By Susan Winston, LCSW

The United States is made up of many diverse groups of people. When we talk about social workers providing culturally competent or culturally sensitive services we mean providing services that are sensitive and responsive to these cultural differences.

The impact of a person’s unique cultural differences – including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical ability – on their care is now being taken into account. Social workers are adapting their skills to fit a family’s ethics, values and customs.

Social workers assisting diverse populations should be acutely aware of the dilemmas they may encounter when they recognize the needs of the diverse clients regarding behaviors, advocacy, controversial issues (such as abortion, gay rights, or women’s rights), and dual relationships.

Bukharian Clients in NYC

At an outpatient mental health clinic in New York City, many clients are immigrants and refugees from Central Asian of the former Soviet Union (eg., Uzbekistan, Turkmenistan). Most of the families served are part of the Bukharian culture, a close-knit community. Any known incidences of mental illness, substance abuse or family conflicts can tarnish a family’s standing in the community. Therefore, privacy and confidentiality is crucial.

A common practice at the clinic has been to use staff with similar backgrounds as the populations they serve, but this practice is not always appropriate. And it should not be assumed that speaking a client’s language ensures cultural competence.

Many Bukharian clients have Russian as a first language. Russian speaking staff is available — but the Bukharian culture is closer to the Central Asian cultures of Uzbekistan and Turkmenistan than to Russian culture. And because privacy and confidentiality are so important to them, Bukharian clients often request a social worker who is in no way connected to their community.

Case Study: Boris S.

Boris S. was a 35-year-old Bukharian man of the Jewish faith. He came to the clinic complaining of anxiety, irritability, anger, and serious marital problems. Married for 15 years, Boris’s problems started six to seven years ago after he immigrated to the United States. His wife adapted to life in the United States quickly; she learned English, graduated from college, and began working. Boris started feeling guilty and lost his identity as a good provider.

He began eavesdropping on his wife’s phone conversations, checking telephone bills, accusing his wife of being unfaithful, and other jealous behaviors. He criticized his wife’s clothes, her spending habits, and attempted to control how often she spoke with her parents and friends.

Boris would yell at his wife and children. He criticized his teenage children, their clothes and way of speaking.

Social workers were able to help Boris to better accept the issues causing him conflict in his new environment.

Family support was key to identifying cultural expectations and norms of behavior and how immigration may have affected his conflict with family members. Often, children of families who have immigrated become “parentified”. They are depended upon to translate the English language and negotiate various systems for their parents. This situation is usually temporary but for parents who  have difficulty adapting to the new environment or otherwise impaired, the road can to cultural transition can be long and difficult.

Case Study: Svetlana K

Svetlana K., a 72-year-old Bukharian widow of the Jewish faith, lives with a single son. She is anxious for him to get married. She began experiencing  agitated depression and she had suicidal thoughts. Her son came with her to her appointments and supervised her medication closely. As Svetlana’s symptoms worsened, her son organized a 24-hour watch over his mother using the entire extended family.

After discussions with Svetlana’s children, a social worker recommended hospitalization for Svetlana. Out of respect for their need for privacy and religion, as well as the need to protect their mother from harm, the family opted for voluntary admission at a well-known Jewish hospital outside their immediate community.

Conclusion

Providing needed services to people in diverse cultures requires much more than having caregivers with similar backgrounds and languages. Cross cultural knowledge, leadership, language, and skills are necessary, but not always enough. To be truly culturally competent, social workers look beyond the obvious and incorporate all their knowledge and competencies to address the needs of all people.