How Can Cultural Differences Make Being A Human Services Professional More Difficult

Introduction

Growing immigration by people from a variety of social and cultural backgrounds to societies with mature welfare systems has challenged human services organizations to adapt their activities to significant demographic change. This is particularly relevant in countries such as Sweden where immigration has occurred rapidly and at scale, and urban areas have become increasingly populated by marginalized groups as a result (Hajighasemi, 2005; Kings, 2011). The number of impoverished neighborhoods characterized as marginalized across Sweden increased from 7 in 1998 to more than 70 in 2008 (SCB, 2017). Management of the effects of the rapid exclusion has become a considerable challenge to the welfare institutions, not least because welfare services in the Nordic societies have historically been more extensive and mainly provided by the public sector (Hajighasemi, 2004; Hort, 2014). In the light of performance issues raised in nursing homes and home care for the elderly – not least during the COVID-19 pandemic – the dynamic adaptation of service provision to changes in care recipients' needs and preferences is now recognized as of great importance. At the same time, the large number of service users and service providers in these organization who are of ethnic origin, and the issues of multicultural competences and cultural sensitivity in human services organizations are now receiving wider attention (Rambaree & Nässén, 2020).(Table 1)

Enhancing diversity climates in human services organizations

Published online:

06 November 2021

Table 1. Characteristics of the interviews

The pandemic might be considered an exceptional event. In social work research, however, the importance of social and cultural differences in the work of human services organizations has become increasingly obvious in recent decades (Fong & Furuto, 2001; Green-Hernandez, 2006; Harrison & Turner, 2011; Lum, 2007; Lusk et al., 2017). In the Swedish welfare state debate, the issue has also attracted the attention of the social workers active in multicultural and multi-ethnic environments. Previous research (Ahmadi, 2008; Hajighasemi, 2019; Kamali, 2002, p. 51) has identified the need for the social services sector to adapt to the demands of a pluralistic and multi-ethnic society. The working conditions for social workers have steadily deteriorated in recent years to the extent that social work is considered one of the occupations most exposed to stress-related illnesses (Barck-Holst, 2020). One of the main reasons for the deteriorating working environment is the extensive cuts made to the welfare sector (Hajighasemi, 2004). The discrepancy between the reduction in funding for social services and a growing need to provide social support to vulnerable groups has placed welfare service providers in the difficult position of mediating (Hasenfeld, 2010) between users with high expectations and the authorities that allocate fewer resources to service organizations. To achieve this, ethnically sensitive strategies are required that enable these organizations to create and constantly develop new programmes and working methods that keep services compatible with the cultures, needs and integration processes of new social groups. Ethnic sensitivity means awareness among staff members of their own and their clients' ethnic affiliations and expectations, and that they must meet and treat people from other cultural backgrounds in a conscious and sensitive way (Green-Hernandez, 2006).

This article discusses ethnically sensitive differences, how the issue should be approached and how social work practice on dealing with diversity in practical ways could be more compatible with the needs, priorities and livelihoods of ethnic minority groups. Fieldwork was conducted in a medium-sized county of Metropolitan Stockholm to examine the strategies of human services organizations for increasing the cultural competences of organizations and the self-awareness of staff, and their outcomes. This is a precondition for establishing culturally sensitive practice that is compatible with multicultural reality.

Cultural competence and sensitivity

The role of cultural competence and ethnic sensitivity in social work practice has long been debated in multi-ethnic societies (Fong & Furuto, 2001; Harrison & Turner, 2011; Lusk et al., 2017; Thyer, 2010). In the United States, the concept of "ethnically sensitive social work practice" was recognized in the early 1980s when the Council on Social Work Education incorporated race and ethnicity into social work education (Devore & Schlesinger, 1981). An expansion of ethnic diversity led to an increasing recognition among policymakers, educators and researchers that culture and cultural identity are crucial issues in health care, social work and other human services provision, and that a failure to consider the cultural ramifications markedly reduces the efficiency of practice in these organizations. Social workers who engage with an ethnically diverse clientele are expected to take account of social and cultural contexts, and the social status and cultural identity of clients when conducting assessments and carrying out interventions (Fong & Furuto, 2001; Lusk et al., 2014). The possession and development of knowledge on the background of clients becomes crucial in this context. According to the US National Association of Social Workers (NASW) the "cultural competence" includes not only race and ethnicity, but also "the sociocultural experiences for people of different genders, social classes, religious and spiritual beliefs, sexual orientations, ages and physical and mental abilities" (NASW, 2001, p. 8). Cultural competence does not just mean that social workers should be highly knowledgeable about the cultures of the recipients of theirs services. They should also have an open and respectful attitude to culturally different people and attempt to understand them. Harrison and Turner (2011) argue that practitioners should achieve "cultural consciousness" and abilities that make them considerate and respectful toward the diverse cultural backgrounds of their recipients.

The concept of cultural competence is widely accepted in various human services organizations but there is still much disagreement about whether it should be considered a theory, a model, a paradigm, a framework or a perspective (Gallegos et al., 2008). While some scholars understand it as a theory (e.g., Lum, 2005; Wu & Martinez, 2006), others (Gallegos et al., 2008) suggest that it fits much better the definition of a social perspective. The concept refers to a set of congruent behaviors, attitudes and policies that come together in a system or among professionals in an organization and enables the system or professionals to work effectively in cross-cultural situations (Gallegos et al., 2008). The crucial issue in being culturally competent is that it can have positive outcomes for service users in shielding them from oppressive and discriminatory attitudes and treatments (Lum, 2007). This, because social workers adopt a superior position in relation to the clients they serve and possess a prerogative that enables them to exercise power. The need to exercise "cultural humility" in social work has therefore markedly increased (Davis & Gentlewarrior, 2015). Cultural humility places the emphasis on respect to whatever clients choose to communicate and prevents the social worker from taking a position of superior expertise. Instead, social workers are urged to be committed to culturally self-aware evaluations and to work against injustices, mainly those built into the culture of the majority society (Rosenblatt, 2016). Thus, critical cultural competence in social work is practice that goes beyond appreciating and honoring diversity to examining and addressing the unequal and dominant relations that are a consequence of oppression based on identity (Davis & Gentlewarrior, 2015).

This critical approach to the initial perception of cultural competence is essential because the traditional idea of migrant assimilation is still prevalent in most welfare services, albeit as the more lucrative social work goal of integrating immigrants into the host society (see Balgopal, 2000'; Kamali,; 2006; Li, 2003). In this strategy, conforming to the dominant culture is outlined as an indicator of the success of social policies (Sakamoto, 2007). This is a strategy that continues to promote "othering" because it sets the overriding position of social workers as advocates of the dominant and prevailing majority culture. An awareness of issues related to power relations, privilege and oppression, and also of the similarities and differences between people from different cultures, contributes to the increased cultural awareness that is crucial if social workers are to be mindful or conscious of cultural diversities between themselves and their clients. This awareness is a precondition for social workers not imposing their values, beliefs and judgments on clients (Maschi & Leibowitz, 2018). Intercultural sensitivity refers to this ability that makes social workers aware not only of discrimination against certain groups, but also of how this phenomenon affects the community and how social work should take these effects into account (Chen & Starosta, 2000).

Cultural sensitivity in Swedish social work

In the Swedish welfare service sector lack of cultural competence has become increasingly obvious in recent decades (Ahmadi, 2008; Ålund, 2000; Dominelli, 1998; Kamali, 2002). Critics such as Ahmadi (2008) have identified the established understanding of culture as a concept and its connection to the concept of ethnicity as a major factor in cultural competence shortcomings. A static perception of culture has long prevailed in the Swedish discourse on social policy, and this has determined the attitude to ethnic groups among professionals in the social services organizations (Dominelli, 1998; Kamali, 2002). According to this critique, culture has been regarded as a fixed set of ideas, norms and traditions that remains unchanged by the influence of external factors and is passed on as a legacy to future generations (Kamali, 2002). Against this background, migrant groups have often been attributed a specific cultural identity that has been considered unchangeable. This has facilitated the categorization of all members of certain migrant groups in relation to the culture of the prevailing majority.

This approach contradicts the dynamic view of culture, which perceives culture as a social act consisting of ideas and experiences that can be expressed in different ways and that can undergo changes linked to the life cycles and experiences of individuals (Skytte & Montesino, 2006, p. 291; Sernhede, 2011). According to this dynamic approach, culture is created through active actions and in interactions between people in social life. It should not be considered a static phenomenon linked to ethnicity. The static conception of culture considers cultures other Western culture to be foreign and incompatible with the culture of the majority society. Ålund (1997, pp. 9–12) addresses the notion of what is Swedish and non-Swedish, and what is normal and abnormal, within welfare organizations. Minority groups are regarded as closed units governed by strong cultural norms and values that have control over all the individuals included in these units. In such an approach, individuals are given a strong ethnic identity with limited room for maneuver. This politics of ethnicization (Römhild, 2017) places migration in a set of cultural containers at the margins of the "majority society" and not only justifies "otherness," but can also make migrants, their children and even their grandchildren problematic "ethnic others" in the host society. This culturalized concept of otherness has formed the basis for official integration policy on migrants, as "minorities" that must fit the prevailing cultural norms or be tolerated (Römhild, 2017). This strong link between culture and ethnicity has been a practical simplification that has shaped the perceptions of social institutions and individual practitioners. The negative effects of this simplification have had affected clients who have been placed in predetermined categories based on this approach. Although a multicultural society has been advocated in the public discourse since the 1970s, a state public inquiry (Kamali, 2006) confirmed that cultural homogeneity has always been revered and that cultural differences have not been given a dignified place in the public sphere. Despite that, in recent years the focus has been on the growing need for ethnic sensitivity as professional skills in social work (Valtonen, 2008). The need was identified primarily to explain the difficulties that arise in communications between social workers and ethnic minority clients. The issue became prevalent following extensive refugee immigration in the late 1990s, when services organizations experienced a growing deficiency in the management of ethnic minority clients (Kamali, 2002). The new paradigm emphasized the need for a shift from labeling clients as the cause of the problems to drawing attention to the structural shortcomings of welfare organizations, and their strategies for advocating the assimilation of migrants into the majority culture.

The recruitment of social workers from migrant backgrounds has become part of a broader social policy strategy to make social services more culturally sensitive. A multicultural workforce would possess more of the crucial skills of social work, such as information gathering, an understanding of migrant clients' social problems and the ability to manage their specific needs. Adoption of this strategy has had positive effects but also reduced the complexities associated with ethnic clients to purely cultural aspects. In this way, the structural problems that complicated the process of inclusion into the society were neglected. A change of perspective was needed that emphasized the significance of cultural differences. Instead of considering immigrants' lack of knowledge of the norms and values of services organizations as a shortcoming, attention turned to the low degree of cultural sensitivity in these organizations as the reason for their inefficiency (Skytte & Montesino, 2006).

Some aspects of cultural differences

There are large cultural differences between different ethnic groups and within each ethnic group. These broad variations mean that simple generalizations about the culture of migrants, or even about a specific ethnic group, are not particularly useful (Congress, 2008). A survey of individual migrant household's social, economic and cultural background and conditions is often essential. This makes it easier for the social worker to design creative action plans adapted to the conditions of the individual household. Various social and cultural differences in the living conditions of migrants have been highlighted by scholars (Congress, 2008; Nagda & Gutiérrez, 2000; Rogler et al., 1987):

Reasons for migration: economic opportunities or social and political repression
Different degrees of integration of household members
Communication difficulties caused by language barriers
Cultural differences in views on healthcare and treatment
The negative impacts of crises and trauma caused by migration
The influence of cultural and religious institutions on the values of migrants
Different values regarding the status of education and labor market position
Hierarchies and power structures within households

Knowledge of these social and cultural characteristics of multicultural environments and their effects on social relations is a prerequisite for creating a culturally sensitive service strategy.

Development of models for cultural competence assessment

Following recognition of the increasing need to improve the cultural competences of staff in human services organizations attempts were made to identify instruments for or construct models of the most effective means of achieving this aim (Campinha-Bacote, 1999; Rooda, 1993; Sue, 2001). Most of these models focused on the cultural knowledge of the staff working with ethnic clients, seeking either to measure the academic knowledge of staff about issues related to the social, psychological or even pharmacological background of ethnic groups (Campinha-Bacote, 1999), or to examine the ethnic-related knowledge of test groups compared to staff members who have never worked with specific ethnic groups (Rooda, 1993). The limitations of these models led Sue (2001) to develop a more comprehensive model that, in addition to the ethnic knowledge of personnel, collects data to obtain a clearer picture of the diversity climate in the organization.

More recently, Calzada and Suarez-Balcazar (2014) have identified three key dimensions that should be monitored when examining the level of diversity in service provider organizations. The cognitive dimension refers to the level of awareness at the organizational and operational levels about the intercultural biases that commonly occur in multicultural environments. The behavioral dimension emphasizes the operational, personal and diversity-related skills required to maintain effective relationships with clients. The organizational dimension includes aspects of the organizational characteristics that affect the climate of diversity across the institution, in the light of contextual issues, and support for culturally sensitive practices.

Since multicultural environments are constantly changing, the organization, and its managerial and operational staff, should also be expected to constantly renew their cultural competences in an ongoing and fluid process. From this perspective, the contextual, experiential and developmental processes of learning strengthen the ability of operational staff to understand and meet the needs of clients (Balcazar et al., 2010). Most of the models that suggest a process of enhancing cultural competence highlight the need for, and willingness of, organizations to be open to adapting their services to the changing and new needs of their client groups. Less emphasized, however, is the importance of the degree of diversity among employees or the impacts of multi-ethnic staffing on the diversity-related activities and development plans of these organizations. In order to meet this shortcoming, Hyde and Hopkins (2004) suggest two criteria that can be used in evaluating the performance of organizations in developing strategies for pursuing diversity goals: 1) the degree of diversity among employees relative to their clients, and 2) the existence of diversity-related activities and development plans. A significant underrepresentation of employees from ethnic backgrounds in relation to the clients may indicate a deviation from diversity goals (Hyde & Hopkins, 2004). One consequence of this deficiency is that the organization might lose natural access to the cultural competence that ethnically diverse staffing provides. This shortcoming could limit the existence of diversity-related activities in the organization, as well as the quality of diversity planning, which is the second important criterion in examining diversity development in an organization. The existence of such a plan can be used to assess the measures and initiatives that aim to make diversity part of the organizational culture. In cases where an organization only offers individual preventive measures against discrimination or competence-enhancing diversity initiatives, it is arguable that the diversity climate is weak or moderate. A robust diversity climate requires a significantly stronger commitment and a long-term diversity strategy (Cox, 2001; Hyde & Hopkins, 2004).

Cultural competence is a multifaceted ability that requires a long learning process. Recruiting ethnic staff who already possess such competence is often a more rapid affordable and convenient way of handling the cultural challenges that human services organizations face. Based on the above aims, it is possible to construct an abstract concept of an ideal type welfare services organization, with regard to diversity at the managerial, staffing and client levels (see Figure 1). The Weberian ideal type methodology (Swedberg, 2018) used here facilitates the construction of certain elements of reality into logically precise conceptions. Figure 1 contains three abstract models of organizations with hypothetical variations in ethnic density at different levels and in different areas of Swedish society. Model A demonstrates that the optimal level of cultural competence is achieved in service organizations where the proportion of ethnic minority staff is approximately the same as the proportion of ethnic clients in the catchment area. Access to personnel who possess comprehensive cultural competence will therefore be at an optimal level. The shading of the arrows in the models represents the effects the staff have on the diversity-related development plan in the organization. The darker the arrows, the more influence there is from ethnic employees on action plans and thus the greater adaptation of the activities to the cultural particularities of the ethnic clients. Representation should not be limited to operational staff, but also include the managerial level where strategic plans are devised. Model B refers to organizations with a large migrant client group and low levels of diversity among the staff. This poor diversity balance between clients and staff increases the need for multiple diverse plans among the native Swedish staff. The absence of ethnic managers is another shortcoming represented in the model, simply because an ethnically homogenous board runs the risk of neglecting ethnically diverse perspectives in its decision making. The third ideal-type model (C) is quite common among service organizations in the elderly care sector, where the proportion of ethnic minority staff is high while clients are largely native Swedes. In such a model, the requirement for cultural competence is reversed, in that the development plan must aim to strengthen the staff members' cultural competences with regard to the majority culture.

Enhancing diversity climates in human services organizations

Published online:

06 November 2021

Figure 1. The ideal-type models: distribution between employees and clients in welfare services organization

Settings and methodology

This paper uses ethnographic methods, such as semi-formal, semi-structured interviews, participant observation and informal conversations, to identify the diversity competences of services organizations in meeting the needs minority ethnic clients in four welfare services organizations. The main characteristics of the ethnographic methods are an emphasis on exploring the nature of phenomena through a primary focus on unstructured data gathered from a small number of cases (Hammersley & Atkinson, 2007). In order to identify the diversity competences of the organizations, the study was conducted in an immigrant-dense suburban area in metropolitan Stockholm. The area has a population of approximately 40,000, and almost half the residents were either born abroad or have one parent who was born abroad. Residents in these areas have a lower annual income than the national average and a lower employment rate, they live to a greater extent in rental apartments. The fieldwork was conducted in the first two months of 2020 and the data was collected through visits, field observations and interviews with employees in each of the service organizations: a counseling unit in a family center, adult social care center, the local high school and the municipal health center. These units represent various services organizations, in terms of fields of activity, service setting size and number of employees. The counseling unit is the smallest, with just 11 employees. The social care center has 30 employees and is considered a medium-sized organization. The high school and health center, with 80 and 130 employees respectively, can be considered large organizations. 12 people were interviewed: eight social workers, two healthcare staff and two teaching staff. The informants were selected using the purposive sampling method (Palinkas et al., 2015) on the basis of their experience in providing services to ethnic clients. Nine of the 12 have an ethnic background but almost all had Swedish university degree and had at least 10 years of work experience in social work, schools or the care sector. Observations and conversations were documented using field notes. This methodological approach made it possible to identify, describe and analyze the contextual meanings, practices and routines that sought to create the conditions for the provision of a culturally sensitive service to ethnic clients. A limited part of the data are presented here, with illustrative quotations from the interviews. Similarly, the strategies employed to increase the cultural competence of the professionals with migrant backgrounds employed in these organizations are outlined, notably the role and impacts of employees in increasing the awareness and cultural sensitivity of the organization and other colleagues.

Accomplishment of the field work

The field work took the form of a three-phase qualitative research approach. In the first phase, the objective was to understand the nature and characteristics of the activities of the organizations, the client base, and the crucial issues that the organizations deal with. During visits to the sites, a key representative was identified in each organization, preferably with a managerial position, who introduced the activities and the organizational structure, outlined the main challenges and was interviewed about these issues. In the second phase, the focus was on the cultural challenges, diversity issues and the role of ethnic employees in the organization. Each organization was asked to identify operational staff, mainly senior social workers or health personnel, for interviews. The third phase of the field work was mainly of a complementary nature, and aimed to fill information gaps or provide missing data related to the first two phases, as well as a deeper understanding of the central issues of the study. In addition, the interviewees were asked their opinions of the initial results and whether they believed they represented a true snapshot of their activities.

Findings

Based on observations and interviews, this section presents the findings on three key measures used to evaluate the efforts of the services organizations to enhance their cultural sensitivity: (a) the proportion of employees from an ethnic background at both the operational and the managerial levels; (b) the level of cultural awareness in the service provider organizations active in an ethnically diverse area, and whether senior managers in these organizations have mapped out the need for cultural sensitivity in the organization; and (c) whether there is a clear strategy in place to increase cultural sensitivity in the organization.

Counseling unit in a family center

The counseling unit is a professional support unit working with family centers in different parts of the municipality. The unit consists of 10 councillors, only one of whom was not born in Sweden. Over 80% of the clients in the local community in which the unit is located were either born abroad or had one or more parents who was born abroad. The main task of the family center is to work with families who are experiencing some form of crisis. Some of the more prevalent challenging issues that the unit is expected to deal with are linked to housing shortage and overcrowding, which many migrant families must deal with. Poverty and the challenges of labor market integration are also issues that dominate minority ethnic families' everyday lives. Difficulties understanding the focus on the individual, which is prevalent in Swedish society and demands greater individual responsibility, were also mentioned by informants as a common challenge. These issues are understood as challenges caused by the insecure position of migrant families due to the lack of stability that migration causes. Another recurring theme emphasized by the center councillors is tensions and misunderstandings between ethnic families and professionals in the education system. Above all, there was dissatisfaction among professionals with parents' lack of involvement in the schooling of their children and in their social activities:

Most of the ethnic minority parents are absent from parent meetings, class parenting and other meetings where cooperation between staff and parents takes place and where commitment from parents is crucial. Then, we often see cultural differences in the ethnic children's upbringing, mainly shortcomings in setting boundaries for young children about what they should or should not do—something that Swedish parents start with their kids at an early age. In many other cultures, experience shows that families start setting boundaries in adolescence, at a time when Swedish parents are instead "relaxing" the boundaries for their children. (Interview, counsellor)

These cultural differences put pressure on both parents and children to navigate their roles, expectations, obligations and rights in meetings at the family center, school and other relevant welfare organizations.

Another pattern identified by informants is the difficulty many migrant families have with deciding to contact a psychologists or counselor when a crisis arises. Among the minorities, it is very rare for internal family matters to be discussed with social institutions. According to the informants, most of the employees at the unit lack training in or experience of the cultural reality of migrants and the social conditions they are born into and have left behind:

They are less skilled at recognizing the potential for misunderstandings, scepticism and preconceived notions that exist in meetings with people from other cultures. The counsellors treat clients based on laws and regulations and try not to get involved in cultural issues, in principle remaining culturally neutral. (Interview, counsellor)

The statements of the employees lead to the conclusion that the managers of this unit have made no systematic efforts to increase the cultural competence of staff members. If cultural competence of other cultures is needed, it is up to the individual staff to gain such knowledge from time-consuming experiential learning or by acquiring it from external expertise.

Adult social care center

This center is provided by the local social services department to offer family therapy, support to individuals who require supervision and drug rehabilitation services. The center employs 27 social workers. Over 70% of the client group is from a minority ethnic background. About half of the employees at this center had an ethnic background other than Swedish. One of the two managers of the unit was from a minority ethnic background.

According to the informants at the center, one of the most prevalent cultural issues in some of the client groups is patriarchal relations within families. In some cases, it is possible that a form of oppression is being perpetrated, especially against girls and young women. A distinctive feature is that the mother in such families often carries the biggest burden, in both defending young girls against the restrictions imposed by men and taking an active role in supporting their daughters in seeking help – and, if necessary, representing them in the meeting at the care center. The high proportion of employees with a foreign background at the center means that lack of cultural competence does not appear to be a dominant problem. These employees help to ensure that there are always staff at the center who have sufficient insight into the cultural conditions of clients:

Even where there is a lack of cultural competence among existing staff, the management has the ambition to recruit ethnic minority staff to strengthen the capacity of the centre to be able to communicate with and understand the cultural norms of the clients. (Interview, director/social worker at social care centre)

According to the director, the center also invests in the cultural competence of its employees by organizing courses on different cultural issues such as violence in close relationships, honor-related violence, and the recruitment of young people into criminal gangs. Regular daily or weekly meetings are also held at the workplace in which employees exchange their experiences on difficult cases and matters that end up in the units. According to the informants, regular meetings held at the workplace are much more effective because staff members are given opportunities to talk through cases that contain cultural elements. This contributes to the development of cultural competence through continuous conversations between staff who are committed to the inherent values of the center. The strategy of the center in recruiting colleagues from different backgrounds explains why the group did not feel alienated from clients' everyday lives:

We actively share our knowledge and experience with each other and in this regard exchanges of cultural skills are the most important discussions we have. We have clients from so many different backgrounds. We take our questions to our meetings and have open discussions about the issues. Our managers are also active in the discussions and also see the advantage of training to enhance the cultural competence of colleagues. (Interview with social worker)

The high school

The visited high school is located at the intersection between migrant-dense neighborhoods and more settled populations. According to the informants, the proportion of students from an ethnic minority background was just over 60%, while the proportion of teachers of ethnic origin was just under 15%. One of the five members of the Senior Management Team had an ethnic background. The informants identified a need for cultural competence in the high school in two key areas: generating knowledge about the differences in socialization processes among students raised in suburban neighborhoods; and providing knowledge and understanding of differences in values, customs and religious habits. The level of diversity in high schools with a large groups of students from minority ethnic origins means that a number of subcultures coexist in close proximity. The school becomes a natural meeting place for interactions between young people with different cultural backgrounds, on the one hand, and between ethnic pupils and teachers, on the other. According to the informants, a lack of cultural sensitivity can lead to increased distancing not only between classmates, but also between ethnic pupils and teachers with lower levels of cultural competence. This kind of distancing can often arise primarily as a precautionary measure to avoid or prevent cultural or religious misunderstandings or tensions. This can happen especially in relation to pupils who are religious believers or religious practitioners. While such distancing can often be in order to respect the integrity of the ethnic pupil, it can also lead to exclusion from the rest of the group. One of the teachers from a minority ethnic background argued that culturally sensitive outreach activities aimed at including these pupils into the group are very important in preventing exclusion and polarization among high school pupils.

Pupils with roots in the Middle East perceive me as a secular teacher but the one who understands their customs. Therefore, I can talk to them about how they can behave in order to prevent eventual clashes between their habits, religious rituals such as fasting, prayer, dress, and the demands and expectations that classmates have of them. During meetings with the parents of ethnic pupils, I actively talk about, and am often able to convince them, why teenage pupils should not fast or not leave the classroom for prayer. (Interview with High School teacher)

The reports of the informants reveal that teaching staff often have a one-sided attitude to ethnic minority pupils. The lack of sufficient skill in the Swedish language among these pupils and their possible deviation from the ruling norms and values of society are given a lot of space in the considerations of teaching staff. Similarly, their lack of school performance, lower school results and less developed social skills are disproportionately highlighted. The prevailing perception among the informants was that the school management is content to follow the school plan (curriculum) and to ensure that the directives and goals of the National Agency for Education are achieved. Less emphasis is placed on the effects of the social and cultural backgrounds of pupils on their socialization processes at school.

The dominant view among teaching staff, including managers in the schools I have worked in, has been that pupils of foreign origin can and should be integrated into society in accordance with the governing norms and values, and the school plan. Ethnic pupils have the potential to learn and embrace these norms. Thus, we do not need to overestimate cultural competence. (Interview with High School teacher)

The health center

The health center included in this study has 28,000 enrolled patients, making it the largest in the municipality. Around 30% of the enrolled patients are from an ethnic background, and there is a roughly corresponding proportion of ethnic minority staff members (27%). All four of the managers at this health center are native Swedes. In describing the cultural competence needs of health care professionals, the informants emphasized a diversity of needs among different groups depending on the patient's age, level of education and social or cultural background. The patients can be divided into three categories: (a) those with a low degree of cultural variation with native Swedes; (b) those who are only culturally integrated to a small degree or not at all, and therefore need to be cared for by culturally competent staff; and (c) those who are partially integrated but retain their distinctive cultural features.

The first group consists of highly educated people with a good ability to communicate and a high level of trust in healthcare staff. These are not in need of staff with any specific cultural skills. The second group, by contrast, which is in great need of support, often consists of older migrants who have difficulties communicating with healthcare staff and need an interpreter. Staff members need a higher degree of cultural sensitivity when meeting these patients:

Within this group, there are many who do not want to receive treatment from a member of the opposite sex. They want to be able to communicate with the doctor, to directly explain their illness or physical and mental ailments and to express their feelings. They also want to be able to hear the doctor's diagnoses or advice for themselves. For some patients, a meeting with a doctor or nurse from their own ethnic group mainly fulfils a therapeutic function because they can then talk about their worries and pains more easily. (Interview with nurse)

The desire to receive treatment from healthcare professionals who speak one's mother tongue is quite common in the group that is partially integrated. Although this group can communicate in Swedish, there may still be situations where they prefer to be taken care of by nurses and physicians who have greater cultural competence. The conventional wisdom is that a care provider from a similar ethnic background will have a wider understanding of underlying cultural codes. The need for culturally sensitive health communication is particularly great in relation to elderly patients. According to the informants, increased access in health centers to staff with language skills and cultural competences have been the most systematic investment to bring about cultural sensitivity in the sector. The proportion of care staff from an ethnic minority background is high in all the units in the health center. This has given care staff opportunities to consult with relevant colleagues in order to obtain the cultural knowledge required about their ethnic minority clients. Staff members are also offered regular training in which diversity issues are a recurring theme.

Diversity through workforce: a growing trend

This survey finds significant variations between the different human services organizations in maintaining cultural sensitive services. Figure 2 shows that all four organizations differ in terms of their diversity climate. Only the adult social care center has an optimal level of density at all three levels (managerial, staff and clientele). The health center has a balance between clients and staff but not management. The High School has a lower level of employees than students from ethnic backgrounds and lacks ethnic minority representation on the school board. The Counseling Unit has the weakest balance when it comes to matching employees with ethnic backgrounds with the clientele, which is predominantly from a minority ethnic background.

Enhancing diversity climates in human services organizations

Published online:

06 November 2021

Figure 2. Level of diversity in the welfare service organizations in this study and the impact of staff on the design of diversity-related development plans in these organizations

Conclusions

The objective of this paper was to survey the preparedness of four Swedish human services organizations to enhance their cultural sensitivity when providing cultural congruent care and services to culturally diverse client groups. The survey reveals that a lack of cultural sensitivity is particularly evident in smaller units with specialized work functions and with sensitive missions. This includes, for example, family centers, tasked with discovering and meeting the needs of families with children. The limited number of employees in such units makes it less likely that they will recruit staff with minority ethnic backgrounds. The situation might be different for units with less specialized tasks and thus a broader recruitment base. Adult social care center has proved more successful at creating the conditions for culturally sensitive service provision. This has been achieved mainly by active investment in recruiting employees with both broad professional backgrounds and a variety of ethnic backgrounds. Staff diversity opens up opportunities for creative working environments, which enables the exchange of knowledge and experience and thus the integration of a culturally sensitive approach into welfare services (Hafford-Letchfield et al., 2014). Active collegiate conversations help to prevent misinterpretations and misunderstandings in the provision of care to clients from ethnic backgrounds.

In the health center surveyed, recruiting staff from a variety of ethnic backgrounds proved an effective strategy for increasing cultural sensitivity. By providing culturally sensitive care staff from the same communities as the patients with the greatest communication difficulties, the majority of the problems linked to cultural diversity were prevented or resolved. Access to ethnic minority staff has been an investment with a double return. In addition to the cultural sensitivity aspects, such as effective exchange of experience and the interpretation of the patients' statements, experiences and care preferences, the care system has avoided a shortage of physicians and nurses.

This proactive attitude in employing ethnic staff can be compared with the school sector's lack of ambition to take advantage of the cultural capital that teachers from ethnic backgrounds possess. This weak enthusiasm can be explained by a lack of interest from the school system in immersing itself in or caring about cultural differences in the home environments of its pupils (Sernhede, 2011). Ethnic minority pupils are perceived to have sufficient ability to absorb the prevailing norms and values of society, and follow the curriculums set out by the National Agency for Education. This strategy is in line with the main task of the school system, which is active influence and the stimulation of students regardless of background to embrace the common values of society (Skolverket, 2009, p. 8). The prevalent opinion in the school system seems to be that these goals can best be achieved if students, regardless of cultural or ethnic background, are included in a common culture based on the dominant democratic norms and values of society (Avery, 2016).

The findings also show with ethnic minorities represented on the board, the probability increases that cultural sensitivity issues will be given enough space in planning and decision making (Schmid, 2004). Social services organizations with a diverse staff and board membership provide a dynamic platform for regular and continuous dialogue on everyday activities and are more receptive to valuing and implementing culturally sensitive approaches. Human services organizations with representative staff and management boards have a greater capacity or ability to design sustainable plans for the development of a diversity strategy (Allen & Montgomery, 2001). A comparison of the plans adopted by the surveyed human services organizations to increase cultural competence reveals that the most pronounced measure was the recruitment of staff from an ethnic minority background. Such staff, and those with special cultural competence more generally, are considered the most effective, long-term and a sustainable investment in increasing cultural competence. As a complementary effort, limited education initiatives were also provided in certain specific areas, such as on honor culture, patriarchal cultural values or religious tenets.

Finally, this paper is based on interviews and observations undertaken at four human services organizations. More research will be needed to draw further conclusions about the validity of the results and to form a basis for the future development of policy recommendations.