings will contribute to the development of continuing education training for the community of social workers in Washington State. Besides, the findings of the study will provide the specific examples of clinical behaviors that are responsible for conveying cultural humility and intersectionality for complementing the studies conducted by Jani, Osteen, and Shipe (2016) aimed at developing cultural competency measures for social work. Also, according to Seedall, Holtrop, and Parra-Cardon’s (2014) review of 8 years of literature, additional research concerning the integration of cultural humility and intersectionality in the mental health treatment is needed to facilitate the process of educating therapists in the social work practice behaviors coupled with increasing their awareness on significance of understanding power dynamics in the delivery of treatment. Finally, NASW (2015) standards of cultural competency endorse the necessity to conduct research on such issues of cultural competency as humility and intersectionality.

Nature of the Study

This study will use basic qualitative methodology to understand how the integration of cultural humility and intersectionality helps social workers understand the client’s worldview and mental health assessment. The qualitative method design was chosen because of the collaborative nature to inspire social action, to demonstrate cultural awareness, and gather descriptive clinical behaviors. Zoom or telephone interviews will specifically be used to collect data. The zoom or telephone interviews will consist of 17 social workers recruited from different locations across the State of Washington. The rationale for using a small sample size of only 17 social workers is to help reduce the transferability and generalization of the data that will be collected. The use of zoom or telephone interview as a data collection method makes the study be an action research design, which will inspire social action as it is collaborative in nature to promote the collaboration between the researcher and the participants (George, Duran, & Norris, 2014). Action research is defined as the approach where the researchers and the participant collaborate in the diagnosis of a selected problem to foster the development of a practical solution. Action research applied to the context of this study as it will involve the collaboration between me as the researchers and the selected sample participants of social workers involved in clinical practice in Washington State to examine the demonstration of cultural humility and intersectionality in mental health settings. As a result, there will be a facilitated gaining of insights from the participants on the community issue of cultural insensitivity in mental health treatment to inspire social action in Washington State. In this regard, the interview process will promote and respect the cultural diversity of the participants since Washington is a culturally minority-majority state making it likely for diversity to be expected as a critical reflection in the social workers who will be selected for participation in the research process. The participants will have to be those who can be accessed online and telephone to facilitate the arranging for zoom or telephone interview process. There will be the inclusion of participants in the decision-making process during the research and the acknowledgment of their contributions will be a valuable approach for encouraging their participation in the research (Sheridan et al., 2013).

Participants to be interviewed will be the clinical social workers providing mental health treatment in Washington State. These participants will be recruited from the Washington State Department of Health list of approved clinical social workers supervisors available in Washington State Society for Clinical Social Work (WSSCSW) and NASW Washington chapter website.  Although the list is not all-inclusive of practicing social workers in Washington State, the social workers on the list possess the license that permits them to provide mental health services. The List is a public record which contains names of approved licensed clinical social work supervisors and their contact information, specifically mailing address, emails and mobile phone numbers. As a result, emails and phone calls will be majorly used to communicate with potential participants in the research. Phone calls will be made to the selected participants to seek for their consent and inform them of the request to engage in the research, on a voluntary basis. An introductory email will be sent to potential participants explaining the research project. Accepted participants willing to participate in the study will receive a follow-up email that will include the demographic sheet and consent form. The information provided by the participants will be kept confidential by not revealing their names, faces, or addresses to limit access to identifiable information and storing the data documents in locked locations.

            Cultural insensitivity has been identified to be on the rise in the mental health making it community issue in Washington State (Coghlan, 2016). Based on the consideration that cultural awareness is an ethical standard of social work practice, the action research will be the most appropriate approach for engaging Washington State clinical social workers in the research process, and the process will present the possibility of inspiring the participants to promote change (Buettgen et al., 2012). Because the study’s focus is clinical behaviors in the mental health treatment, the recruitment will be purposeful to help in obtaining participants with first-hand experience in the provision of mental health services. The two concepts that will be examined are cultural humility and intersectionality in the clinical social work practice. The use of zoom or telephone interviews will, therefore, help in gathering detailed rich data, and the data will be consequently analyzed and organized using thematic data analysis to look for common patterns and themes.