Rethinking practice with multicultural communities: Lessons from research-based applications

Social work recognizes “the power and possibility of story” (Burack-Weiss, Lawrence, & Mijangos, 2017). We listen to our clients’ personal narratives and establish relationships with them. But the power of eliciting people’s stories can also be applied to entire communities. Communities serve not only as a context for people’s lives but have a character, a story of their own. To understand what they consider we need to know about them and respond to their priorities is the aim of social work practice with multicultural communities.

Why, then, is there a disconnect between social work and multicultural communities? A survey of an African American community revealed overwhelming agreement that social workers can be a great source of comfort to people in times of need (Williams, Simon, & Bell, 2015), consistent with perceptions of the general population (LeCroy & Stinson, 2004). Yet there was significantly less agreement that social workers were sensitive to their needs. Most associated social work with child protection and child welfare agencies. Negative perceptions are influenced by client relationships with broader institutions. This is particularly evident among clients who are navigating multiple social barriers. For example, in her research Mackall (2018) found that adolescents in the juvenile justice system view social workers and other frontline workers as representing social institutions (associating them with police and detention staff), thus responding with distrust and further isolation. Under conditions of racial segregation, high poverty and unemployment, and lack of access to resources and opportunities, distrust in institutions often carries over to social service organizations (Plaza, 2017). The extent to which clients access services, often attributed to barriers related to provider cultural competence, has been found to be associated with a series of interconnected events in their lives, events that precede and eventually lead to contact with social service agencies (Lauck, 2000, p. iii).

These oppressive environments often eclipse the stories, the cultural richness of many communities—the totality of their life experience, their beliefs, social norms, and institutions. And so we don’t fully integrate this cultural richness into our social service systems. Yet, cultural background significantly influences encounters with social services. It shapes help-seeking behaviors, service use, satisfaction with services, and treatment outcomes.

The studies in this special issue offer tangible, empirically-based approaches to engaging with racial and ethnic communities and critically assess barriers and challenges posed by current models of social work practice. We present innovative practice methods based on qualitative, intervention, and community-based studies. The studies, all of which were conducted in collaboration with community members or included the participation of researchers of diverse backgrounds, project some fundamental changes in social work practice.

State of the art

A parallel analysis of provider and client experiences in the opening article reveals challenges that arise in the provision of care to multicultural communities. Based on a scoping review of the literature, Katarzyna Olcoń found that racial and ethnic minority clients are generally dissatisfied with the way they are treated, citing experiences of discrimination and barriers to accessing services. What makes a difference for clients is being treated with high regard and the sense of a strong therapeutic alliance. Although committed to practice with multicultural communities, for their part, providers question whether their social work education adequately prepared them for practice with diverse groups. Many report difficulties with identifying client strengths and moving beyond stereotypical beliefs.

Intervention studies

Three articles describe the results of empirical studies of innovative interventions adapted for specific multicultural communities and highlight the factors associated with positive outcomes. Each of these studies demonstrates a specific approach to restructuring practice and service delivery: actively involving the communities being served, expanding content, and modifying methods of service delivery. Kristina Lopez, Sandra Magaña, Miguel Morales, and Emily Inland conducted a randomized controlled trial that tested the efficacy of a culturally informed education intervention developed in collaboration with community-based partners. Parents Taking Action is an intervention for Latino parents of children with autism spectrum disorder (ASD) that uses Latina mothers of children with ASD to provide health information. By communicating information in a way that resonates with parents, the intervention helps breach common barriers to diagnosis and care faced by Latino children with ASD.

A systematic review by Krystallynne Mikle and Dorie Gilbert explores the effectiveness of marriage and couple relationship education programs that use culturally relevant content designed for African-Americans. Seven empirical studies were reviewed. The programs used Africentric principles and African-centered curriculum content, which instill traditional cultural values and incorporate discussion of historical socio-cultural influences. The studies showed evidence of the positive effects of these components by facilitating skills development for healthier relationships and increased couple satisfaction.

Mitra Naseh and collaborators analyze studies on psychosocial treatments for refugees with post-traumatic stress disorder (PTSD) and explore the use of cultural adaptations. Based on a systematic review of randomized controlled trials of nonpharmaceutical interventions, the authors found that eye movement desensitization and reprocessing (EMDR) psychotherapy had the strongest evidence of effectiveness. Common cultural adaptations in the implementation of treatment involved the restructuring of service settings, personnel, and format. This included the provision of services in clients’ homes, local clinics, community settings, churches, or outside areas; the use of lay counselors, trained community members, and refugees; and the use of group intervention protocols.

Studies assessing current practices

Several studies analyze the extent to which cultural practices that are valued by multicultural communities receive sufficient attention in social service provision. Samantha Hack, Christopher Larrison, Melanie Bennett, and Alicia Lucksted conducted a qualitative study to investigate if mental health care delivery systems draw on the African-American tradition of family and kin support. Research has shown frequent family contact and its positive effect on psychosocial functioning. Based on interviews with 26 African American men with serious mental illness and 26 members of their kinship network, the authors found that although kin generally wanted to be involved in the care process, they were largely excluded from treatment planning and delivery. Some of the barriers to kin involvement included agency gatekeeping, confusion related to who to talk to, and misinformation about confidentiality restrictions.

Emma Elliott-Groves carried out an exploratory study aiming to incorporate culturally relevant approaches to promote mental health in adolescents from the Cowichan Tribes. In collaboration with the community, she developed an Indigenous biopsychosocial assessment and administered the protocol to a small group of youth. She found that the protocol, in addition to gathering standard clinical information, tapped on important elements of Indigenous knowledge systems that can help in diagnosis and treatment. The youth were able to reflect on resources from Cowichan traditions, including multigenerational support and the healing power of Indigenous views on the cycle of life.

The often unrecognized challenges that arise for providers serving multicultural communities, specifically in the context of culturally congruent care, are explored by Swathi Reddy. Using phenomenological methodology, the author illuminates on the lived experiences of ethnically matched social workers in South Asian women’s organizations. South Asian women’s organizations, which were originally established in the 1980s, continue to fill a gap in domestic violence services. An important theme that emerged from the interviews with the social workers centered on their efforts to reach out to their communities to break the silence around domestic violence, which they themselves had personally experienced. They strived to balance their understanding of their clients through the lens of their own cultural familiarity while questioning their assumptions of ethnic identity. In attempting to create relationships responsive to the cultural expectations of their South Asian clients, moreover, the social workers found themselves needing to push professional boundaries.

Conclusion: Reinventing social work

More than what needs to be done differently for different groups, the studies in this special issue indicate a reassessment of how we conceptualize practice with multicultural communities. The focus needs to be on the process of engaging with clients, on integrating the broader circumstances of their lives outside of our service settings, and on transforming service delivery systems (Crampton, 2015; Kutukdjian, Corbett, & Rivière, 2009; Nadan & Ben-Ari, 2013). This begins with social work education. Social workers often struggle with stereotypical, reductionistic views of their clients. We need to reevaluate how we teach cultural competence so as not to reify those attitudes. Do we exoticize cultural groups, other them as “different” (when what we are dealing with are social disparities and race relations), confound the social barriers they face with their social identities, paint them as nothing more than a reaction to their oppression (Corley & Young, 2018; Emdin, 2016; Epner & Baile, 2012; Kohlberg & Hersh, 1977; Murray, 1969)?

Although these approaches to cultural studies are part of social work education standards, we need to take into account how multicultural communities see themselves. A recent study (Maleku, Phillips, Kagotho, & Subedi, 2019) of Bhutanese refugee women in the United States dealing with questions of identity and belonging brings up precisely the problems with our current conceptualizations. The study used an open-ended arts-based visual mapping technique. Although un-prompted, the refugee women are resisting the terminology that we use, almost word-for-word.

“We were not born a refugee. We were cool people who were forced to be uncool. The word refugee makes us feel like people are saying you are different, you do not fit in. It is almost mocking our difficult past, which will always be a part of our interconnected identities.”

And even more pointedly: “We are not ashamed of our refugee identity. It is not only what defines us—we are much more than that. Our beliefs, experiences, faith, philosophy, work ethic, aspirations for women’s equality, family, friends and our support network are all a part of our identities.”

We need to do a better job of communicating the value of cultural richness to our students—from the perspective of the communities that we are concerned about—and put literature written by authors from these communities at the center of our teaching.

Perhaps as a result of our current disconnect, social work underutilizes rich family and community networks. By not facilitating their involvement, social service systems in effect create the conditions for the loss of these vital resources which social services cannot replace. The studies here show how facilitating their involvement can widen the circle of care. Other research supports this. For example, research shows support for the need to develop family programs “that are socioculturally synchronous with the caregiving ideology of Latino culture…, using family-based approaches that focus on conserving and cultivating Latino cultural resources” (Barrio & Yamada, 2010, pp. 483–484).

We need to reconsider how we do social work. We need to expand professional boundaries to encompass indigenous practices, family and extended kin, and therapeutic relationships that make sense to different cultural groups. As Reddy (in this issue) suggests, speaking to the issues that emerged from her study of service provision to South Asian communities, “on a more fundamental level, they invite an examination of the implications of current professional values and principles for building culturally sensitive relationships in practice with diverse communities.” At its core, the work of social workers involves listening to the stories of individual clients as well as that of communities, but the profession needs to be ready to re-adjust practice to integrate their realities. Or risk becoming irrelevant to their lives.

Disclosure statement

No potential conflict of interest was reported by the authors.