Why cultural humility is key to successful employee benefits

As employers look for new and effective ways to help their workers manage behavioral and mental health challenges in their home lives, it is important for everyone in the benefits selection process to have effective tools for identifying programs that employees will find respectful and worthwhile.

To do this, benefits brokers and human resources professionals must understand a concept that is gaining traction in the world of clinical professionals—that of cultural humility.

For decades, clinical professionals aimed to practice cultural competency. That is, they adopted behavior, attitudes and policies to work effectively across cultures. While it is important in our diverse world to honor cultural differences, the problem is that competency implies mastery. Mastery is unattainable when applied to culture, especially if that culture differs from our own. This perception of competency limits learning, as it affords a sense of completion. This is problematic when working with a diverse population. Understanding of a culture is never mastered.

Cultural humility is a term that came on the scene in the late 1990s, as it was applied to physicians’ work with culturally diverse patients. It has since spread to other helping professions. Cultural humility rejects the false perception that clinical professionals can become “expert” in the cultures of each of the individuals in their care. Instead, a 2019 article in the Journal of General Internal Medicine defines cultural humility as:

“A life-long commitment to self-evaluation and self-critique in an effort to address power imbalances and to advocate for others. The practice of cultural humility helps mitigate implicit bias, promotes empathy, and aids the provider in acknowledging and respecting patients’ individuality. The universality of cultural humility principles puts emphasis on the provider’s need to connect instead of being an expert on the patient’s race, culture, or ethnicity.”

Diversity exists in many forms in our world including race, ethnicity, gender, religion, socioeconomic status, sexual orientation and more.  However, that should not preclude us from striving to address the inequities that currently exist in the delivery of benefits.

Related: The long, hard road to improving diversity in the benefits industry

Microagressions—intentional or unintentional indignities that communicate hostility or insult to a person or group with a harmful psychological impact—committed by a therapist have been found to result in those therapists being rated less culturally humble, causing a rupture in the therapeutic relationship. Similarly, a 2016 study published in Professional Psychology: Research and Practice found that clients who felt their therapists missed opportunities to discuss cultural experiences reported worse therapy outcomes, and those who rated their therapist as culturally humble reported improved therapy outcomes. The importance of cultural humility in medical appointments and counseling relationships is established, but what does being culturally humble look like?

We work with parents from throughout the United States and around the globe, many in personalized sessions with our board-certified behavior analysts. These consultations are opportunities to practice our cultural humility. Each family presents a unique familial structure that requires consideration by the analyst.

Consider the following scenario:

A behavior analyst meets the family of a 9-year-old boy and quickly learns that his mother is doing what the analyst perceives as “everything” for him—dressing him, cleaning up after him, making him snacks upon request, etc. The clinician thinks she is being helpful by brainstorming ways to help the mother teach her son independence and suggests they start teaching basic life skills such as getting dressed independently.

However, in this family’s culture, it is quite common for the mother to complete these tasks for her son, and the mother in this case says she “wants to make his life easy and happy.” She does not see this as an area in need of change, while the analyst is looking at this situation through the lens of her own culture and values. Other examples of potential cultural differences include making eye contact, co-sleeping, teaching “acceptable” social behavior and table manners.

In order for the family and the analyst to make progress, it is crucial that the analyst recognize that while she may be an expert on teaching new skills or reducing challenging behaviors, the family is the expert on their child, their culture and their values. The analyst should ask questions to determine the family’s goals for their work with the analyst, asking, “I’m really looking forward to learning more from you about what brought you to our program. Would you like to share with me what you’re interested in working on together?”

She must also elevate the family in the relationship to dispel any power imbalance and encourage them to become equal partners. From this point forward, the family can state what they would like to learn based on what is important to them. The consultant remains both a learner and a resource.

As a clinician myself, I can recall instances early in my career when I judged a family for not following through on behavior protocols or skill-building programs I created for them, and for not being, in my eyes, “invested.” It was only after critical self-reflection that I realized my own biases and attitudes and how they affected my relationship with these families.

I wondered if I recommended something that wasn’t in line with the family’s values, but they did not want to disagree with me because I was the “expert.” Maybe I hadn’t adequately addressed that inherent power imbalance?

At that stage of my career, I came into each meeting feeling that I needed to be the expert and have every answer, because why else would they ask for my help? It was only after I started to elevate parents as experts, too, asking questions and encouraging them to tell me when I was wrong, did we start to have a more collaborative and effective relationship.

I have been fortunate to consult for years within schools and homes in my hometown of Los Angeles, Native American reservations in New Mexico, Detroit, Alaska, the Bronx, New York, and other places filled with diversity. Now I work with parents all over the world.

Also: Employee benefit trends in 2021: Diversity, equity and inclusion

While I have seen how humans are far more similar than different, approaches to parenting differ significantly across cultures. I cannot detach from my own culture, values and experiences, so practicing cultural humility is a conscious decision I make during every interaction with parents, paired with a post- interaction self-critique with an eye toward improvement for my next interaction. I prioritize being culturally humble to ensure empathy, respect and regard for the people with whom I’m collaborating.

Where do we go from here?

As employers hope to make the most of the money they invest in benefits programs, brokers and HR professionals would be wise to add cultural humility to the set of qualities they look for when evaluating new programs. This means more than asking whether a provider offers diversity among the clinicians or consultants it employs. A true evaluation means looking at whether that provider engages in behavior that reflects the values of cultural humility.

Here are some best practices to look for among providers who have truly engrained the concept of cultural humility in their work:

• They offer training and professional development on cultural humility in the form of professional reading, mentorship, membership in equity and diversity special interest groups and conference attendance.
• They encourage clients to voice concerns about microaggressions or discomfort during interactions with consultants (with a clear and established channel) and humbly take action to honor each concern that is raised.
• They include specific questions about cultural humility on surveys for critical, objective feedback. For example, in follow-up surveys, we include: “My behavior expert was respectful and considerate of my cultural background, and was open to my perspective when giving suggestions/strategies, with 0 being not at all and 10 being very much.”
• They conduct ongoing quality checks, including sitting in on consultations between consultants and clients with prior consent, and include cultural humility items on performance rating scales.
• They encourage the completion of online assessments to uncover implicit biases.
• They create coaching tools to directly measure cultural humility.
• They establish critical self-reflection and self-management as ongoing, professional improvement goals.

While it might sound counterintuitive for the “expert” to be a learner in a consultative relationship, think for a moment of the connectedness and trust that could be established when each member of the relationship is empowered. While the efficacy of many clinical practices is predicated on a multitude of factors, prioritizing culturally humble behavior in the relationship is a conscious and empathetic way to set all parties up for success.

Angela Nelson, MS, BCBA, is Vice President and Executive Director of Clinical Services for Rethink Benefits, which provides behavioral health solutions that leverage clinical best practices in education, training and intervention strategies to a global neurodiverse population. She leads the company’s team of board certified behavior analysts providing services to parents through their employee benefits programs.