Meryl Schulman, MPH and Mariel Gingrich, MPHAugust 22, 2017
Cultural humility — a respectful approach toward individuals of other cultures that continuously pushes one to challenge cultural biases — is an often-overlooked component of trauma-informed care. As a child clinical psychologist and mental health consultant, Allison Briscoe-Smith, PhD, leads trainings on cultural humility and trauma-informed care for organizations throughout the San Francisco Bay Area. Dr. Briscoe-Smith encourages those she works with to think of trauma-informed care and cultural humility as synonymous concepts, rather than separate ones. Oppression, she argues, is often the broader context in which trauma happens. “I have never really worked with people where trauma wasn’t housed in some sort of cultural context — poverty, mass incarceration, etc.,” she says. As a result, practitioners cannot provide trauma-informed care without paying attention to the underlying cause of the trauma they are treating.
Several pilot sites in Advancing Trauma-Informed Care, a national initiative led by the Center for Health Care Strategies (CHCS) through support from the Robert Wood Johnson Foundation, have invited Dr. Briscoe-Smith to lead staff discussions regarding tough issues such as inequality, racism, and the effects of systemic oppression to enhance their trauma-informed care efforts. CHCS recently spoke with Dr. Briscoe-Smith about how cultural humility can support health care practitioners in delivering trauma-informed care.
Q. What are the benefits of promoting a focus on cultural humility for health care professionals?
A. Promoting cultural humility can help strengthen relationships among staff, staff and leadership, and staff and patients. In addition, a focus on cultural humility can support higher quality care — if staff feel valued, they will be better equipped to care for others. These skills translate to providers’ work with patients, who are then more trusting of their providers, and thus better able to openly communicate about their health, wellness, and histories of trauma.
Placing an emphasis on cultural humility also encourages organizations to make purposeful, deliberate efforts to build a more diverse workforce, which can help them become more representative of those they serve. Lastly, the processes of reflection, deep engagement, and self-critique that are embedded in cultural humility can help an organization recognize the importance of self-care and pay attention to staff burnout. This helps with staff turnover and keeps current employees healthier, happier, and better able to provide for their patients or clients.
Q. How can organizations take steps to address cultural humility?
A. The first step is often conducting an honest assessment of an organization’s potential flaws or “pain points” — in communication, hiring procedures, etc. In some cases, issues related to race may come to the fore in response to an incident, or when staff approach leadership about addressing inequalities within the organization. It is important to learn where the organization is struggling before addressing the issue(s) at hand. A mandatory all-staff training that focuses on developing a shared language around race and culture can help co-workers better communicate and resolve issues, particularly those related to bias. Staff from multiple levels and locations within an organization can work together to create a mission and vision statement about equity inclusion, or a charter or scope of work that clearly outlines what they would like to accomplish in advancing an open dialogue and opportunities to address cultural humility. Monthly meetings can help ensure that these staff remain engaged, and changes are sustained.
Q. Why is it important to cultivate trust among coworkers when it comes to topics such as race?
A. One of the premises of cultural humility is racial justice, and it can be difficult to build trust around the issue of race. Race is a place that many people have not had the opportunity to practice engaging in dialogue. People may be concerned that they will say something wrong and be seen as either racist or overly sensitive. To establish trust, organizations should be very transparent about how difficult, challenging, and fundamentally disruptive talking about issues of race, trauma, and culture can be. This will encourage the creation of an environment of trust and open, honest communication. In my experience, I have found it particularly useful to also find opportunities where we can connect around joy and humor. Conversations about trauma and race are often framed without articulating our resilience and joy. This makes these topics something that people would rather avoid.
Q. What can organizations do that are interested in pursuing cultural humility, but may not have the resources to commit to long-term training?
A. A more formal staff-wide training is one option to generate awareness about cultural humility. Another option is to provide an opportunity for staff who are interested in cultural humility to get together. For example, staff might form a book club to harness the natural energy that might be within the organization and to get staff to start talking about issues of race, trauma, oppression, and culture. These kinds of opportunities allow staff to begin discussing and articulating the work that they want to see done within themselves, their organization, and more broadly.
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