Meeting the needs of immigrants: Must acculturation be a condition of agency service

Case Study

Ms. Li and her five children live in a Section 8 public housing unit supported primarily through AFDC payments. Her oldest daughter, Pareth Ling, is enrolled in a GED course, but her attendance has been sporadic. She would like to complete high school but feels strong obligations to her mother and the rest of the family. Her mother wants her at home to help with the children, handle various housekeeping responsibilities, and serve as an interpreter as needed.

Ms. Li complains of headaches and difficulty sleeping. She dresses in traditional Cambodian garb. Her mother, father, and seven brothers and sisters were murdered, and a Cambodian therapist has stated that she may be suffering from post-traumatic stress disorder. She has been defined programmatically as displacing child-rearing responsibilities to her teenagers, particularly to the client, 19-year-old Pareth. But in Cambodian culture, this is quite normal, even to be expected.

Social services within the housing development are oriented toward economic independence and moving out of low-income housing. Ms. Li has expressed a desire to learn English and has been scheduled for ESL classes, but she does not attend. Agency staff have labeled her highly resistive: She says she will learn English when the children are grown. Her youngest child is 4 years old.

Pinderhughes in “Understanding Race, Ethnicity, and Power” states that a counseling situation that ignores cultural issues is setting the client up for disempowerment and re-oppression. Chan’s article argues that ten potential impasses in worker-Cambodian client relationships may be attributable to cultural differences between Cambodian culture and the Eurocentric culture of the United States. These include the following, with Cambodian/Asian values listed first:

• Family is understood as the primary unit versus the individual as the primary unit.
• Family solidarity, responsibility, and harmony versus individual pursuit of happiness, fulfillment, and self-expression.
• Continued dependence on family is fostered versus early independence is encouraged.
• Hierarchical family roles and ascribed status are emphasized versus variable roles and achieved status.
• Parent-child (parental) bond is stressed versus husband-wife (marital) bond is stressed.
• Parent provides authority and expects unquestioning obedience and submission to structure versus parent provides guidance, support, explanations, and encourages curiosity and critical/independent thinking.
• Family makes decisions for the child versus child is given many choices.
• Children are extensions of parents versus children are individuals.
• Parents ask, “What can you do to help me?” versus parents ask, “What can I do to help you?”
• Older children are responsible for the siblings’ actions versus each child is responsible for his or her actions.

Many Eurocentric values are congruent with the values of the agency, such as an individualistic focus, independence, and success/performance/achievement orientation. The ethical dilemma then becomes honoring culturally specific family structures and life orientations versus following agency programs and policies. It can be stated as: Client Self-determination vs. Agency Policy and Values.

Honoring culturally specific family structures and Cambodian life orientations.

Draine and Hall (1986) state that cultural understanding in one’s culture occurs early and is typically established by age 5. We use these groundings to interpret our reality, to think, feel, and behave in a manner that provides safety and adaptiveness. Our culture becomes an integral part of our lives, and we become culturally programmed. As such, it remains outside of our conscious awareness. When attempting to function within a second culture, we continue to interpret reality with our original, culturally specific cognitive structures, assuming that these interpretations are right. These orientations may prove quite ineffective for cross-cultural work. Discomfort may manifest itself and be expressed in such emotional or physical ways as frustration, anger, depression, withdrawal, lethargy, aggression, and/or illness. The client may distance him- or herself, as may the worker. Axelson (1993) suggests cultural minorities may choose one or a combination of four positions in cross-cultural situations:

1. They may accept mainstream conditions to the extent of reducing primary group identity and suppressing various personal psychological needs “in order to gain success.”
2. They may compromise with mainstream standards by blending and harmonizing distinctive cultural aspects with the demands of the larger society.
3. They may revolt against the dominant cultural conditions, seeking to change the standards of “acceptable behavior.”
4. They may withdraw “into the security of familiar cultural patterns with which the person most clearly identifies and can readily gain self-respect,” providing for personal needs for security, status, and social relationships. Each position is espoused at a price. The first can frequently result in ridicule from the primary group. The second can be extremely stressful, demanding constant personal monitoring to bring congruency in many social roles. The third can be fraught with constant anger, hostility, resentment, and explicit retaliatory hostility from the dominant culture. The fourth can lead to a sense of imprisonment and suffering, “life apathy,” depression, grieving, a sense of loss of meaning in life, and feelings of “nonbeing.”

Chan (1992) suggests that cross-cultural competence can be built by workers through:

1. Self-awareness
2. Knowledge specific to each culture
3. Skills that enable the worker to engage in successful interactions.

The NASW Code of Ethics requires workers to be culturally sensitive and addresses this issue in several sections. Section 1 states that: Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures. Social workers should have a knowledge base of their clients’ cultures and be able to demonstrate competence in the provision of services that are sensitive to clients’ culture and to differences among people and cultural groups. Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, and mental or physical disability. In reference to broader responsibilities:

Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. Social workers should act to expand choice and opportunity for all people with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups. Social workers should promote conditions that encourage respect for the cultural and social diversity, promote policies and practices that demonstrate respect for difference. Social workers should act to prevent and eliminate domination against any person or group.

Demographic changes are also demanding cultural competence. US Census Bureau Statistics for 2000 show that the Hispanic population in the United States has doubled between 1980 and 2000 and that percentages of other races and ethnicities have also increased. Current statistics drawn from US Census reports that the US population is now 69 percent white, 12 percent black, 11 percent Latino, 4 percent Asian/pacific islander, and 1 percent Native American and “other,” and 2 percent multiracial. The non-white percentage of the population is expected to continue to increase, both through immigration and a higher birth rate. Traditional Asian and Cambodian orientations espouse philosophical positions of fatalism, tradition, living with the past, and contemplating circular things.

Our dominant culture emphasizes “personal control over environment and one’s fate, change and a future orientation, and analytic linear thinking.” The traditional Cambodian culture emphasizes a collectivistic social orientation, group welfare, collective responsibility, and obligation, while the dominant culture emphasizes individual autonomy, independence, and self-reliance. Hierarchy role rigidity and status defined by ascription are generally emphasized within traditional Cambodian positions, while the dominant culture emphasizes equality, role flexibility, and status defined by achievement.

Honoring program imperatives and obligations: An expression of Anglo-European life positions, This state goals of the agency program include:

• Empowering residents to take control of their lives through various self-sufficiency initiatives.
• Providing a comprehensive and integrated program of social services.
• Helping families become economically self-sufficient.

The housing program agency utilizes case management to provide services.

“Central to case management is the function of linking clients with essential resources and empowering clients to function as independently as possible in securing the resources they need. Social work case management is a method of providing services whereby a professional social worker assesses the need of the client and the client’s family when appropriate, and arranges, coordinates, monitors, evaluates, and advocates for a package of multiple services to meet the specific client’s complex needs.

The effectiveness of case management in providing services to people with multiple needs has been documented in a number of studies. Implicit and embedded in case management are the stated objectives and values of the social work profession which include the dignity and worth of the individual and a commitment to social justice and integrity. The case management approach is congruent with Anglo-European values. Relevant to this dilemma are orientation, an action/work/goal orientation, directness, materialism, and personal control over the environment. As a tendency, teleological and utilitarian ethical positions would be more congruent with this life position.

Section 3 of the NASW Code of Ethics supports the obligation of the work to the practice setting: Social workers generally should adhere to commitments made to employers and employing organizations. Social workers should work to improve employing agencies’ policies and procedures. Social workers should ensure that employers are aware of the social workers’ ethical obligation as set forth in the NASW Code of Ethics.

Reflections, Reasoning process, and resolution: The worker follows the worldview of the client as able, while recognizing that personal values might conflict with some Cambodian values. The worker values both “accomplishment” (Anglo-European) and “being” (Cambodian). Values include oneness of people, spiritual connection, sharing of power, compassion, perseverance, accomplishment, flexibility, and fairness/justice.

From a postmodernist social constructionist position, values and beliefs are understood as forever with us, shaping our perceptions and actions. The worker and the client are in a relationship. The shape of that relationship and the response of the client are strongly influenced by the theoretical orientations assumed by the worker. The ethically defined choices available are in some ways prefigured by the orientation chosen.

The Kantian theory of obligations, the utilitarian theory of consequences, and the liberal individualism theory of rights tend to come out of the positivistic science tradition. These theories move epistemologically from several assumptions, among them:

1. A separation of subjective from object and by corollary, worker from client
2. Judgment formulated from “firm universal principles”.

Critics of the obligations/consequences/rights orientations suggest that they can only provide limited insight into what should be much broader conversations on moral decision making.

The ethics of care orientation emphasizes relationship, contextuality given relationships, compassion, sympathy, discernment, sustenance, and care. Another article notes, “The case perspective is especially meaningful for roles such as parent, friend, physical, and nurse, in which contextual response, attentiveness to subtle clues, and the deepening of special relationships are likely to be more momentous morally than impartial treatment typical of traditional theories. Moreover, in any hierarchical situation, systems of any kind, the people in power define reality. We can mitigate this imbalance by selecting an ethical theoretical base that works to minimize hierarchical influence.

Instead of being viewed as resistant, a culturally sensitive ethics of care approach might be to understand Ms. Li as possibly fearful of authority and involvement in a cultural community that is foreign to her. Pressure may drive her further into her house, possibly into depression, hurting individuals and family structural ties. Compassion from an ethics of care would suggest the worker tread easily and remain aware of imbalances in the worker/client relationship.

A communitarian theory might be chosen as a supplemental framework. This orientation has grown out of reactions to social and familial fragmentation, understood as due to the individualism espoused by advanced industrial societies. It can serve as criteria for judging actions that do or do not reinforce and promote communal and family values, cooperative virtues, and goals and obligations built up from and within historically constituted groups. These roles, responsibilities, and obligations are understood as historically constituted.

The communitarian ethics approach closely approximates the Asian Cambodian life orientation presented previously. This framework tilts the worker in the direction of the cultural side of the previously presented dilemma. One must begin by redefining the client as the family, rather than Pareth. This is not altogether in opposition to the program imperative that states: “Helping families become economically self-sufficient.” Though family in this context is understood in “American” family terms of performance and achievement. Focus needs to be given to family solidarity and responsibilities, as understood from the Cambodian orientation.

Ms. Li, the hierarchical head of the family, places her responsibility to her children above her desire to learn English. Pareth has also expressed a sense of responsibility to her mother and family ties and a willingness to delay GED studies. Continued dependence and integration with ascribed family roles are expected and fostered.

An appropriate goal perhaps would be to help facilitate better linkage to a Buddhist temple. Ms. Li describes herself as Buddhist, though only visiting the temple on New Year’s Day. The Buddhist orientation is consistent with the ethics of care/relationship perspective. The worker may also advocate that the agency move toward greater cultural competence, a value supported by the NASW Code of Ethics. The consequence of this “universal” philosophy is assimilation of cultural values into the Euro-centric melting pot. A culturally proficient agency improves services and actively seeks advice and consultation from a variety of ethnic communities and includes such practices into the organization. Communication and mutual support between the agency and Buddhist Temple would possibly both assist Ms. Li and establish a valuable link to enhance cultural proficiency. A professional social worker assesses the need of the client and the client’s family when appropriate, and arranges, coordinates, and advocates for a package of multiple services to meet the specific client’s complex needs. These approaches would enhance “respect and appreciation for individual group differences, willingness to persist in efforts on behalf of clients despite frustrations, and commitment to social justice for all members of society.”

Analysis

Ethical Dilemma: The ethical dilemma in this case revolves around the conflict between honoring culturally specific family structures and life orientations of the Cambodian client, Ms. Li, and following the program imperatives and obligations of the agency, which emphasize Anglo-European life positions and self-sufficiency.

Resolution using the Ethical Dilemma Resolution Model (EDRM):

1. Identify the Dilemma:
   • The dilemma is Client Self-determination vs. Agency Policy and Values.
2. Stakeholder Consideration:
   • Ms. Li and Her Family:
     • Needs:
       • Preservation of their cultural values and family structure.
       • Assistance with their immediate social and economic needs.
       • Access to services that respect their cultural context.
     • Values:
       • Family solidarity and collective responsibility.
       • Preservation of Cambodian cultural values.
       • Compassion and understanding of their situation.
   • The Agency:
     • Needs:
       • Fulfillment of its mission and program objectives, which include self-sufficiency initiatives.
       • Compliance with established policies.
       • Ensuring efficient allocation of resources.
     • Values:
       • Self-sufficiency, independence, and economic empowerment.
       • Adherence to agency policies.
       • Achievement of program goals.
   • The Social Worker:
     • Needs:
       • Ethical and effective service delivery.
       • Adherence to professional and agency standards.
       • Balancing the client’s needs with those of the agency.
     • Values:
       • Client self-determination and autonomy.
       • Cultural competence and sensitivity.
       • Ethical practice in alignment with the NASW Code of Ethics.
   • Balancing the diverse needs and values of these stakeholders is a complex task. The resolution should aim to harmonize the values and address the needs of Ms. Li and her family, ensuring that their cultural context is respected, while also working towards the agency’s objectives of self-sufficiency. The social worker must navigate this delicate balance to provide effective and ethical services.
3. Ethical Theories:
   • Explore different ethical theories to guide the decision-making process:
     • Kantian Theory: Focus on client self-determination and respecting Ms. Li’s autonomy.
     • Utilitarian Theory: Consider the consequences of decisions on Ms. Li and her family.
     • Ethics of Care: Emphasize compassion, relationship, and understanding of Ms. Li’s cultural context.
     • Communitarian Ethics: Align with Cambodian life orientation and family solidarity.
   • Kantian Theory: Prioritize Ms. Li’s autonomy and self-determination in decision-making.
   • Utilitarian Theory: Evaluate the outcomes and consequences of choices, aiming for the greatest benefit to Ms. Li and her family.
   • Ethics of Care: Emphasize compassion, understanding, and maintaining a strong relationship with Ms. Li, taking into account her cultural context.
   • Communitarian Ethics: Align decisions with Cambodian cultural values, focusing on family solidarity and responsibilities.
4. Decision and Resolution:
   • Acknowledge the importance of cultural competence and respect for cultural differences, as mandated by the NASW Code of Ethics.
   • Consider the implications of assimilation versus cultural proficiency.
   • Recognize the need to redefine the client as the entire family, not just Pareth.
   • Prioritize family solidarity and responsibilities in line with Cambodian values.
   • Encourage the agency to enhance cultural competence by seeking advice and consultation from ethnic communities.
   • Promote better linkage to a Buddhist temple, consistent with Ms. Li’s values and the ethics of care.
5. Implementation:
   • Advocate for cultural proficiency within the agency.
   • Establish communication and mutual support between the agency and the Buddhist Temple to enhance cultural proficiency.
   • Work with Ms. Li and her family to facilitate their needs while respecting their cultural values.
   • Consider a more flexible approach to Ms. Li’s English language classes and self-sufficiency initiatives that align with her family responsibilities.
6. Evaluation:
   • Continuously assess the progress of Ms. Li and her family in achieving their goals while preserving their cultural values.
   • Ensure that the agency’s services are culturally sensitive and respectful.

By following these steps, the social worker can navigate the ethical dilemma by prioritizing cultural competence and family values while working towards the self-sufficiency goals of the agency. This resolution aims to respect and empower Ms. Li and her family within their cultural context.