(Published in 2005)
Why does a community partnership with a name like SALSA (Seniors Accessing Long term care through Strategic Planning and Advocacy) invite Humberto Reynoso-Vallejo, national expert on cultural humility, to conduct a workshop in El Paso? Wouldn’t he simply be preaching to the choir? After all, a border city where 65 percent of the population is Hispanic/Latino understands the importance of culture in planning and delivering services for older people. The training has spread to many partners and was delivered at the Texas Department of Human Services in 2007.
Layers of Diversity
El Paso has been described as a bicultural city in which people of Hispanic/Latino origin are a “majority minority.” Although they comprise 65 percent of the population, Hispanics/ Latinos have less education and income than the city’s white minority. Physicians, a group with high educational levels and high income, are mostly white. Being both white and a doctor makes a person a formidable authority figure and, according to Edward Espinoza of the Rio Grande Area Agency on Aging (AAA), many older Hispanic/Latino people instinctively defer to figures of authority. For example, if told by the doctor that he’s not sick, an older Hispanic/Latino man is not likely to challenge the doctor or seek another opinion. Instead, he may self-medicate by crossing the border and obtaining pharmaceutical drugs or herbs that are not available without a prescription in the U.S.
But cultural differences are not limited to those between Hispanic/Latinos and whites. Within the Hispanic/Latino community, age differences present an increasing challenge. About 60 percent of the older people associated with Rio Grande AAA speak only Spanish, yet increasing numbers of young Hispanic/Latinos speak only English and use the English slang with which they grew up. This “Americanization” of young people reinforces notions among older people that their progeny have lost their roots and may no longer share their values.
SALSA has recognized these issues for some time and has been involved with multiple training sessions over the years addressing the issue of cultural competence. Cultural competence is based on the assumption that we can all become expert in each other’s cultural preferences and perform our services in culturally competent ways. After hearing the message multiple times, it seemed there was little more the community could do on the topic.
Bringing the Cultural Humility Concept to El Paso
Then Edward Espinoza and Adan Dominguez, both active in the SALSA partnership, heard Humberto Reynoso-Vallejo introduce the topic of cultural humility at a Dallas meeting for grantees of the Community Partnerships for Older Adults Program. They were instantly struck by the concept that it is not humanly possible to become culturally competent in every culture and subculture, and that instead we should approach each other with humility, with an assumption that we do not really fully understand each other’s cultures and need to be constantly open and receptive to cultural guidance from individuals.
Inspired by conversations they had over the course of the conference, Edward and Adan agreed that they should bring the concept to El Paso. The idea of a workshop was taken to SALSA’s joint cross-training committee, which meets regularly to identify opportunities for training across El Paso’s service provider network. The group reacted positively to the idea and decided to target social workers for an initial workshop on cultural humility. Social workers were thought to be a key audience because of the important roles they play in the aging services network in both institutional and community settings, and because they are frequently the point of direct contact with older people who are accessing services. Paso Del Norte Health Foundation, a SALSA member, quickly agreed to help underwrite the costs of bringing Reynoso-Vallejo to El Paso, and plans were made to hold a workshop.
Making the Workshop Appealing to Financially Stressed Provider Agencies
SALSA sent e-mails to its partner agencies and asked if they would support sending social workers to a half-day training session on the topic. Reeling from recent state budget cuts, many supervisors responded that staff shortages would make it difficult for them to release social work staff. To make the workshop attractive to agencies, SALSA arranged to provide continuing education units (CEUs) for those attending, and to provide the training at no cost to the agencies. Because agencies are generally responsible for paying the costs of obtaining CEUs, the offer was very attractive. SALSA had hoped for 60 people to attend the training and ended up with 81.
Response to the workshop was very positive, with several requests to do more of them. Many participants commented that cultural humility was a concept that enabled them to examine anew their own theories and practices regarding culture. A social worker in her twenties noted that she had been working from a perspective of cultural competence and, being Hispanic/Latino, felt she was competent. But the cultural humility concept allowed her to see the differences that age alone produce, and she left the workshop determined to approach older people with greater deference and fewer assumptions.
The response to the workshop has encouraged SALSA to pursue the issue further. The partnership will be looking for ways to expand on the cultural humility theme at future workshops and meetings.
For More Information
Adon Dominguez, Rio Grande Area Agency on Aging
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