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This is a googledoc where you can add your ideas for activities, materials, resources for running workshops or groups or anything really to help others practice cultural humility.

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Cultural Humility – towards a practical toolkit

Posted on June 14, 2022 Updated on June 14, 2022

After running a successful co-learning reflective experience on Dismantling Racism with my solution-focused colleague and friend, Jonas Wells, we have now started a new series on ‘cultural humility’. This was a new concept for us and one which came to our attention during the Dismantling Racism experience. It struck us both as a useful way to frame how we would like to be in a world where racism was no longer a structural problem. In true solution-focused style we had (in the dismantling racism group) tried to imagine what would be happening in that post-racist world. How would people interact? How would they approach difference?

The term ‘cultural humility’ emerged in medicine and healthcare literature as an enhancement of ‘cultural competence’, which had been critiqued as a shallow and potentially stereotyping practice despite its good intentions. One of the earliest papers suggested that “cultural humility incorporates a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations” (Tervalon & Murray-Garcia 1998). More recently, Hook et al describe it as “having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual’s cultural background and experience.” (2013).

Jonas and I discussed how the concept might be useful to us, personally, and to the solution-focused community until we reached a point when we felt we needed more input. This is the impetus for creating the co-learning group. We want to learn from others at the same time as creating a space for those who wish to learn. Our co-learning reflective spaces are led by us with only the lightest of touch to create a minimal structure for our four 90 minutes sessions over seven weeks and mostly involve each participant sharing their learning and how it relates to their particular context and interests. Learning is an emergent quality, a natural inevitability in this fecund reflective space!

My own interest in cultural humility, beyond the personal (becoming a better planetary co-habitant), is in my work in equality, diversity and inclusion in higher education. I look for ways to help staff and students work together better in the academic community. I was therefore drawn to an article called ‘Cultural Humility Toolkit’ (Foronda et al, 2022) and hoped to find some practical ideas. While there were some useful tools, particularly for managing the emotional and physical context of education, the teaching methods relied on some of the stock activities in unconscious bias and anti-racist training. My problem with these, such as the ‘privilege walk’, is that they tend to be focused on educating dominant populations to be aware of the challenges faced by minoritised ones. This isn’t per se wrong, but too often such activities lead to dominant students feeling shamed, confused, angry and resentful. Another unfortunate outcome is feeling sorry for minoritised students and only seeing them through a deficit lens. Research on unconscious bias training shows almost no evidence for effectiveness or success and one gets the impression it is done over and over because someone needs to be seen to be doing something.

As a solution-focused practitioner, cultural humility and the related concept of identity safety speak to outcome rather than problem-solving. What would be happening when people from different cultures no longer seek to impose superioty of their culture on others? What would be happening when everyone in a classroom felt safe to turn up as themselves?

I found an earlier article by Foronda et al (2016) reporting on a concept analysis of cultural humility on which they had based their proposed toolkit. As I’m a sucker for a diagram (I like to see everything at once), I did what I often do when reading articles, I turned my learning into a diagram.

Cultural Humility Process Map based on Foronda et al (2016)

Taking the two definitions of cultural humility I mentioned earlier:

a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations” (Tervalon & Murray-Garcia 1998),

an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual’s cultural background and experience.” (2013).

I could see how they related to the concept analysis, but also pointed to different activities and outcomes. I could see how they worked together – a lifelong commitment to self-evaluation producing an interpersonal stance with particular characteristics. In Foronda et al’s (2016) article, the attributes of cultural humility are presented as distinct and discrete in this order: Openness, Self-Awareness, Egoless, Supportive Interaction and Self-Reflection and Critique. What I tried to do with this diagram is to work out a process that a person could undertake to develop the stance and attendant behaviours that characterise cultural humility. Importantly, I wanted to work out how to do this without requiring one group of people to be either shamed or turned into a victim, and to make it inclusive so anyone from any culture could use it (i.e. it’s not just targeted at the ‘baddies’)

Foronda and colleagues (2016) included a set of antecedents to cultural humility – the structural factors which lead us to needing a solution. These are presented again, as discrete entities; diversity and multiculturalism, and power imbalances, but for me the issues clearly arise in the intersection between the two, where social injustice arises, so I depicted them as a Venn diagram. The first stage of developing cultural humility was therefore to deepen one’s understanding of these antecedents as a lifelong learning practice. When I reflected on the concepts, it seemed to me that openness and self-awareness related to diversity/multiculturalism and self-reflection and critique, to power imbalance and social injustice. This would constitute the ‘doing the work’ part of the process but does not require remedial methods (those which ‘teach’ white people how to behave or which further victimise people of colour, for example). I am imagining a series of activities for the two strands which anyone could use.

The outcome of this process would be a developing stance. Foronda et al use ‘egoless’ but I prefer ‘decentred’ and ‘solidarity’ which seem more descriptive of the claim they make that “one must enact a belief system of equal human rights and flatten any hierarchy or power differential” (2016). Their ‘supportive interaction’ therefore becomes the observable difference. This is defined as ‘intersections of existence among individuals that result in positive human exchanges’. This is ripe for miracle questioning!

My next task will be to develop the questions and activities that could go in the ‘Doing the Work’ section.

References:

Foronda C, Baptiste DL, Reinholdt MM, Ousman K. (2016) Cultural humility: a concept analysis. Journal ofTranscultural Nursing. 27(3):210-217. doi:10.1177/1043659615592677

Foronda C, Prather S, Baptiste D-L, Lictkar-Flude M (2022) Cultural humility toolkit, Nurse Education doi:10.1097/NNE0000000000001182

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117-125

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I thought there were some useful ideas in here.

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I found this on an intercultural website

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Imagine a world…

…where everyone feels expected and welcome.

A world where children, friends, strangers, guests, customers, and co-workers have the courage and willingness to meet each other for real.

A world where our meetings are characterized by respect, dignity, and care.

A world where we first see our similarities, and then meet our differences with an open, inclusive and welcoming approach.

We mean that this is fundamental for real and sustainable success for us as individuals, our organisations, our societies, and our planet.

From the Swedish book “Om värdskap – konsten att få människor att känna sig välkomna” – (about hostmanship – the art of making people feel welcome) by “Värdskapet”, an organization founded by Jan Gunnarsson

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This classic poem is maybe the closest description of the first step towards "cultural humility" practice that I could find. Once we are able to suspend judgment, for a brief moment, and embrace the full experience of being human, we are the Guesthouse and the Host, at the same time.

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A question asked by Lubaina Himid  - that I think is relevant to producing a toolkit.

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A question asked by Lubaina Himid  - that I think is relevant to producing a toolkit.

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On page 119 of Cultural Humility v Cultural Competence we are asked to recognise when we do not know.
Alongside this we need to create an environment that can begin to respond to this ‘state of being’ - of ‘not knowing’ - so the person can take the next step and not ‘freeze’ ‘become too anxious’  - this negative experience is described by a staff member in one of the videos.
To respond is to ‘Steward the System’ - a term created by Toby Lowe and others - who have also pointed out that the system does not invest money in what needs done.
I think that the next steps of how to do this are appearing and could be taken.

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Lubaina Himid - Artist and Cultural Activist

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Lubaina Himid - Artist and Cultural Activist

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The words which people who attend Lubaina Himid’s Exibition at the TATE are given - asked to read as one enters the exhibition are below  - they are in a leaflet and on the wall.

And this short video takes you into her and her work as a Cultural Activist and Artist.
https://www.tate.org.uk/art/artists/lubaina-himid-2356/lubaina-himid-painter-and-cultural-activist

She says at the end of the video that what is good is that    “she can see two things at once”  - this may be a key to Cultural Humility. Lesley

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Recognising the importance of names - where they come from, how they are pronounced, what they mean to the person/family.

Tayabah commented to me that I pronounced her name in the "ethnic way" which made her think of home and all that that meant.

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Delivering training to a crisis team - we had covered in great detail with Q's and A's the subject of acceptance, non judgement, SF being a process model and therefore content is brought by the client and situation.

Moving on to exercises and Q's and A's around listening to and picking up on nuances of language - in the context of the above - a paradigm shift from diagnosis and needing to know "why"

Argument ensues around whether or not Jamaican Patios can be recognised as a language!

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A scalable empathic-mindset intervention reduces group disparities in school suspensions

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An “empathic-mindset” intervention with teachers reduces suspensions and suspension disparities.

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Seeing the best in others or seeing others as doing their best
Deliberate conversations (with people we disagree with)
Sharing of values - seeing where they overlap, maybe using a values checklist
Encourage enjoying ignorance - opens up the possibility of learning.
Navigate via curiosity
Listening to the 'sweetness of language' in other's speech
Sharing one's cultural heritage

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Cultural openess

Tools of engagement

- How to engage with people who make a racist remark
- How to engage with people who are part of a completely different political view
- How to engage with people who are verbally agressed
- How to engage with people who are verbally or physically aggressive towards people form a different culture
- How to engage with people from different cultures
- How to engage with people from your own culture, but with a different view on it
- How to engage with victims of racism
- How to engage with your own feelings of cultural guilt
- How to engage with kids when they have witnessed racist incidents or heard about them on the news

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A beautiful podcast episode! /JW

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Cultural Humility

Episode Summary

Cultural humility is as essential as anything else in the journey toward equity. Humility comes when we're critical of ourselves and able to realize our map is only a piece of the whole territory. Miguel Ruiz, MD, inspires us with a conversation about cultural competency vs. cultural humility, seeking to understand vs. seeking to be understood, and the hospitality of the heart.

Episode Notes

Cultural humility is as essential as anything else in the journey toward equity. Humility comes when we're critical of ourselves and able to realize our map is only a piece of the whole territory.

Miguel Ruiz, MD, a HealthPartners hospice and palliative medicine physician, inspires us with a conversation about cultural competency vs. cultural humility, seeking to understand vs. seeking to be understood, and the hospitality of the heart.

Hosts: Kari Haley, MD, and Steven Jackson, MD

HealthPartners website: Off the Charts podcast

Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.

Episode Transcription
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency,
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to the show. In this episode, we spoke with Dr. Miguel Ruiz. He's a HealthPartners hospice and palliative care physician.
Kari Haley:
Our conversation surrounded cultural humility. I think Dr. Ruiz did a great job comparing the differences between cultural competency, which is something that often we are taught or have a little bit more education, on versus actual cultural humility, which probably is the more important piece to having these conversations.
Steven Jackson:
Honestly, let's face it. There is no way I'm going to be competent in every person's culture. But approaching it from a standpoint of, "I don't know, but I'm willing to know," puts us ahead of the game, in terms of patient care.
Miguel Ruiz:
For me, humility is a very important concept. And just starting from the very word of humility comes from the Latin "humus." And humus means "soil." And what I think humility does and provides is a reminder, a constant awareness that we come from the same soil; of our common humanity. And actually, that's also the root for the word "humanity." So to me, when we see our patients and also our colleagues ask the human fellows, who have come from the same root that we are, from the common soil, that really helped me understand the importance of trying to meet people where they're at because they're fellow humans. Yeah, they may be patients. Yeah, they may be chiefs of departments. They may be our colleagues. But they're a person. They're a human being. And I think, when we go to our common human humanity is where we can start to understand each other and realize that they may have points to make that we may be missing.
Steven Jackson:
Dr. Ruiz, he demonstrated how going into a situation, not knowing, especially in the context of patient care, if you go into something not knowing or having the attitude of not knowing, it opens up possibilities of knowing. It opens up possibilities of truly getting to the crux of learning about your patient, their situation, which in turn can lead to the care that you're trying to give in the first place. I thought it was a brilliant conversation.
Kari Haley:
I agree. And I think a lot of it is really just approaching. He goes back to his original talk about the humility being part of "humus" and humanity and just talking to each other on the same level and being open to talking to each other on the same level. Because really ultimately, it comes down to, we're talking person to person here and to be able to relate to each other and be able to have that open mind to be able to do that.
Miguel Ruiz:
That's why having a framework by which you understand and you see an interaction with patients, for all patients, but certainly for patients from different backgrounds to yours, is helpful. And this framework I'm referring to, I have been studying and really focusing on, is the framework of cultural humility. Back to the word "humility" here; the concept of really approaching our patients from the standpoint of wanting to know, of accepting that we don't know, that we need to know. Humbly approaching that. And I don't know if it is OK to talk a little bit about this framework.
Steven Jackson:
Please do.
Miguel Ruiz:
... at this point?
Kari Haley:
Oh, yes.
Steven Jackson:
Please do. Teach us.
Miguel Ruiz:
Really... Well, no. No, no, no. Far from teaching you. Just sharing what is something that actually was developed or at least put on paper by a couple of physicians in California in the late '90s actually, in the setting of a teaching clinic and serving patients from many different cultures. And these two authors, Dr. Tervalon and Dr. Murray-Garcia, they coined this concept of "cultural humility" in contraposition to "cultural competence." And that is an important distinction to consider here because, if you think about it, competence speaks more of developing mastery and confidence in a finite set of knowledge, of principles. And we're already familiar with that, correct?
Kari Haley:
Yes.
Miguel Ruiz:
The knowledge that can be demonstrable, like we do the haircut, or you do with the bar exam or whatever else. And that is a way that to demonstrate you are competent. And I think we sometimes have approached cultural and intercultural communication in such a way, where I take a little course on Latino culture. Or I do some workshops and then suddenly, I come to the conclusion that I'm an expert on African American, on Somali culture, or whatever else.
Miguel Ruiz:
So far from that, and a little bit in response to that, the idea of a cultural humility starts by stating that actually, we need to proclaim, "We don't know. We need to know."
Steven Jackson:
Nice.
Miguel Ruiz:
Because even if you are actually taking care of many Latino patients, and you are familiar with the culture, and you have lived or visited Latin countries, you don't know exactly what the patient in front of you, who is Latino, actually is all about. What are his or her priorities? What's important to them? What cultural traits are key in their life?
Miguel Ruiz:
The problem with competence is that that may lead to stereotyping, and that is something we really want to stay away from. So that first tenant of cultural humility is really a commitment, a lifelong journey to self-critique, to self-reflection, to self-awareness, as we were saying before, to say, "I need to seek to understand. I need to find out."
Steven Jackson:
This next point that Dr. Ruiz made was pretty convicting. And if I can be honest with myself, I will gladly take the blame for most of the problems that I've ever had with patient communication being on me.
Miguel Ruiz:
I think most of the problems with patient communication and interactions have to do much more with attitude of the provider than with knowledge of the provider. And I think patients do pick on that. I think if it was a knowledge issue, in terms of even cultural knowledge, it would be something that we could take a course and again, fix. But the thing is, what is our attitude? What approach? How are we coming to that encounter? What are you thinking before you get into the encounter? That I think is important. And that's what you need to adjust, both in the clinic, to a more rapid pace, in the hospital, where you may have the luxury to spend a little more time. But also there's more acuity, and sometimes that can be an impediment. So I think you need to really be flexible on how that fits best the situation you are in.
Steven Jackson:
The one thing that's highlighted in our conversation is that the concept of cultural humility is inherently patient-centered. And when you walk into a patient's room, or you walk into the clinic room, you understand immediately that there are power imbalances. And I believe that Dr. Ruiz did a great job of explaining exactly what that means.
Miguel Ruiz:
The first tenet of cultural humility, the journey, and to have that such a journey, you have to approach it with humility. You want to be looking at yourself, become a student of the patient, leave your agenda behind, and try to understand what's important to the patient. The second tenet of cultural humility has to do with identifying and recognizing power imbalances.
Steven Jackson:
I love it.
Kari Haley:
Yes. Yeah.
Miguel Ruiz:
And I think that's another point; that we are talking about patient interactions, communication, patient care.
Steven Jackson:
And I've stolen this from you, by the way. I've used this, so.
Miguel Ruiz:
It's not mine. I think I mentioned the authors, yes? Five minutes ago. But the importance, when we enter that sacred moment of an interaction with a patient, to be mindful, to not forget that power imbalances exist most of the time. I will say always. And that privilege. And I'll say here, why privilege plays a role in inpatient physician-patient interactions? It's a reality; we need to be aware of it. And not only we need to identify power imbalances in that relationship, we need to try to do something about it.
Miguel Ruiz:
Just think about it. You enter a room, and I could think of hundreds and hundreds of examples with my team. Here we are, the body of knowledge. We are in a familiar place, our hospital. And here we have this lady who just was here, visiting her daughter from Africa, who has been in Minnesota, in the U.S., For the last two months, who feels sick, but yet doesn't speak the language, or at least know well. Who is afraid because she's unfamiliar with the system. Now, let's think about this past year with COVID if who cannot have a visit from her family in the hospital. Just start thinking about the imbalances there in this interaction, in this relationship.
Miguel Ruiz:
You're feeling well, you had your coffee, and you are ready to go for the day. You got all your results of the test. You know the nurse. You know the social worker. You know how this works, this patient is there, not feeling well. Not having knowledge. In an unfamiliar place. Sick.
Steven Jackson:
That's right.
Miguel Ruiz:
You're well-dressed. You got your white coat. You're protecting yourself even. And she's there half-naked.
Steven Jackson:
Wow.
Miguel Ruiz:
And what do we do about that? How must that...
Steven Jackson:
... powerful.
Miguel Ruiz:
How must that feel? I tell the residents working with me that it's thing to, before you enter in a room, let's do the same way the surgeons in the operating room say, "Time out." "Is this the patient we think it is?" "Are we going to do their right leg?"
Steven Jackson:
That's a good question.
Miguel Ruiz:
"Is it the right or the left?" "OK."
Kari Haley:
That's very...
Miguel Ruiz:
We go through that safety, which have proven to really save lives and decrease errors and so forth. I encourage our residents, "Do a bit of a power imbalance time out before you enter to the room. Set your mind in a tone in which you're going to be looking for this. Because unless you're aware of these issues, you're not going to do much about them." Simple things as sitting down at the patient's level, as opposed to, I'm above you. Even try to be below their level. It's OK, sometimes, to be on your knee, so that they can look down on you. That's powerful.
Miguel Ruiz:
Make sure that you do bring with you a professionally-trained interpreter, if they don't speak the language. That is basic, but language discrepancy is a huge imbalance. And even when you approach them, you say, "I'm so sorry. I don't speak Somali. I apologize. Can I bring an interpreter?" You're not saying, "Hey, you don't speak English." You're saying, "I don't speak Somali, I'm sorry."
Steven Jackson:
I love it, man.
Kari Haley:
Yeah.
Steven Jackson:
That's great.
Miguel Ruiz:
That is a position of humility.
Steven Jackson:
That's great.
Miguel Ruiz:
So this humility applies to every one of these three tenants, the first tenant being: wanting to know, debunking stereotypes. Wanting to understand requires humility. Self-critique requires humility. The second tenet of identifying power imbalances requires humility. OK?
Miguel Ruiz:
I think one of the things I found most important in trying to do something about these power imbalances is to try to identify an area in which you are below, in which you, as a provider, as a doctor, as a clinician, are at a lower level than the patient is. Because they happen to have more knowledge in that area. Because of their job, their occupation. Because their life experience. They're older. They have had children. They have experience in parenting that I may not have because I'm struggling with my teenagers. Am I humble enough to say, "I see that your children come to see you here. They look like wonderful people. Would you give me a couple of tips on what you've done well to have such wonderful children?" How would that make that patient feel?
Steven Jackson:
Yeah, it sounds like it would sort of shift the power back towards them.
Miguel Ruiz:
You will elevate them...
Steven Jackson:
Yeah. That's right.
Miguel Ruiz:
... above you. You become a little vulnerable on this interaction, and you are seeking to learn from them.
Kari Haley:
I think the key points for me was that acknowledgement of that power imbalance is a key important piece. And then, the secondary piece of that would be going forward and thinking more about, how do we work on making those imbalances more equal? How do we change or flip the situation, where our patients themselves feel more empowered in the conversation and in their own health care?
Steven Jackson:
Let's tune in.
Miguel Ruiz:
So what is the third tenant of cultural humility, just to close the loop here of the three tenets, which also requires humility? Well, it's developing non-paternalistic, collaborative partnerships with the patients and the communities we serve. And that is important because, for that, you also require institutional accountability.
Miguel Ruiz:
As an organization, you need to commit that we are going to work with these communities, with these individuals, not from the, we are here, and they are there; above or the power over, but from saying, "We do provide the medical expertise, obviously. And we are a hospital. We have doctors, and there is science here. But we come to you, our community that we serve and that uses our hospital, with a humble approach of wanting to learn from you and say, 'We bring our medical expertise. You bring your cultural knowledge, your areas of expertise. And together, hopefully we put together something that helps both of us, but not in a paternalistic way.'" And I can think of many examples I've seen through the years, with patients, in which these relationships, these partnerships really give fruit to very good outcomes.
Steven Jackson:
The practice of medicine is different today than it was us back when grandma and grandpa were getting medical care. Back in the day, the doctor said something and everybody listened. And "go home and do this, do what I say." And there was maybe even a one sided-relationship there. But today it's all about partnership and collaboration. And this was really touched on very well.
Kari Haley:
I did really appreciate that he did specifically mention, too, that the collaborative partnership is not only with our patients, but with the communities that we serve as well, because I think that brings up the fact that health care is not just within the clinic walls, not just within the hospital walls, but also with out into the community.
Miguel Ruiz:
Clinicians, physicians for the most, I think we are biased towards data. You're right. We are scientists. We want to see the numbers because we've learned, through the history, that sometimes perceptions can be misleading and misguiding us and so forth. And yet I think this is a pendulum that we may have gone a little bit toward the heavier reliance on numerical, quantitative data than perhaps we should. [crosstalk 00:16:41] And I want to say that the feel of phenomenological research, the lived experience of individuals is also scientific. That qualitative quality improvement is also a science and that non-quantifiable numerical processes and information should also be science and is also science, in my mind. That we cannot measure it doesn't mean that doesn't exist. Tell me, how can you measure pain?
Kari Haley:
We tried that.
Miguel Ruiz:
We tried, and we failed.
Kari Haley:
Yes.
Steven Jackson:
Yes.
Miguel Ruiz:
And yet, is pain real?
Steven Jackson:
Very real.
Miguel Ruiz:
How do you measure love?
Steven Jackson:
On a scale of... I'm joking.
Miguel Ruiz:
And you're right.
Steven Jackson:
How big can you open arms?
Miguel Ruiz:
With your hands. So, there's so many things that we cannot measure numerically and that we know are real and are there. I think-
Steven Jackson:
It's a great point.
Miguel Ruiz:
... it goes back to the fact that we need to really listen to patients. Because no matter what the data says, in terms of numbers for... and by the way, numerical quantitative data continues to show that there are significant discrepancies by race, ethnicity, language, etc. So I think now we have a body of evidence, in the quantitative world, of the disparities. So there is a problem. There is a problem. But I think part of the solution and the assessment is really to sit down. Small focus groups, small groups, conversation, where patients hopefully are able to tell us how they feel. And realizing that at the end of the day, regardless of what numbers say... And again, I'm a physician, I'm all for numbers.
Kari Haley:
Yes.
Steven Jackson:
Sure.
Miguel Ruiz:
I like to believe things that are demonstrable, if possible. But I think we have to be careful that we don't fall into that because then we start losing the heart.
Steven Jackson:
There's no doubt that data is needed to inform our medical decision-making as well as coming up with prognoses and things like that. But I agree wholeheartedly that sometimes we rely too much on data and miss out on the value of the qualitative aspects of care, which I think are equally important.
Kari Haley:
Dr. Ruiz did a great job summarizing that difference between the data, the hard facts that we as clinicians often use, and how we can mix in those other pieces that are not necessarily measurable, like compassion or empathy, into our patient care.
Steven Jackson:
I think just because it's not measurable, doesn't mean it's not important. In fact, qualitative data is the nonverbal communication of information, and it's very important. The last points of our conversation were powerful and humbling, and I believe there was a proverbial mic drop as Dr. Ruiz finished up with talking about how we should seek to understand more so than seeking to be understood.
Kari Haley:
As we listen to this last piece, I really think that if listeners are able to really just sit with this quote that he does, because it really is powerful.
Miguel Ruiz:
Yeah. I'm just thinking about something that Ibram Kendi says, which is: "Being an anti-racist requires persistent self-awareness, constant self-critique, regular self-examination." And-
Steven Jackson:
I love it.
Miguel Ruiz:
And to me, humility comes when you realize that you need to... you are critical to yourself. You have to constantly realize that you may not have it all together, that you actually may not know some of the factors that are leading this patient to think the way they're thinking or to do or to say what they said or to perceive you in the ways they did. You are humble enough to realize that your map is not the territory. You have just one view of the territory, but you don't have the whole picture. That requires humility.
Steven Jackson:
That's great.
Miguel Ruiz:
To think that... Seeking to understand before you want to be understood. And and in doing...
Steven Jackson:
I got to write that down. That's awesome.
Miguel Ruiz:
And in doing so you realize that, oh, perhaps there's another way to look at this situation that I wasn't aware. Or perhaps this patient is responding in such a way because this and this and this happened before to them, with such a doctor with such a situation in such a health care. Oh, boy. If I would have been on that situation...
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy with creative by Peggy Arnson, Tina Long, Tim Myers, and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.

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Cultural humility is as essential as anything else in the journey toward equity. Humility comes when we're critical of ourselves and able to realize our map is only a piece of the whole territory. Miguel Ruiz, MD, inspires us with a conversation about cultural competency vs. cultural humility, seeking to understand vs.

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Although this research has been developed in US school education, I think the concept is one that can usefully be repurposed to think about any environment where diverse people come together to participate in whatever that space is offering.

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The goal of most American teachers is to successfully educate all students, but too many black and Latino students underperform academically and fail to meet their potential. Educating all students well is not only important for the students themselves, but for our nation as a whole. We cannot have a just and democratic society without fully educated citizens.

Among the many remedies for student underperformance, we find didactic teaching aimed at skill remediation and zero-tolerance policies. These remedies have not worked. Disproportionate numbers of low-income students and students of color are pushed out of school and fail to graduate. Our work on identity safe teaching shifts our focus from the deficits of students to an examination of what we do in classrooms that helps them succeed socially and academically.

Identity safe classrooms are those in which teachers strive to ensure that students feel that their social identity is an asset rather than a barrier to success in the classroom, and that they are welcomed, supported, and valued whatever their background.

Our work evolved from the body of research on "stereotype threat" done by Claude Steele and colleagues. They wanted to understand why black college students had lower grade point averages than white students with the same ACT scores-at every level. Stereotype threat theory states that people from negatively stereotyped groups may fear, in situations that are relevant to them, that they might "be judged or treated in terms of the stereotype or that [they] might do something that would inadvertently confirm it" (Steele, Spencer & Aronson 2002, p. 389).

Literally hundreds of studies have demonstrated the power of stereotypes to depress human performance. For example, black students performed less well than white students on an intelligence test when it was described as a test of ability. But when the same test was called a game, they did as well as the white students. Studies of women taking math tests had similar results.

In another set of studies, white athletes did better than their black teammates when the task was described as one based on "sports intelligence." By contrast, the black students performed better than the white athletes when it was described as a "test of natural athletic ability." (See reducingstereotypethreat.org.)

Our research, the "Stanford Integrated Schools Project" on identity safe teaching practices, explores how to lift the threat to improve success in elementary classrooms. How can teachers reduce the sense of stereotype threat for students whose social identities (race, gender, ethnicity) link them to low school outcomes? Our question: Are there ways to incorporate social and academic practices so students from all backgrounds feel a sense of belonging and purpose in the classroom, so they can fully engage in learning?

Our researchers observed in 84 classrooms to document the arrangement of students and materials, the nature of their relationships, the types of questions directed toward students, the presence or absence of cooperative learning activities, the level of student autonomy, and the teachers' approaches to dealing with misbehavior. We looked for evidence of the use of diverse materials and activities as a resource for teaching, rather than a more color-blind approach that ignores student differences. We discovered a link between identity safe teaching and enhanced student performance. We found:

Students in higher identity safe classrooms had higher scores on standardized tests than students in lower identity safe classrooms.

The Student Questionnaire revealed that students from higher identity safe classrooms had an increased liking for school and motivation to learn, liked challenging work, and felt a sense of belonging compared to students from less identity safe classrooms.

This approach is based on the assumption that teaching and learning are social processes that depend on building trusting, positive relationships between teachers and students and among the students-no matter what their social identities.

Social identities are attributes in each of us-whether we are white or black, young or old, rich or poor, gay or straight, Methodist or Muslim, etc. Everyone has multiple social identities. Sometimes, because of our racialized American history, some social identities are linked to school success and others are not. In identity safe classrooms, student diversity becomes a resource for learning.

Identity safe teaching is in stark contrast to schools whose curriculum is high on remediation and low on inspiration, and whose discipline is punitive and based on heavy-handed control that does not promote compassion, responsibility, and problem-solving.

By contrast, identity safe teaching focuses on how what we do affects students' experience in the classroom. From our research, we learned there is a constellation of things teachers can do that change life in the classroom so that students achieve at higher levels and improve their liking for school, their willingness to work hard, and their feeling of belonging in school. The components of identity safety fall into four major categories: child-centered teaching, cultivating diversity as a resource, classroom relationships, and caring environments. How to put the components into practice is the topic of the next four blog posts in our series.

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The components of identity safety are:

1. Child-centered teaching: promotes autonomy, cooperation, and student voice.

2. Cultivating diversity as a resource: teachers provide challenging curriculum and high expectations for all students in the context of the regular and authentic use of diverse materials, ideas, and teaching activities.

3. Classroom relationships: relationships are based on trusting, positive interactions with the teacher and among the students.

4. Caring classroom environments: social skills are taught and practiced to help students care for one another in an emotionally and physically safe classroom.

This blog is the first in a series of blogs on Identity Safe Classrooms. You can read the second blog in the series here.

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Introduction to Identity Safe Teaching Practices - Center for the Collaborative Classroom

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The goal of most American teachers is to successfully educate all students, but too many black and Latino students underperform academically and fail to meet their potential. Educating all students well is not only important for the students themselves, but for our nation as a whole. We cannot have…

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Promoting Inclusion and Identity Safety to Support College Success

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“When I first arrived at school as a first-generation college student, I didn’t know anyone on campus except my brother. I didn’t know how to pick the

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My best hopes from this discussion group are:
To make some meaningful and lasting connections between the people in the group
To develop a confident way of speaking about cultural humility so that it becomes something which other people can use to reflect on the way they are in relation to each other.
To make the world a better place for humans and non-humans

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Best hopes from this discussion group JW

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Amazing resource for all sorts of approaches

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Racial Equity Tools offers tools, research, tips, curricula, and ideas for people who want to increase their own understanding and to help those working for racial justice at every level –in systems, organizations, communities, and the culture at large.

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Improving Cultural Responsiveness in Therapy

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Improving Cultural Responsiveness in Therapy

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Scott Miller interviews Jesse Owens

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International Center for Clinical Excellence ICCE

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Improving Cultural Responsiveness in Psychotherapy: An Interview with Dr  Jesse Owen

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apparently one of the original mentions.

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Cultural Humility: Measuring Openness to Culturally Diverse Clients

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Cultural Humility: Measuring Openness to Culturally Diverse Clients

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Joshua Hook et al (2013)

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Attendees Cultural Humility Discussion Group May