Charmaine C. Williams

The Epistemology of Cultural Competence

Cultural competence is a high priority in social work, but it is not conceptualized in a way that can effectively guide practice. The author proposes an organization of cultural competence strategies into epistemologically defined paradigms for multicultural practice. The paradigms discussed are based in postpositivism, constructivism, critical theory, and postmodernism. These paradigms are presented as potential tools for developing a better understanding of what constitutes effective multicultural practice and what contributes to cultural impasses. The author suggests that cultural competence should be defined by the capacity to work across multiple paradigms to find ways to engage with clients.

HIV Prevention for Black Women: Structural Barriers and Opportunities

Black women bear a disproportionate burden of HIV/AIDS in North America. The purpose of this investigation was to explore Black Canadian women’s perspectives on HIV risk and prevention. Four 90-minute focus groups (n = 26) and six key informant interviews were conducted in Toronto with Black women of African and Caribbean descent and low socioeconomic status. Data analysis revealed a number of potent barriers to existing HIV preventive interventions: stigma, cultural disconnections, lack of engagement of Black religious institutions, and multiple intersecting forms of discrimination. Recommended HIV prevention opportunities included the Black church, mainstreaming, health care providers, and ethno-specific agencies. HIV prevention strategies for North American Black women, rather than focusing on HIV and individual risk behaviors, may benefit from a primary focus on social and structural factors (e.g., promoting gender equality, economic opportunity, women-controlled prevention technologies and combating racism in health care) thereby integrating HIV prevention into the larger context of community health and survival.

Childbirth Experiences of Professional Chinese Canadian Women

OBJECTIVE To explore the connections between culture and expectations surrounding the childbirth experience for professional Chinese Canadian women. DESIGN Descriptive and qualitative, using ethnographic interview. SETTING Women were recruited from a community health care center in metropolitan Toronto. PARTICIPANTS Six professional Chinese Canadian women who had experienced at least one childbirth. RESULTS The respondents described adherence to many traditional values, beliefs, and practices throughout the pregnancy and childbirth experience. However, some practices were modified to address functioning in a context that could not support full expression of cultural traditions. Recent immigration to Canada was associated with less adherence to traditional Chinese rituals and beliefs. CONCLUSION Nurses cannot make assumptions about who will use traditional cultural practices or about the circumstances in which they are relevant. Nurses need to be aware of cultural expectations so they can provide culturally competent care, but they should also be aware of how to engage in discussions to clarify individual patient priorities.

Insight, Stigma, and Post–Diagnosis Identities in Schizophrenia

This paper examines insight into mental illness, particularly as it applies to people diagnosed with schizophrenia. The paper argues that insight should be reconceptualized as a component of post–diagnosis identities that are defined in relation to other social identities, and under conditions of stigma against mental illness. The proposed conceptualization suggests there are at least four possibilities for post–diagnosis identities in schizophrenia: engulfed, resistant, detached, and empowered. Revising the insight concept to integrate the influence of social context and the potential for multiple post–diagnosis identities could be the basis for therapeutic dialogues with individuals about the implications that diagnosis has for their lives.

The Social Construction of Disability in Schizophrenia

Chronicity and disability can accompany a diagnosis of schizophrenia, but long-term follow-up studies are demonstrating that these outcomes are not inevitable. There is growing awareness that characteristics of long-term illness previously understood to be part of the disorder can be partially constructed through a convergence of physical, psychological, and social processes. In this study, the potential for social construction of disability was explored through secondary analysis of qualitative data. Findings suggest that family, consumers, professionals, and society each have a role in shaping a person with schizophrenia’s perceptions of his or her worth, competence, and place in society but that the individuals are not passive recipients of this input.

Training for Cultural Competence

Abstract This paper reviews the experience of evaluating a cultural competence workshop series for social workers practicing in a mental health care setting. The study used a pretest-posttest nonequivalent comparison group design, and evaluation was based on both quantitative and qualitative data collections. Between subjects analyses suggested that there were no differences between the intervention and comparison group after the intervention was completed, but within-subjects analyses revealed that the intervention group had made superior gains in their scores on the Awareness subscale of the Multicultural Counseling Inventory. Qualitative data contributed additional information about important individual and group processes that affected the experience of training and contributed to self-reported outcomes from training. The study suggests that evaluating process and outcomes of training at both the individual and group levels may be particularly important to understanding how cultural competence develops for social work practitioners in interdisciplinary settings.

HIV prevention risks for Black women in Canada

The future availability of HIV vaccines can increase options available to Canadian Black women for risk reduction. However, current conceptual frameworks do not adequately address barriers to HIV prevention for this population, and may be inadequate to address challenges with vaccines. This study explored knowledge and attitudes regarding HIV vaccines and associated prevention methods to inform appropriate conceptual frameworks for their dissemination to Canadian Black women. We completed four 90-min focus groups with women (n=26) of African or Caribbean origins, and six interviews with key informants providing health and social services in the Black communities of Toronto. The participants suggested that there were significant risks associated with seeking prevention information and attempting to reduce exposure to HIV infection. They described individual, familial, community and institutional domains of risk and predicted the same spectrum of risk for HIV vaccines. Participants advocated for education, empowerment and institutional change to create a supportive environment for vaccines and other HIV prevention methods. They further indicated that preparation for vaccine dissemination will need to prioritize building trust between women of the Black communities and institutions in the research, health and government sectors.

Professional competencies for promoting recovery in mental illness.

Abstract This study explored professional caregiving from the perspective of people diagnosed with schizophrenia to develop proposed professional competencies for promoting recovery. We conducted semi-structured qualitative interviews with 40 people diagnosed with schizophrenia to explore their experiences of caregiving. Interview segments related to professional caregiving were analyzed to derive categories and themes that described aspects of caregiving that clients believed contributed to their recovery. The proposed competencies derived from the interviews overlap with hypothesized competencies identified in the literature, but also suggest other areas of skill and attitude that relate to promoting recovery, including use of time, talk, and teamwork. The significance participants attach to time and talk suggests that services play an important role in recovery by creating the space for service users and service providers to engage in recovery-promoting practices.

Care: Giving, Receiving and Meaning in the Context of Mental Illness

Abstract Understanding the dynamics of caregiving is essential to providing effective support to individuals and families living with serious mental illnesses. Yet, research in this area has typically explored caregiving without consulting mentally ill people. This paper adds this overlooked viewpoint by exploring the experience of care relationships by people diagnosed with schizophrenia. A secondary analysis of interview data from 21 individuals reveals that relevant dimensions of care relationships include: providers of care; types of care received; self—care; contested practices in care; negotiating practices; recipients of care; and types of care provided to other people. Addressing care within this broader conceptualization can contribute to developing interventions for individuals and families that more fully recognize the potential for people with mental illnesses to be active participants in care relationships.

Re-reading the IPSS research record.

The International Pilot Study of Schizophrenia has had a major influence on mental health and research practice since its inception in the 1960s. It is most famous for demonstrating superior outcomes for people living with schizophrenia in developing countries over those living with schizophrenia in developed countries. Like other international research initiatives, it has been shaped by social, political and economic circumstances that contribute to positive and negative outcomes for participating nations. This paper evaluates the contribution of the pilot study by analyzing the discourse surrounding the dissemination of its results. The discussion of long-term outcomes across cultures is used to scrutinize the process of long-term research collaborations across nations. Discourse analysis of the research records indicates that, in various ways, the discourse was constructed to preserve an image of Western superiority and Third World inferiority. As the international research context shifts in psychiatry, it is hoped that inequitable practices that affect this and other studies will be challenged to benefit knowledge-building and mental health care across the world.