Multicultural Competency in Geropsychology

Section 1: Introduction

This report summarizes the work of the American Psychological Association Committee on Aging and its Working Group on Multicultural Competency in Geropsychology. The purpose of this report is to: explore the key issues regarding the infusion of multicultural competence throughout geropsychology; make recommendations for future action addressing practice, research, education and training, and public policy issues; and inform psychologists of existing resources to improve their own multicultural competence in working with older adults.

“As we focus on the aging process through a cultural lens, this changing racial and ethnic minority population will represent unique groups of individuals. As culture has affected their lifetime experiences,  it will also affect their aging experiences” 
(Jackson, Antonucci & Brown, 2004, p. 225).

Definitions

Before exploring issues pertaining to multicultural competency in geropsychology, it may be helpful to review what we mean when using the terms geropsychology and multicultural competence. Geropsychology is the specialized field of psychology concerned with the psychological, behavioral, biological, and social aspects of aging. The science of geropsychology further presumes that these aging processes are iterative and interactive; taking form within a context/environment that influences outcomes and experiences.

The literature most commonly refers not to multicultural competence but to cultural competence, the latter being viewed as a specific form of competency. The term cultural competence has a history extending back at least 30 years (e.g. Sue, 1977). As used with respect to health care, multicultural competence generally refers to the adequacy of care provided to racial/ethnic minorities.

However, the U.S. Department of Health and Human Services Office of Minority Health (OMH) broadens this definition to include individuals and organizations less directly linked to the actual provision of care, such as religious and social groups. Cultural and linguistic competence are defined by OMH as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities” (OMH, 2006, p.1). The OMH definition emphasizes that cultural competence is a term that applies not only to the individual provider but to the provider organization, and to the health care system as a whole.

For the individual provider, cultural competence involves awareness and acceptance of difference; awareness of one’s own cultural values; understanding the dynamics of difference; development of cultural knowledge; and ability to adapt practice to the cultural context of the client. For the provider organization, elements of cultural competence include valuing diversity; conducting self assessment; managing for the dynamics of difference; institutionalizing cultural knowledge; and adapting to diversity in its policies, structures, and services.

Building upon psychology’s efforts to develop competencies

APA’s future efforts at developing multicultural competencies in geropsychology begin on a firm foundation. Industrial and organizational (IO) psychology has contributed much to the modern notion of competencies. Job analysis was one of the first systematic procedures created to identify competency requirements (McCormick, 1976; Harvey, 1991). Specifically, job analysis data is in the format of job knowledge (K), skills (S), abilities (A), and other characteristics (O). Collectively referred to as KSAs or KSAOs, procedures were developed to directly (K/S) and indirectly (A/O) measure attributes that can help differentiate high from average or poor job performance. Closely related to the KSAO approach is industrial organizational psychology's method of competency modeling (McClelland, 1973).

The area of multicultural competency has been a major focus within the counseling psychology profession. For the past few decades, counseling psychologists have worked to conceptualize multicultural competency (Arrendondo et al., 1996; Sue et al., 1982, 1988; Sue, Arrendondo, & McDavis, 1992; Pederson, 1994; Pope-Davis & Coleman, 1997; Ponterotto, Fuertes, & Chen, 2000). To date, a three-component model of multicultural competency – Awareness (of Attitudes), Knowledge, and Skills — is widely accepted and used in multicultural counseling training and education. The three-component model was further delineated by D. W. Sue and D. Sue (2003) in their consecutive editions of Counseling the Culturally Diverse: Theory and practice. Now in its fifth edition, this work addresses the politics, sociopolitical considerations, barriers, intervention strategies, and cultural identity aspects for individual and organizational multicultural competence. Similar to the industrial organizational model of competencies described above, counseling psychology references a core group of characteristics associated with competence, although the ordering is different, placing an emphasis on awareness of values and biases first: attitudes and beliefs, knowledge, and skills. Counseling psychology's competency models have spawned several instruments to measure multicultural competency, including self-report tools for individuals as well as inventories for organizations (Arredondo, et al., 1996).

In 2002, the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology (Kaslow, et al., 2004) helped to consolidate information regarding competencies as applied to the education, training, and credentialing of psychologists. A new model for competency development, the “Competency Cube” originated from one of the conference's work groups. The Rodolfa, et al. (2005) Cube Model for competency development builds upon Sue’s Counseling Model of Attitudes, Knowledge and Skills relevant to multicultural competency issues. It elaborates on foundational competency domains, functional competency domains, and stages of professional development.

Foundational competencies are skills needed for basic practice. With regard to multicultural diversity, these are designated as reflective practice, scientific knowledge and methods, relationships, ethical-legal standards-policy, individual-cultural diversity and interdisciplinary systems. Functional competencies then build on the foundational ones. With regard to multicultural diversity, this would include assessment, case conceptualization, consultation, research-evaluation, supervision-teaching and management-administration. Finally, stage of professional development, from graduate education through licensure and beyond, is highlighted. It is expected that the foundational and functional competencies in multicultural issues will evolve across the individual’s career development.

More recently, the APA Task Force on the Assessment of Competence in Professional Psychology: Final Report (2006) reviewed current practices in the measurement and assessment of competence in professional education, training and credentialing in psychology and other health-related professions and made recommendations regarding models and methods for the assessment of competencies in psychology education and training. Subsequent to this latter report, the Assessment of Competency Benchmarks Work Group proposed A Developmental Model for the Defining and Measuring Competence in Professional Psychology that identifies benchmarks for core competency areas at four developmental levels of education and training. One core competency area is: “Individual-cultural Diversity - Awareness and sensitivity in working professionally with diverse individuals, groups and communities who represent various cultural and personal background and characteristics” (APA, 2007, p. 22).

Specific to multicultural competency, the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (PDF, 372KB)were adopted as APA policy in 2002. In the Guidelines, the term multicultural is defined “narrowly, to refer to interactions between individuals from minority ethnic and racial groups in the United States and the dominant European-American culture.” While this definition applies to all clients, the authors note that, “There is a greater need for psychologists working with the elderly overall, and a need for them to be able to work with a racially/ethnically diverse population, as well as working with employers and organizations as they cope with an aging workforce” (APA, 2002, p. 2).

The premise of this present report is that one critical aspect of culture is age itself and this culture also continues to evolve. Since older people from a given cohort have been exposed to events, conditions, and changes different from what was experienced by their counterparts from another cohort, one finds between-cohorts differences in attitudes, values, and behaviors. For example, the beliefs and practices of cohort retiring during the next ten years would differ significantly from the cohort that retired in the 1950’s. These changes, in turn, will affect the experiences and expectations of future cohorts as they age. In addition to the differences across cohorts of older adults, there is substantial variability within each cohort as well. Thus, at any given point in time the members of the older cohort are not only different from their younger counterparts but they are also different from each other. They comprise a group with diverse characteristics and needs that are often overlooked. It is therefore essential that those who work with older adults are equipped with multicultural competence.

Furthermore, addressing the needs of the diverse population require attention and collaboration across the discipline of psychology – including cultural specialists, geropsychologists, and practitioners and researchers from all of its subfields. In addition, we must also link our efforts and engage all sectors within the larger professional community to address the needs and to support the strengths of the growing number of diverse elders.