Sample Literature Review Paper on Intersectionality, Cultural Humility, and Mental Health Treatment in Washington State

SECTION 1: FOUNDATION OF THE STUDY AND LITERATURE REVIEW
Cultural awareness is a fundamental clinical practice standard within the social work
profession and it is usually reinforced by the personal-centered approach of profession (Zeitlin,
Altschul, & Samuels, 2016). Even though the engagement of social workers is guided by person-
centered theory with unconditional positive regard in helping to have an understanding of the
client’s worldview, the prevalent problem common to the social work practice is the failure to
integrate cultural awareness in the mental health settings (Rogers, 2006). The code of ethics of
NASW (2015) requires that it is mandatory for social workers to have an understanding of the
functions of culture in both the society and lives of clients.
The provisions of NASW (2015) also bestow the obligatory responsibility of social
workers to develop skills needed in facilitating the process of working effectively with diversity
and obtaining knowledge of other cultures. In 2018, the standards of cultural competency were
revised by NASW, a situation that led to the consequent development of the indicators and
standards for cultural competence in the practice of social work. Intersectionality and cultural
humility were identified by these revised standards as the indicators of social work practice
(NASW, 2018). This qualitative study will use an action research approach to examine the
clinical behaviors that help in demonstrating intersectionality and cultural humility in mental
health treatment.
The study will seek to promote social change by advancing its contribution to the
literature regarding cultural awareness in matters concerning social work practice. In this
capstone project, the paper will be divided into two main sections. The first section will seek to

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describe the problem inhibiting the integration of cultural awareness within the settings of mental
health, the description of the purpose, nature, and significance of the study followed with the
theoretical framework that acted as the guidance for the study. The literature review describes
the historical context, summary of current clinical applications, and the rationale supporting this
study on intersectionality and cultural humility in mental health treatment. The second section
offers description of research design and data collection process to explain the methodology
adopted in conducting the study. The methodology section includes a description of the
participants, procedures of recruitment, rationale for using zoom or telephone interviews for data
collection, participants of the study, design of the study for obtaining informed consent and
protecting participants, instrumentation, description of the data analysis process, and the study’s
ethical procedure for ensuring that the study’s participants are protected.

Problem Statement

In mental health treatment, considering that there continues to be growth of diversity in
the United States, for clinical social work to be effective, it is necessary for the practice to
incorporate cultural awareness. It is unclear how cultural humility and intersectionality are
specifically integrated into in social work practice in Washington, and this will be problem that
this study seeks to address. The study will more specifically examine the clinical behaviors that
the social workers use in demonstrating cultural humility and intersectionality when offering
mental health treatment to patients. Cultural humility is the awareness of the privilege and power
present in self-monitoring process and relationships to help in addressing any existing power
imbalances. Cultural humility bestows the obligation upon social workers to recognize their
distinctive positions of power so that they can actively be involved in mediating the imbalances
in their relationships when working with diverse groups of clients. Cultural humility thus infers

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to the process by which social workers are effectively and respectfully responding to people of
all diversity factors such as sexuality, races, cultures, languages, classes, ethnic backgrounds, and
religions in ways communicating and protecting the worth and dignity of all individuals (Kohn-
Wood & Hooper, 2014). Intersectionality is a concept that focuses on examining the prevalence
of gender inequalities within the structures of power and confines of social relations (Ratts,
2017). Cultural awareness is regarded as the process by which social workers are effectively and
respectfully responding to people of all diversity factors such as sexuality, races, cultures,
languages, classes, ethnic backgrounds, and religions in ways communicating and protecting the
worth and dignity of all individuals. Cultural awareness bestows the requirement on social
workers in building positive working alliances with clients for the purpose of achieving positive
treatment outcomes (Worthington Jr. & Utsey, 2013). Lee and Horvath (2014) conducted a study
where they examined the adverse outcomes of treatment when there is lack of cultural awareness
on the therapists’ dialog. The study found out that responses of the therapist helped minimize the
cultural factors such as the moral values, beliefs, language, and traditions that are involved in the
process of decision-making for the client. The actions of the therapist strained the working
alliances consequently leading to the less engagement of the client in the treatment.
The problem pertaining to the ignorance of integration of cultural humility and
intersectionality in the clinical social workers practice has been exhibited through the issues of
implicit and explicit power differentials and acceptance and fostered therapy (Tourse, 206). An
argument floated by Tourse (2016) is that the existence of explicit and implicit power
differentials embedded within cultures is usually taken for granted. Social workers have ignored
and continue to overlook cultural power dynamics and clients have progressively been
disempowered in the process of treatment by identifying the behaviors that are culturally specific

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and imposing interventions that are culturally sensitive (Edwards, 2016). However, Edwards
(2016) informed that the recognition of the client’s culture in treatment planning and mental
health interventions is associated with an increase in the participation of client. The increase in
participation of client in treatment consequently led to an increase in positive outcomes on
mental health. Hook et al. (2013), support that there is occurrence of positive outcomes in mental
health in strong therapist-client working alliances. Hook and his colleagues replicated four
studies in their research to demonstrate how the existence of strong working alliances serves a
significant role in predicting the improvement in functioning that the clients reported. The
perception by the clients that the therapists have respect for their culture developed strong
working alliances that served to demonstrate cultural humility (Hook et al., 2013).
According to Rogers (1957), there is the occurrence of effective therapy through the
alliances of acceptance and fostered therapy. In unconditionally accepting environments, clients
have the ability of exploring their states of incongruence. The states of incongruence are the
discrepancies between the perceptions of the clients of self and the life situations, and these
perceptions make the clients to experience emotional and mental distress (Rogers, 1979). The
occurrence of internal conflicts is a contributing factor to the symptoms related to depression and
anxiety. The existence of positive working alliances facilitates the provision of environments that
allow clients to become involved in the change process. The purpose of mental health treatment
is to serve in assisting clients through this change process tailored towards helping in the
alleviation of associated symptoms, and this is the problem that this study will primarily seek to
advocate for its solution in the delivery of treatment by ckinical social workers for the diverse
population in Washington State. Understanding the culture of the client assist in building strong
working alliances, but this also creates the possibility of causing power imbalances that can

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influence the working alliances (Berg, 2014). The revised standards of cultural competency have
incorporated the concepts of cultural humility and intersectionality that facilitate the recognition
of power dynamics (Tourse, 2016). Cultural humility and intersectionality are concepts
responsible for examining oppression, privilege, and power present in societies and existing
within the context of interpersonal relationships (Azzopardi& McNeill, 2016). Cultural humility
and intersectionality are concepts responsible for examining oppression, privilege, and power
present in societies and within the context of interpersonal, and have specifically bestowed their
emphasis on the principles of social justice and the advocacy skills implementation (Danso,
2016).
In Washington State, cultural competence is an imperative requirement for clinical social
work practice owing to the diversity of its population to ensure that every person’s unique needs
are considered in the provision of mental health treatment services. The population consists of
African Americans, Native Americans, Cuban Americans, Vietnamese Americans, Caucasians,
Hispanics, LGBT (Lesbian, Gay, Bisexual, and Transgender persons), and large number of
people living in poverty (U.S. Census Bureau, 2016). Washington State is unique from other
States in America since it has the highest percentage of Hispanics approximated at a 48% of its
total population (World Population Review, 2017). Of the total Hispanics population, 17% are
immigrants from Latin America and 83% are native-born. Washington is third to Alaska and
New Mexico in terms of having large population of Native Americans, estimated at around 16%
of its total population (U.S. Census Bureau’s, 2016). Washington is one of the four States in
America to have an ethically minority-majority population. Besides, about 10% of the residents
of Washington live in poverty, and it is ranked 53 rd as the poorest states in the U.S. (Center for
America Progress, 2017). In addition, Washington is ranked as one of the top 5 States for the

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LGBT people (The Daily Best, 2018). Considering that Washington is culturally diverse with a
considerable population still living in poverty, the needs of the community require service
providers who are culturally competent.
In 2013, Washington suffered from mental health services across the State being abruptly
terminated, and the situation made the grassroots community organizers to seek for having a
holistic understanding of the mental health needs of the residents. The community organizer
recorded 84 interviews and documented that Washington residents were experiencing long
waiting lists to see mental health therapists, constant increased turnover rate of the mental health
providers, and mental health services lacking cultural sensitivity. Washington houses high
percentage of people living in poverty and homeless and its population is ethnically and
culturally diverse, open to mixed sexual orientations (U.S. Census Bureau, 2016). Therefore, to
adequately and effectively address the mental health needs of Washington’s population, the
integration of cultural humility and intersectionality is necessary.
The practice that entails integrating cultural humility and intersectionality has been
determined to be an imperative necessity to adequately address the mental health needs of the
population in Washington State. The study will seek to explore how the integration of cultural
humility and intersectionality helps social workers understand the client’s worldview during
mental health assessment. It has been determined that there exists a gap between social
oppression and power dynamics knowledge and their integration into clinical practice (Bubar,
Cespedes, & Bundy-Fazioli, 2016). Therefore, based on this gap, when it comes to mental health
treatment, it is still evident that there continues to be lack of effective clinical social work
practice that incorporates cultural awareness, cultural humility, and intersectionality to address
the needs of the ethnically and culturally diverse population. In this regard, the principal focus of

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this study will be tailored towards supporting the current efforts at the grassroots level seeking to
improve mental health services in Washington by extensively researching the clinical behaviors
in mental health treatment.

Purpose Statement and Research Questions

The purpose of the research study will be to examine the clinical behaviors used in
demonstrating cultural humility and intersectionality in the mental health in Washington State.
The focus will thus be to determine how the integration of cultural humility and intersectionality
help the social workers acquire knowledge and skills that enable them to exhibit suitable clinical
behaviors needed to provide quality mental health treatments to clients from culturally diverse
backgrounds. Person-centered theory will guide the research to facilitate the process of
examining how the integration of cultural humility and intersectionality can be help to the social
workers in understanding the worldview of the clients and their respective incongruence state.
Research Questions
The study will focus on the following research questions:
1. What clinical behaviors do social workers use in the different stages of mental health
treatment (i.e., engagement, assessment, intervention, and evaluation) to convey cultural
humility and address intersectionality?
2. How does the training of social workers help in integration of cultural humility and
intersectionality that enable them to acquire the appropriate knowledge and skills to
understand the client’s worldview from diverse backgrounds needed to promote mental
health assessment?
The study will contribute to the advancing of the professional practice of social workers in
three distinct ways. The study will support the grassroots efforts that have been started in

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Washington State with the goal of helping improve services of mental health treatment. The
study will examine the cultural awareness of social workers. The clinical social workers will
provide examples of the successful interventions specific to the clients in Washington State. The
study findings will contribute to the development of continuing education training for the
community of social workers in Washington State. Besides, the findings of the study will provide
the specific examples of clinical behaviors that are responsible for conveying cultural humility
and intersectionality for complementing the studies conducted by Jani, Osteen, and Shipe (2016)
aimed at developing cultural competency measures for social work. Also, according to Seedall,
Holtrop, and Parra-Cardon’s (2014) review of 8 years of literature, additional research
concerning the integration of cultural humility and intersectionality in the mental health
treatment is needed to facilitate the process of educating therapists in the social work practice
behaviors coupled with increasing their awareness on significance of understanding power
dynamics in the delivery of treatment. Finally, NASW (2015) standards of cultural competency
endorse the necessity to conduct research on such issues of cultural competency as humility and
intersectionality.

Nature of the Study

This study will use basic qualitative methodology to understand how the integration of
cultural humility and intersectionality helps social workers understand the
client’s worldview and mental health assessment. The qualitative method design was chosen
because of the collaborative nature to inspire social action, to demonstrate cultural awareness,
and gather descriptive clinical behaviors. Zoom or telephone interviews will specifically be used
to collect data. The zoom or telephone interviews will consist of 17 social workers recruited from
different locations across the State of Washington. The rationale for using a small sample size of

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only 17 social workers is to help reduce the transferability and generalization of the data that will
be collected. The use of zoom or telephone interview as a data collection method makes the
study be an action research design, which will inspire social action as it is collaborative in nature
to promote the collaboration between the researcher and the participants (George, Duran, &
Norris, 2014). Action research is defined as the approach where the researchers and the
participant collaborate in the diagnosis of a selected problem to foster the development of a
practical solution. Action research applied to the context of this study as it will involve the
collaboration between me as the researchers and the selected sample participants of social
workers involved in clinical practice in Washington State to examine the demonstration of
cultural humility and intersectionality in mental health settings. As a result, there will be a
facilitated gaining of insights from the participants on the community issue of cultural
insensitivity in mental health treatment to inspire social action in Washington State. In this
regard, the interview process will promote and respect the cultural diversity of the participants
since Washington is a culturally minority-majority state making it likely for diversity to be
expected as a critical reflection in the social workers who will be selected for participation in the
research process. The participants will have to be those who can be accessed online and
telephone to facilitate the arranging for zoom or telephone interview process. There will be the
inclusion of participants in the decision-making process during the research and the
acknowledgment of their contributions will be a valuable approach for encouraging their
participation in the research (Sheridan et al., 2013).
Participants to be interviewed will be the clinical social workers providing mental health
treatment in Washington State. These participants will be recruited from the Washington State
Department of Health list of approved clinical social workers supervisors available in

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Washington State Society for Clinical Social Work (WSSCSW) and NASW Washington chapter
website. Although the list is not all-inclusive of practicing social workers in Washington State,
the social workers on the list possess the license that permits them to provide mental health
services. The List is a public record which contains names of approved licensed clinical social
work supervisors and their contact information, specifically mailing address, emails and mobile
phone numbers. As a result, emails and phone calls will be majorly used to communicate with
potential participants in the research. Phone calls will be made to the selected participants to seek
for their consent and inform them of the request to engage in the research, on a voluntary basis.
An introductory email will be sent to potential participants explaining the research project.
Accepted participants willing to participate in the study will receive a follow-up email that will
include the demographic sheet and consent form. The information provided by the participants
will be kept confidential by not revealing their names, faces, or addresses to limit access to
identifiable information and storing the data documents in locked locations.
Cultural insensitivity has been identified to be on the rise in the mental health making it
community issue in Washington State (Coghlan, 2016). Based on the consideration that cultural
awareness is an ethical standard of social work practice, the action research will be the most
appropriate approach for engaging Washington State clinical social workers in the research
process, and the process will present the possibility of inspiring the participants to promote
change (Buettgen et al., 2012). Because the study’s focus is clinical behaviors in the mental
health treatment, the recruitment will be purposeful to help in obtaining participants with first-
hand experience in the provision of mental health services. The two concepts that will be
examined are cultural humility and intersectionality in the clinical social work practice. The use
of zoom or telephone interviews will, therefore, help in gathering detailed rich data, and the data

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will be consequently analyzed and organized using thematic data analysis to look for common
patterns and themes.

Significance of the Study

The study will contribute to the advancement of social work practice in cultural
competency with research, practice, and policy. The revised NASW (2015) cultural competency
standard is a policy that explicitly identifies intersectionality and cultural humility as the
competency indicators. The data collected from the study will provide information on how to
integrate current policy standards that the agencies of social work profession will be required to
have on cultural humility and intersectionality required to be demonstrated by the social workers.
Understanding how cultural awareness translates into practice behaviors that contribute to the
development of measures specific to the social work profession is critical (Jani, Osteen, &Shipe,
2016), and the data from this study will describe the specific clinical behaviors that demonstrate
intersectionality and cultural humility. The data from this study will provide the practical clinical
examples on how to improve cultural competency in offering direct services to clients.
The study will support the social change efforts in Washington State that started in 2006,
tailored towards helping improve mental health services. Since Washington is a State with a
highly diverse population, the data gathered from the study will provide insight into the
integration of intersectionality and cultural humility in mental health practice. The study will
identify the continuing education needs and resources for cultural humility and intersectionality.
As a qualitative research study that is action-oriented, the promotion of collaborative efforts
among the communities to improve cultural competency in Washington State will be the
predicted outcome of the study.

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Theoretical Framework

The practice concepts of social work profession are based on person-centered theory and
are aligned with the research on cultural humility and intersectionality. Person-centered theory
helps the social workers to view the world of their respective clients (patients) from different
lenses considering their unique race needs based on the diverse experiences and difficulties.
Person-centered theory allows the clinical social workers to understand their patients and the
associated struggles with cultural, ethnic, and racism experiences. Rogers (1979) explained that
clients often enter therapy in conditions of incongruence and changes systematically occur in the
presence of empathic environments. The fundamental tenets of person-centered theory include
(a) trustworthiness of people, (b) people are intrinsically moved towards attaining self-
actualization and good health, (c) people have inner resources to propel themselves towards
positive directions, (d) people respond to their world as they uniquely perceive, and (e) people
have interaction with these external factor that form the basis of their fundamental beliefs.
Rogers (1942) created an emphasis on justifying the relationship between clients and
therapists as a crucial factor in facilitating the change process of the client. According to Rogers
(1942), the cultivation of the therapeutic relationships lies in the congruence of the therapists.
The therapists’ congruence allows for the development of genuine relationships to foster specific
conditions necessary for change. Rogers (1942) identified six core conditions that serve the
critical role necessary for the promotion of constructive change and growth, (a) the clients and
therapists are in psychology contact, (b) the clients are in conditions of incongruence, (c) the
therapists are congruent in the relationships, (d) therapists demonstrate unconditional positive
regard, (e) therapists display empathic understanding, and (f) therapists communicate
genuineness, acceptance, and warmth, which is often minimally achieved.

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Person-centered theory will align this study on cultural humility and intersectionality in
the mental health practice. Person-centered theory is in recognition of the clients as the experts of
their lives (Rogers, 1942), which is often supported by the practice of cultural humility. Cultural
humility requires the social workers to let go of the professional power and be in recognition of
the clients’ power (Joseph & Murphy, 2013). Furthermore, person-centered theory emphasizes
on the need to understand the worldview of the clients and intersectionality (Tourse, 2016).
Intersectionality offers explanation of understanding the client’s worldview through the lens of
multiple identities in the social structure promoting discrimination, oppression, and privilege
(Crenshaw, 1989). The intersection of multiple identities serves to predict the degree of
discrimination encountered on individual basis. The use of person-centered approach will
facilitate the provision of a comprehensive framework that helps to explore cultural humility and
intersectionality in mental health treatment.

Values and Ethics

The NASW released the amendments to the Code of Ethics on January 1, 2018. There
was a change in section 1.05 heading from “cultural competence and social diversity” to
“cultural awareness and social diversity” (NASW, 2018). The revisions provided are reflection
of the insights presented in NASW’s (2015) The Standards and Indicators for Cultural
Competence in Social Work Practice. Since NASW made implementation of these changes just
as recent as 2018, the terms competence and competency will still be used throughout this
capstone project for the purpose of aligning with the terminologies used in the literature
reviewed.
The NASW (2015) revised cultural competency standards made an incorporation of
expanded definitions of cultural humility and intersectionality. Cultural humility and

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intersectionality incorporate the recognition of the innate human rights regardless of the status or
identity of the clients for the social workers to step into action (Azzopardi & McNeill, 2016; Cho
et al., 2013; Fisher-Borne et al., 2015). The ethical standard 1.05 cultural awareness and social
diversity is of the requirements of knowledge in different cultures, having an understanding of
the influence of culture on society and human behaviors, and developing awareness of the nature
of oppression and diversity (NASW, 2018). In this capstone project, the focus will be to examine
cultural humility and intersectionality in the mental health practice, and the ethical standard 1.05
is in support of this study.
Cultural humility and intersectionality align with the core ethical values of social work
that considers the worth and dignity of social justice and the person (NASW, 2018). The
concepts of cultural humility and intersectionality are the awareness of oppression, power, and
privilege in the larger society and the client-social worker relationships (Ratts, 2017). Cultural
humility and intersectionality integrate social justice and advocacy actions (Cho, Crenshaw, and
McCall, 2013). The standard 6.04 political and social action mandates the social workers to
advocate for change for the betterment of all people and promoting respect for cultural diversity
(NASW, 2018). The code of ethics guides social work advocacy and practice with diverse
cultures and are aligned with the purpose of this study to facilitate the process of examining
cultural humility and intersectionality in mental health practice.
The Washington Social Work Board of Examiners is the governing and licensing entity
for all the social workers in the State and the board holds cultural competency in high esteem in
compliance with the licensing requirements of the State. The Washington Board mandates that
all social workers providing mental health services to possess social work license issued by the
State. Social workers can apply for social work license at any level ranging from bachelor,

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master, to independent, but they need to meet the standard of cultural competency either by a
three-credit hour course in Washington cultures listed on the transcripts of the applicants; a
board-approved course, workshop, or seminar in Washington cultures; or proof of previously
passing the Washington cultural examination. The cultural competency expectations do not stop
after making an initial application. At the time when applying for renewal of license, the Board
requires social workers to must have obtained six of the thirty continuing education hours in
cultural awareness. The Board’s commitment to the cultivation of cultural competency by the
social workers will be in alignment with this study on cultural humility and intersectionality in
mental health practice.
The study on cultural humility and intersectionality in social work in Washington will
promote ethical service values of NASW. The ethical principle of service mandates that the
primary goal of social workers is to help the people in need and to address the social work
problems (NASW, 2018). This capstone project will examine the practice behaviors needed for
the integration of cultural humility and intersectionality to promote the self-actualization of the
client, which consequently service to enhance the social work service. The knowledge gained
from this study will help in improving the delivery of service in mental health treatment and
encourage the participation of clients in mental health services.
The study will follow the ethical standards when conducting the action research on
human subjects. All the selected participants will receive information on the purpose of the study
and contact information for any question as well as get informed on any of the potential risks that
will be encountered by participating in the study and their explicit rights to stop participation at
any time. All the participants will be required to sign the consent form and will be provided with
a copy of the form.

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Review of Professional and Academic Literature

Library searches will be conducted until the completion of this capstone project to collect
extensive literature on the selected themes. The following databases will be used PsychInfo,
SocIndex, Education ProQuest, Ebscohost, Sources, Social Science Citation, and the Academic
Journal. These databases will be used because they supply the extensive past and scholarly
literature on the issues of cultural competency in mental health practice. The following are the
list of the key terms that will be used in the searches: cultural competence; awareness; cross-
cultural practice; cultural responsiveness; cultural sensitivity; diversity; multicultural practice;;
social work; clinical practice; cultural humility; intersectionality; mental health; and therapy.
There are variety of terms will be utilized to add to a comprehensive search of the literature.
Peer-reviewed scholarly articles published in the past 5 years will be utilized. Older articles will
also be incorporated because they are works that reflect the original core concepts of the writers.
For example, the original work of C. Rogers (1942, 1957, and 1979) will be utilized to support
the person-centered theory. The original work of Crenshaw (1989) will be used to describe
intersectionality. Finally, Tervalon and Murray-Garcia (1998) will be perceived as the primary
supporters of the idea of cultural humility. The search in literature exhibited a huge range of
research on cultural competence. The research will be organized into three fundamental themes:
the critiques of cultural competence, clinical practice, and the working alliances in mental health.
Each theme will be divided into subcategories to examine them in detail. The result will be a
literature review that supports this study to examine cultural humility and intersectionality in
mental health settings in Washington State.
Cultural Competence: Significance and Critiques

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The mental health professions such as medical, marriage and family, counselors, and
social work therapists value cultural competency as an ethical practice and as a socio-political
merit (Chang et al., 2012; Edwards, 2016; Horevitz et al., 2013; Kohn-Wood & Hooper, 2014;
Seedall et al., 2014). The huge range of professional associations integrate the guidelines of
cultural competency in their ethical practice codes, for example, the American Psychologist
Association (Chu, Leino, Pflum, & Sue, 2016), the American Psychiatric Nurses Association
(Nardi, 2014), the American Counseling Association (M. J. 1 Ratts, Singh, Nassar-McMillan,
Butler, & McCullough, 2016), American Association for Marriage and Family Therapy (Seedall
et al., 2014), and the National Association of Social Workers (NASW, 2015). As demonstrated
by emerging research that cultural competent practice can help address health disparities among
the minority clients (Chu et al., 2016; Jackson, Williams, & Vander-Weele, 2016), cultural
competence keeps on being of prime importance in mental health treatment.
The evolution of culturally competent practice started during the 1950s when the idea of
diversity promoted the Melting Pot analogy, hence, treatment distinctively focused only on
interventions and problems (Kohli, Huber, &Faul, 2010). As the social injustices against the
people of color were exposed by the Civil Right Movement in the 1960s, the approach to
minimize discrimination colorblindness became the approach that was increasingly advocated for
(Fong, 2001). From the 1980s through the 1990s, the cross-cultural practice proceeded into
multicultural and cultural sensitivity, then transformed into the framework of social
constructionist ethno-cultural structure in the past decade (Boyle & Springer, 2001; Kohli et al.,
2010; Lee & Greene, 1999). The definition of cultural competency acknowledged across
disciplines is that provided by Cross, Bazron,Dennis, and Isaac's (1989), which portrayedcultural
competence as behaviors and values shown among professionals and supported by agency

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policies to empower effective and successful cross-cultural interactions. Although cultural
competence is immensely valued, the literature critiques the existing array of cultural
competency frameworks (Azzopardi & McNeill, 2016; Danso, 2016; Edwards, 2016; Sheridan et
al., 2013). The critiques are: (a) logical inconsistency and contradiction in cultural competency
terminology, (b) competency needs to go beyond knowledge and skills frameworks, and (c) the
clinical and cultural integration into practice. These critiques of cultural competence are of great
contribution to the integration of cultural humility and intersectionality into NASW's (2015)
standards of cultural competency.
Critique of Terminology
Terminology influences the role of the social workers and how the social workers
function and perform the given role. The term cultural competence infers the social workers can
gain mastery of another culture (Fisher-Borne et al., 2015; Hollinsworth, 2013; Horevitz et al.,
2013). The term cultural competence is of the implication that the social workers execute their
roles professionally (Fisher-Borne et al., 2015). Numerous researchers present other
terminologies that create emphasis on the function of cultural competence practice, for example,
cross-cultural competencies (Lee, 2011), cultural equity (Almeida, Hernandez-Wolfe, & Tubbs,
2011), cultural consciousness (Azzopardi & McNeill, 2016), critical cultural competence (Danso,
2015), cultural awareness (Furlong & Wight, 2011), cultural intelligence (Edwards, 2016), and
cultural humility (Fisher-Borne et al., 2015). The terminology presented creates a shift in the
social workers’ roles as the learners and facilitates the establishment of the clients as the experts
(Hollinsworth, 2013), hence, setting the mood for the need and importance of establishing
working alliances and empowering the clients within the social work practice context.

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Although cultural competence is an on-going procedure of learning, the terminology
suggests an endpoint (Azzopardi & McNeill, 2016). With the increasing demand for evidence-
based practice, much focus has been tailored towards minimizing risks and increasing cost
effectiveness, the implementation of cultural competence practice turns out to be less of a
priority (DelVecchio, Good, & Hannah, 2015; Huey Jr., Tilley, Jones, & Smith, 2014). The
importance of cultural competence becomes more of a task than a clinical practice goal (Furlong
& Wight, 2011; Hollinsworth, 2013). When cultural competence becomes a task, the focus is
vested upon meeting the task through continuing education training requirements instead of
clinical practice engagement with clients (Furlong & Wight, 2011; Huey Jr. et al., 2014). The
consideration of cultural competence as task prevents integration of culture into clinical practice.
Cultural competency, being an on-going learning process, has led to the interpretation of
competency by the overworked professionals as administrative duties whose competent
execution is attained by education.
The term cultural competence is related with social workers’ moral obligation and ethical
responsibility, while agencies and system-level approaches avoid scrutiny (Delphin-Rittmon,
Andres-Hyman, Flanagan, & Davidson, 2013). Most social workers are employed by
government agencies, nonprofit organizations, and private organizations managed by nonsocial
workers (Hays, 2009). The management of entities has chiefly focused on outcomes and finances
and failed to hold culturally competent standards (Hays, 2009; Huey Jr. et al., 2014). The burden
to meet the standards of cultural competency is bestowed as a sole responsibility of the social
workers (Delphin-Rittmon et al., 2013; DelVecchio et al., 2015), again transforming it to a task.
As the term cultural competency is frequently used, its significance is lost and it is consequently
translated into tasks (Azzopardi & McNeill, 2016; Boyle & Springer, 2001; Chu et al., 2016;

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Comas-Díaz, 2014; DelVecchio et al., 2015; Edwards, 2016; Fisher-Borne et al., 2015). When
cultural competency loses its value as a practiced behavior, the social worker-client relationships
cannot manage to develop its maximum potential capacity.
There are several cultural competence terminologies, which creates confusion for social
workers and clients (Boyle & Springer, 2001). The terminologies are too broad, questionable,
ambiguous, or abstract (Azzopardi& McNeill, 2016; Edwards, 2016; Fisher-Borne et al., 2015).
The variety of these terminologies lack consensus, which creates challenges in measuring,
tracking, and training social workers in clinical behaviors (Chu et al., 2016; Jani et al., 2016).
Cultural humility (Tervalon & Murray-Garcia, 1998) and intersectionality (Crenshaw, 1989) are
two terms introduced into the social work competency standards (NASW, 2015). The literature
on cultural humility and intersectionality are emerging (Fisher-Borne et al., 2015; M. A.
Robinson, Cross-Denny, Lee, Werkmeister-Rozas, & Yamada, 2016). The challenge is defining
and characterizing cultural humility and intersectionality into clinical practice behaviors
(Almeida et al., 2011; Azzopardi & McNeill, 2016; Boyle & Springer, 2001; Bubar et al., 2016;
M. A. Robinson et al., 2016). The challenge to define, characterize and quantify culturally
competent behaviors makes cultural competency to become an altruistic goal rather than clinical
practice behaviors to foster working alliances.
Critique of Frameworks
Across disciplines, Sue's (1981) framework is the most broadly used to conceptualize
cultural competency. The American Psychological Association, American Counseling
Association, and the NASW utilize Sue's framework as the foundational pillar for cultural
competent skills and the development of multiple cultural competency measures (Boyle &
Springer, 2001; Krentzman & Townsend, 2008; Kumaş-Tan, Beagan, Loppie, MacLeod,

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&Frank, 2007). The cultural competence framework describes that therapists need to (a) create
self-awareness of their cultural values, biases, and recognition of the influences in the therapeutic
alliance through their perceptions of the presenting problem and the clients, (b) gain knowledge
of the client's cultural background and the function of their worldview, and (c) improve skills
needed to provide culturally sensitive interventions (Derald Wing Sue, Arredondo, & McDavis,
1992). Sue's framework inspired researches, educators, and clinical social workers to incorporate
cultural knowledge, skills, and self-awareness as cultural competency standards. Sue’s
framework provides the foundation for the standards of cultural competency, as the demographic
of the population of the United States, and so is Washington State, continues to diversify,
cultural competency foundations are increasingly being questioned by the modern scholars if
these standards are sufficient.
Gaining Knowledge
Cultural competency frameworks require social workers to increase their knowledge
about different cultures such as possible language barriers, traditions, and historical events
(Lusk, Baray, Palomo, & Palacios, 2014). In spite of the fact that some researchers argue that
increased knowledge on diverse cultures improves clinical practice and cultural specific
behaviors (Berg, 2014; Tourse, 2016), others scholars argue that the knowledge is concerned
with making the social workers feel more “comfortable” with the “others” within the clinical
setting(Fisher-Borne et al., 2015). Besides, social constructionist ethno-cultural frameworks
define culture as sexuality, economic class, language, religion, ethnicity, and race among other
aspects identified to be important by the clients (Azzopardi & McNeill, 2016; Fisher-Borne et
al., 2015; M. A. Robinson et al., 2016). The process of gaining knowledge on the clients’ culture
is more complex than defined by the cultural competency frameworks.

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As the diversity of communities expand and the individuals continually embrace multiple
identities, social workers encounter the complexity of structural oppressions and discriminations
in society (Davis & Gentlewarrior, 2015; Jimenez et al., 2013; McCall, 2005;Mora-Rios &
Bautista, 2014; M. A. Robinson et al., 2016). Many researchers have presented the argument that
cultural competence needs more than knowledge but critical lens to help have an improved
understanding of the complexities of the experience of minority cultures in middle-class, White,
and heterosexual mainstream culture (Cho et al., 2013; Furlong & Wight, 2011; Krumer-Nevo &
Komem, 2015; Manseau & Case, 2014; McCall, 2005). Through the oppression, power, and
privilege lens of intersectionality, the functioning of the clients is assessed by considering the
oppressive experiences (Cho et al., 2013).
Diverse populations such as the poor, LGBT, and racial and ethnic minorities often
experience discrimination in different degrees depending on the intersection of their multiple
identities (Cho et al., 2013). Arthur (2015) conducted a systemic review of research studies on
LGBT elder patients in end-of-life (EOL) care and reported that the needs of the LGBT clients
were minimized in the clinical assessment because of the use of heterosexual perspective.
Bostwick (2014) study showed that the LGBT clients experienced greater extents of
discrimination that made them to suffer from severe and higher rates of mental health problems.
Bostwick (2014) surveyed data from 577 participants from the National Epidemiologic Survey of
Alcohol and Related Conditions (NESARC). The findings of Arthur (2015) and Bostwick (2014)
are consistent with other studies as they supported the need to integrate critical assessments of
privileges and oppressions in clinical practice.
Gaining knowledge, a component of cultural competency frameworks, propagates the
existence of power imbalances that consequently results in oppressive perspectives on minority

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cultures (Davis & Gentlewarrior, 2015; Unsung Lee, 2011; Ratts et al., 2016; Seedall et al.,
2014). As cultural competency frameworks bestow emphasis on gaining knowledge of cultures,
separations between clients and social workers begin to be witnessed. The separation is focused
on making the social worker to be expert, and the client is the “sick other “for not conforming to
the status quo (Williams & Parrott, 2014).
Azzopardi and McNeil (2016) and Fisher-Borne et al. (2015) review of the cultural
competence literature did demonstrate that the prevailing assumption is that the social workers
are viewed as coming from the dominant culture, hence, promoting “othering.” When the focus
is vested on gaining knowledge about the “other” culture, the practices of the dominant culture
are deemed as normal functioning (Hollinsworth, 2013; Eunjung Lee, 2011).Therefore, the
assessment of the functioning of the non-dominant clients is negatively skewed. The “othering”
fuels the prevalence of power imbalances owing to the consideration that implies the social
workers are competent because of gaining knowledge of the other cultures (Chang et al., 2012).
When cultural competency frameworks emphasize gaining knowledge and neglect critical
analyses of intersectionality and cultural humility, there is the hindrance of clinical practice.
Skills and Interventions
Research on cultural competency has contributed to the development of intervention and
skills. Studies have gathered information on clinical practice behaviors and facilitated the
development of practice resources (Ratts, 2017; Yasui, 2015; Zeitlin, Altschul, & Samuels,
2016). The practice tools that assist social workers to integrate knowledge of the clients’ cultures
include cultural background, race, ethnicity, religion, and economic status (Yasui, 2015). The
integration of the clients’ cultural knowledge is regarded as the predominant intervention in
cultural competency frameworks (Zeitlin et al., 2016). Edwards (2016) argues that the unilateral

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focus on the knowledge of cultural frameworks neglects the recognition of within-group
diversity. The interventions can thus contribute to the stereotyping of cultures and impeding self-
determinations. Although knowledge of cultures has positive contribution to cultural
competency, there is need for emphasis to be based on critical analysis.
Recent qualitative cultural competency studies by Mulder (2015) and Nagai (2013)
demonstrated the advancements in the process of incorporating previously taboo topics such as
religion and spirituality in clinical practice. The researchers, Mulder and Nagai, examined the
importance of inquiring about the spiritual practice of the clients to improve planning for
treatment and demonstrated similar findings in their respective studies. Mulder (2015) studied
ten master social work students using photo-voice method that included the use of individual
interviews. Nagai (2013) conducted focus groups with clinicians. The two different groups of
participants reported spirituality as an important aspect of their lives and were open to
incorporating it into their treatments. The process of incorporating the spirituality of the clients
in treatment is an example of the integration of cultural knowledge into clinical practice and
respected the cultural competence practice.
However, the intersectionality and cultural humility studies demonstrate oppression,
power, and privilege as concepts that must also be integrated into clinical practice (Cho et al.,
2013; A. Davis & Gentlewarrior, 2015; Holley et al., 2016). Clients live with social contexts,
which allow the clients to experience situations that influence their functioning (Muntaner et al.,
2015; Prins et al., 2015; Su et al., 2016). The scholars, Muntaner et al. (2015), Prins et al. (2015),
and Su et al. (2016) argued that the social experiences of the clients need to be examined to help
in developing culturally just practices. The researchers introduced the social justice and
multicultural counseling competencies assessment forms to facilitate identifying the therapists

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and client and improve their relationships by promoting privilege and power in their working
alliances. The assessment form helps provide opportunities for discussing the privilege and
power in therapeutic relationships, which allows addressing the imbalances. The integration of
intersectionality and cultural humility are skills for enhancing the social workers-client working
alliances in clinical social practice.
Self-awareness and self-reflection
Self-awareness and self-reflection are used interchangeably and often integrated into
cultural competency training (Mirsky, 2013). Social workers engage to build self-awareness such
as beliefs and values, defining and identifying their culture, and assessing how the cultural
difference with the clients influences the social worker-client relationships (Mlcek, 2014).
Although power, discrimination, and privilege are often discussed in cultural competency
training, little discussion has been provided on how these standards translate into clinical practice
behaviors (Block, Rossi, Allen, Alschuler, & Wilson, 2016; Bubar et al., 2016; Garran
&Werkmeister -Rozas, 2013; Jani et al., 2016; Mirsky, 2013; Mlcek, 2014; Varghese,
2016).Tervalon and Murray-Garcia (1998) argued that self-awareness need to incorporate actions
for mediating the privileges and power in the working relationships so that it presents cultural
humility. Self-reflection requires critical lens to identify privilege and the possible use of power
in the social workers’ working relationships with the clients.
The knowledge of power imbalances and oppressive societal structures that lack action
perpetuate the oppression of clients (Danso, 2016). Bubar et al's. (2016) qualitative study on
graduate students demonstrated the gap between cultural competency and the integration of
oppression, privilege, and power into clinical practice. The study examined 19 master social
work student narratives in a clinical practice assignment (Bubar et al., 2016). Despite the fact

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that the students offered a demonstration of the ability to engage in self-awareness and possessed
knowledge of oppression, privilege, and power, the students, however, failed to apply this
knowledge to their clinical practice (Bubar et al., 2016). The narratives of the students had
omitted an analysis of the clients ‘culture beyond class, race, and gender and lacked assessments
of the intersectionality within the social context. Also, the narratives lacked cultural humility,
awareness of the students’ professional power and the associated influence on the client. Bubar
et al's (2016) findings are similar to other studies on social work students in relation to the
translation of the concepts of cultural competency into practice behaviors (Block et al., 2016;
Jani et al., 2016; Mlcek, 2014; Pivorienė & Ūselytė, 2013).
Azzopardi and McNeill (2016) presented the argument that missing a critical lens on
discriminatory and oppressive personal actions and thoughts has impact on the practice
behaviors. Culturally competent practice is not possible to realize when there is failure by the
social worker to examine the power dynamics in the worker-client relationship and insights on
personal privileges. Self-awareness, widely promoted as the optimal effective cultural
competency behavior, if practiced as an isolated activity is ineffective to produce culturally
competent practice (Mirsky, 2013).Critical self-awareness to oppression, power, and privilege as
an application in clinical practice is imperative necessity for empowering clients in the working
relationships(Almeida et al., 2011, Edwards, 2016). Self-awareness lackingclinical behaviors
inhibits the working alliances.
Pedagogy Critique
The process of bridging cultural competency into clinical practice behaviors often begins
in social work education. However, recent studies have demonstrated that cultural competency
pedagogy does not offer any connection of ideology to practice behaviors (Block et al., 2016;

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Bubar et al., 2016; Jani et al., 2016).Although there has been the emergence of innovative
approaches tailored towards teaching cultural competency, the primary focus of the curriculum
has been on facilitating the integration of knowledge into clinical practice. Lusk, Baray, Palomo,
and Palacios (2014) taught a clinical social work practice graduate course in Spanish. The
students reported that the course broadened their cultural competency skills through the
experiential learning of the culture in Spanish. Social workers gain knowledge of the Hispanic
cultures to conduct linguistically and culturally appropriate interventions and assessments (Lusk
et al., 2014). However, Block et al. (2016) inform that the predominant approach for teaching
cultural competency is in the dominant language by basing focus on the knowledge of diverse
cultures. The scholar argue that education and training of cultural competence often lack the
connection into practice behaviors (Block et al., 2016).Mlcek (2014) demonstrated that the focus
of cultural competency pedagogy is insufficient and narrow to address the diverse of the current
societies. The cultural competency training concentrates on skills development, self-awareness,
and increasing knowledge on culture, while the integration of oppression, power, and privilege as
clinical social practice behaviors are missing. Nadan and Ben-Ari (2013) carried out research on
social work students and demonstrated the limited integration of intersectionality and cultural
humility into clinical social work practice. According to the qualitative studies of Williams and
Parrott (2014) and Garran and Werkmeister-Rozas (2013), determined that the social constructs
of oppression, power, and privilege were usually overlooked as relevant factor practice
behaviors, and even though the students recognized these constructs, they did not integrate this
knowledge into their assessments of the clients.
Block et al. (2016) study of 168 bachelor social work students, reported improved
cultural competency post-test after attending cultural diversity courses. Delphin-Rittmon et al.

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(2013) agreed that cultural competency is necessary for social work education as it helps
improve practice behaviors. Since oppression, power, and privilege are components of cultural
competency standards, the integration of intersectionality and cultural humility into cultural
competency education has the potential of providing positive impact on practice behaviors
(Varghese, 2016). There is numerous body of literature on cultural competency that presents its
advantage on clinical practice (Azzopardi & McNeill, 2016; Edwards, 2016; Fisher-Borne et al.,
2015). The critiquing research reinforces the standard that cultural competency is an ongoing
process that requires reassessment, modification, and change (NASW, 2015). Power, privilege,
and oppression require additional attention in clinical practice (Azzopardi & McNeill, 2016;
Fisher-Borne et al., 2015). As communities advance in complex diversity, more studies in
cultural humility and intersectionality are important to comprehend their integration in clinical
practice (Chu et al., 2016; M. J. Ratts et al., 2016; Seedall et al., 2014).
Clinical Practice: Power, Privilege, and Oppression
The NASW (2015) revised the indicators and standards of cultural competency to
facilitate the incorporation of cultural humility and intersectionality as social work practice
indicators. Cultural humility and intersectionality primarily focuses on promoting equality by
addressing oppression, privilege, and power. These practices have often been associated with the
activities of community organizing (Chun, Lipsitz, & Young Shin, 2013). However, the revised
standards have created an expectation of cultural humility and intersectionality at the social work
practice levels (NASW, 2015). The main focus of framework of cultural competency is vested
upon the skills, cultural knowledge, and self-awareness as the basis of the measures of cultural
competency (Edwards, 2016). In this section, the measures of cultural competency are reviewed
and a discussion is provided on the cultural humility and intersectionality in social work practice.

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Measures
There is no existence of a cultural competency measure specific for social work (Jani et
al., 2016). However, Boyle and Springer (2001) and Krentzman and Townsend (2008) carried
out two distinct meta-analyses specifically focused on measures of cultural competency across
social work disciplines. They agreed on four measures that are universally appropriate to be
applied in social work 1) Quick Discrimination Index, 2) Multicultural Counseling Awareness
Scale, 3) Multicultural Counseling Inventory, and 4) Cross-Cultural Counseling Inventory-
Revised. The psychometric support for these four scales depicts promising outcomes that are
easy to administer and score. The scales are responsible for measuring self-awareness, awareness
of the worldview of the client, and the implementations of interventions that are culturally
appropriate (Boyle & Springer, 2001; Krentzman & Townsend, 2008).
However, these used in measuring cultural competency face some critiques. One of the
critiques is relates to the concept that there is self-administering of all the measures by the social
workers, which presents the risk of a non-bias perspective being demonstrated by the evaluation
(Tao, Owen, Pace, & Imel, 2015). The other critique pertains to the argument that cultures,
although they are supported by theoretical constructs, have vast complexity and diversity, and
this is likely to lead to the behavioral indicators being rarely measured and defined (Boroughs,
Bedoya, O’Cleirigh, &Safren, 2015). There are scholars, Baker and Beagan (2014) and
Eunyoung-Lee (2016), who argue that owing to the diversity of cultures, the use of measures that
are culturally-specific is the best approach that should be adopted in the evaluation of cultural
competency. These scholars, therefore, posit that the measures proposed by Boyle and Springer
(2001) and Krentzman and Townsend (2008) do not include cultural humility and
intersectionality.

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The challenge involved in the development of measures of cultural competency pertains
to the length of time taken in validating the instrument (Jani et al., 2016). In the situations where
there is the absence of cultural humility and intersectionality in measures of cultural competency,
there is often a high probability of these components being overlooked by social workers as
aspects of clinical practice (Azzopardi& McNeill, 2016). There is demonstration by emerging
research that considers cultural humility and intersectionality as integral aspects of mental health
treatment (Davis & Gentlewarrior, 2015; Hook et al., 2013; Ortega & Faller, 2011, Rivers &
Swank, 2017). It has been reported that there is the possibility of additional research on the
subject of cultural humility and intersectionality geared towards the identification of practice
behaviors contributing to the development of measures of cultural competency (Bubar et al.,
2016; Garran & Wekmeister-Rozas, 2013).
Cultural Humility in Practice
Cultural humility refers to the awareness of the privileges and power present in different
relationships and the practice of self-monitoring focused on addressing the imbalances of power
(Fisher-Borne, Cain, & Martin, 2015). Cultural humility bestows the obligation that requires the
social workers to have recognition of their respective positions of power. In professional roles,
social workers are placed in the positions of power where their primary mandate is to influence
the clients’ lives. Clinical social workers who had practiced their respective roles for a minimum
of 10 years were studied by Davis and Gentlewarrior (2015), and the researchers asked these
participants matters concerning the mediation of White privileges in working alliances,
specifically in the client-therapist relationships. The tools that were identified to be addressing
the power imbalances in the therapeutic relationships are the recognition of self-reflection,
privilege, and humility (Davis &Gentlewarrior, 2015). The incorporation of action, philosophy,

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and continuous practice are the requirements for the integration of cultural humility into social
work. However, as posited by Tervalon and Murray-Garcia (1998), cultural humility extends
beyond the power imbalance knowledge and action is necessary for the mediation of the
imbalance.
Cultural humility facilitates the identification of privileges and mediation of power
imbalances (Fisher-Borne et al., 2015). In a 2015 study conducted by Davis and Gentlewarrior
using a focus group of ten clinical social workers, the researchers reported self-reflection to be an
imperative component needed to propel the process of integrating cultural humility and
intersectionality in mental health treatment. Reflective practices on White privileges were
identified by the participants to be facilitating an improvement of the working alliances with the
clients when the social workers actively bring power dynamics to their awareness. The study by
Davis and Gentlewarrior (2015) thus creates the dialogue concerned with making cultural
humility an important behavior in the clinical practice. As a result, cultural humility is
considered to be a vital action in social work practice within clinical settings rather than just
being mere ethical values to pursue.
Rats (2017) developed a chart that was intended to be used in session with a client and
the purpose was to specifically help in identifying power imbalance and discuss the issue
bilaterally between the therapist and client. The subject that has been reported to be commonly
avoided with the clinical practice is the psycho educational experiences to help promote the
empowerment of clients. Ratts et al. (2016) floated the argument that privilege and power are
topics that often challenging to holistically discuss, and that this makes them to the critical lens
that are usually missing in efforts of achieving culturally competence practice, and this argument
was similarly supported by Azzopardi and McNeill (2016), Fisher-Borne et al. (2015), and

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Seedall et al. (2014). Likewise, Hook et al. (2013), in regards to the validation process, present
client administered measures for the assessment of cultural humility of the therapists. It is
demonstrated by the research that clients positively received the cultural humility practice (Hook
et al., 2013).
Intersectionality in Practice
Intersectionality is a concept grounded in the feminist theory, which focuses on
examining the prevalence of gender inequalities within the structures of power and confines of
social relations (Crenshaw, 1989). Intersectionality concept offers detailed explanation of
multiple cultural identities on matters relating to poverty, race, and gender with the goal of
helping intensify the experience of clients on issues of domination, oppression, and
discrimination by the society (Ratts, 2017). Intersectionality provides a revelation of the design
of societies inhibiting the progress and interaction of the marginalized groups through the
different forms of discrimination and oppression, and chiefly creates emphasis on working
towards the attainment of social justice and equity for all (Cho, Crenshaw, & McCall, 2013).
Krumer-Nevo and Komem’s (2015) study with a sample participant of female adolescents found
out that there a positive response by these study’s subjects to group therapy where the topics of
intersectionality such as sexuality, class, race, and gender were integrated led by social workers
who had competent training in intersectionality. The training of social workers in
intersectionality helped in improving the analysis of problematic behaviors for the female
adolescents through the lens of intersectionality to increase understanding serving to foster the
creation of unconditional empathic environments (Krumer-Nevo&Komem, 2015). The
researchers, Krumer-Nevo and Komem, offered a demonstration of the integration of
intersectionality in the practice of social work through the empowerment of social workers to

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enhance the response to clients in positively unconditional manners as well as advancing the
efforts to educate the clients in intersectionality.
Intersectionality recognizes that discrimination, power, and privilege are the experiences
of the clients that get intensified in the situation where there is intersection of multiple
marginalized identities (Cho et al., 2013). There are studies that have examined mental health
through the framework of intersectionality and its integration into the mental health treatment as
clinical practice behaviors, and have provided consistent reports that the higher health disparities
rates are experienced by the marginalized population. Krumer-Nevo and Komem (2015) and
Matsuoka (2015) demonstrated creativity within the context of integrating psycho education on
oppression, power, and privilege into group work treatment and supported the idea that the
intersectionality awareness by the social workers is the key factor of translating this knowledge
and experience into practice. The Data gathered by Krumer-Nevo and Komem (2015) were those
from narratives of staff reporting positive outcomes on mental health with female Arab and
Jewish adolescents aged between twelve and 18 years old after they had participated in the group
sessions covering the oppression and privilege topics. Matsuoka (2015) collected secondary data
as part of the six-week group session evaluation with sample participants of eight Canadian older
adults and offered the demonstration that positive outcomes on mental health were realized. In
both the studies by Krumer-Nevo and Komem (2015) and Matsuoka (2015), it is reported that
the clients exhibited increased insights within the social context into their personal experiences.
Majority of the clients were determined to have reported reduced anxiety symptoms but gained a
sense of increased empowerment (Krumer-Nevo&Komem, 2015; Matsuoka, 2015). These
scholars, therefore, agreed that intersectionality serves an imperatively essential component of
the practice of cultural competence, and suggested the needed for additional research to be

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conducted to fuel the process of operationalizing the integration of intersectionality into the
clinical practice behaviors.

Training Cultural Humility and Intersectionality
The assessment of discrimination, privilege, and power in clinical practice usually begins
in social work training. The cultivation of self-reflective practices of privilege and power serve
as integral components for designing graduate-level experiential course assignments stimulating
critical discussions of intersectionality. When social worker students manage to draw on
respective personal experiences and examine the paradigms of intersectionality, there is an
associated resonance in developing and transferring them into clinical practice (Robinson et al.,
2016). Deliberate attention is a prerequisite requirement of cultural humility and intersectionality
when providing training on cultural competence coupled with the need for integration into all the
diverse aspects of social work training.
However, there are studies that have demonstrated the gap between training cultural
humility and intersectionality and their consequent operationalization into clinical practice. The
research by Block et al. (2016), Bubar et al. (2016), and Jani et al. (2016), for instance, which
focused on studying graduate social work students did demonstrate that there are deficits in the
integration of oppression, privilege, and power into the clinical practice behaviors. The
researchers reported that the students could articulate good knowledge of the issues of
discrimination and power knowledge, however, this knowledge could not still be translated in the
assessment of client vignettes. It is not only the students who can be regarded as social workers
struggling with the process of integrating cultural humility and intersectionality into clinical

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practice. In a different study conducted by Varghese (2016), the researcher analyzed the
responses of fifteen university faculty on case vignettes that presented issues on clinical practice.
Varghese’s qualitative study of social work faculty members did offer demonstration of the
views on racism and race as primarily individual ethnics and cultural identities that failed the
integration structural oppression knowledge in modern society. Varghese (2016) is one of the
few studies that examined operationalization of power and privilege in the faculty of social work.
Seedall et al. (2014) informed that since cultural humility and intersectionality are standards of
cultural competence, it is has been deliberated that there is need for more studies to connect these
two concepts to the clinical practice behaviors. As momentum continue to be gained by cultural
humility and intersectionality in clinical practice literature, there are additional studies such as
Cho et al. (2013), Chu et al. (2016), and Ratts et al. (2016) that have focused on examining the
practice behaviors contributing to the development resources and tools necessary for improving
the clinical social workers behaviors.
Cultural Humility and Intersectionality – Building Alliance
There is contradiction in literature concerning whether cultural competence practice can
conclusively improve the outcomes in mental health because majority of the studies fail to meet
the rigorous empirical standards of research. Chu, Leino, Pflum, and Sue (2016) identified some
of the challenges in the study of cultural competency as follows, 1) the operational definition
inconsistencies in the instruments responsible for measuring cultural competency, 2) the
mandates and guidelines of cultural competency practice lack detailed and explicit strategies of
implementation, 3) there is little knowledge in regards to the contribution of cultural competence
on the change processes therapeutic mechanisms. However, ethical codes of professional

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associations serve to facilitate the upholding of cultural competent practice as the optimal
approach of best practice (Renzaho, Romios, Crock, &Sønderlund, 2013).
However, the studies by Manseau and Case (2014), Cook et al. (2014), Jimenez et al.
(2013), and Kohn-Wood and Hooper (2014) demonstrated that cultural competence practices had
a positive impact by increasing the participation of clients in treatment. They argued that positive
social worker-client working alliances are fostered by cultural competent practice. Strong
working alliances improve the involvement of the clients in the change process, hence, justifying
that positive work alliances are essential in helping attain positive treatment outcomes
(Manseau& Case, 2014; Cook et al., 2014;Jimenez et al., 2013; and Kohn-Wood & Hooper,
2014). The quality of the working alliances that is developed can, therefore, be influenced by
cultural humility and intersectionality as cultural competency components.
The studies, Hook et al. (2013), Eunjung Lee and Horvath (2014) and Tourse (2016)
reported that the process of integrating intersectionality and cultural humility into clinical
practice helped foster positive social worker-client working alliances. Positive working alliances
have immense contribution to the change process of the clients owing to the consideration that
the clients often experience the safety held and promoted within the therapeutic environments
(Rogers & Koch, 1959). The ability of the clients to change and challenge incongruence requires
the willingness to take risks, which can only be realized in safe environments (Rogers, 1957). It
was highlighted by Tourse (2016) and Berg (2014) that integrating cultural humility and
intersectionality in clinical practice has the potential of help prevent the re-victimization of
clients. Safety needed to contribute to the process of building strong working alliances is thus
created by cultural humility and intersectionality.

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Building strong working alliances is a fundamental requirement in mental health
treatment (Rogers, 1957). Since the working alliances are the core to positive outcomes in
treatment, the process of examining intersectionality and cultural humility as clinical practice
behaviors provides great contribution to the emerging literature on cultural competency.
Emerging literature on cultural competency makes an attempt of operationalizing cultural
competence practices to demonstrate evidence-based practice outcomes (Henry Jr. et al., 2014;
Chu et al., 2016). Cultural humility and intersectionality, as per the standards of cultural
competency enshrined in NASW (2015), require further examination to be conducted on mental
health treatment to document the clinical practice behaviors.
The literature on cultural competency, therefore, demonstrates wide range of research on
the frameworks of clinical practice, critiques, and the influence of cultural competency in the
mental health treatment outcomes. NASW (2015) two components, cultural humility and
intersectionality, address oppression, power, and privilege in practice. The current literature
demonstrates a gap in the operationalizing of cultural humility and intersectionality into clinical
practice. The literature review will support this study to examine cultural humility and
intersectionality in mental health settings in Washington State.
Summary

As the publication of the sophisticated ethical standards of NASW (2015) demonstrates,
cultural awareness is a value of social work clinical practice that is held in high esteem. The
purpose of this capstone project will be to examine the clinical practice behaviors specifically in
the settings of mental health in Washington State. The project will employ an action research
design to help in examining the concepts of cultural humility and intersectionality. The study

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will reflect the core values of social work needed in pursuing cultural competence to promote
social justice.
The current literature has demonstrated the existence of a gap in the operationalization of
cultural humility and intersectionality into clinical practice. The project will thus seek to address
this gap by contributing to the cultural competency literature based on examining cultural
humility and intersectionality in clinical practice. The data from this study will provide examples
of specific clinical behaviors intended to convey cultural humility and intersectionality in mental
health treatment. The data will contribute to the development of social work cultural competency
measures and resource tools to be used in practice. The study will contribute to the development
of a training curriculum on cultural humility and intersectionality for both the professional social
workers and students.

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SECTION 2: RESEARCH DESIGN AND DATA COLLECTION
The Code of Ethics for social work stipulates cultural awareness to be a standard of
practice that applies within diverse, if not all, areas of social work practice (NASW, 2017).
Considering that the profession of social work remains a current practice with numerous research
findings, NASW (2015) pursued the incorporation of cultural humility and intersectionality as
distinct indicators of standards of cultural awareness practice. The occurrence of a problem in the
practice of social work is witnessed when the standards of cultural awareness fail to be integrated
into the respective social work practice (Azzopardi& McNeill, 2016; Fisher-Borne et al., 2015).
In Washington State, in 2016, for instance, the community organizers working at the grassroots
issued the revelation that the clients of mental health were experiencing services that are
culturally insensitive despite the consideration of the fact that the state embodies a population
that is highly diverse in composition (U.S. Census Bureau, 2016). In this project, the focus will
be to conduct an examination of the clinical behaviors with the potential of demonstrating
cultural humility and intersectionality within the settings of mental health treatment. An action-
research model will be applied to conduct this study.
Research Design

The purpose of this study will be to examine the clinical behaviors within the setting of
mental health treatment that specifically provide a demonstration of cultural humility and
intersectionality. Clinical social workers bestowed with the responsibility of providing mental
health treatment in Washington State will be interviewed. The study will focus on two research
questions.

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The research questions:
 What clinical behaviors do social workers use in the different stages of mental health
treatment (i.e., engagement, assessment, intervention, and evaluation) to convey cultural
humility and to address intersectionality?:
 How does the training of social workers help in integration of cultural humility and
intersectionality to acquire the appropriate knowledge and skills to understand the clients’
worldview and mental health assessment?
The study will use zoom or telephone interviews in process data collection to gather
extensive details and rich data contributing to realization of a deeper and comprehensive
understanding of cultural humility and intersectionality when it comes to the mental health
treatment. Individual zoom or telephone interviews will be used for the purpose of capturing
both rich and detailed data for the study.
An action research design will be used in the study and was chosen, as argued by Stringer
(2013), owing to the collaborative nature that it embodies to facilitate the process of inspiring
social action so that to provide the candid demonstration of cultural awareness coupled with
gathering descriptive behaviors of clinical practice. The use of action research will vest its
primary emphasis upon seeking to create collaboration with the Washington State’s community
members with the chief goal of improving services of mental health in the state. As explained by
Coghlan (2016), one of the core principles for action research is the establishment of
collaborative relationships between the study’s participants and the respective researcher to help
in inspiring change. The prevalence of cultural insensitivity in the provision of mental health
treatment services in Washington State has been reported to a critical issue of concern in the

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community. Since cultural awareness is regarded to be one of the standards of ethical practice in
social work, action research will be the most appropriate approach for engaging with the clinical
social workers in Washington State during the research process, and the process will present the
ability of inspiring the selected participants to pursue the promotion of social action. Guided by
the understanding that this study will focus on examining clinical behaviors in the treatment of
mental health, the recruitment process will be explicitly purposeful to help in obtaining the
sample participants having the first-hand experience in the provision of mental health services.
Considering that the study employs an action research design, however, owing to the
current COVID-19 crisis that has now limited social interactions, the participants will not be met
physically but on an online platform through video communications using zoom. The study will
specifically use zoom or telephone interviews for the purpose of helping capture both the
nonverbal and verbal cues of the selected participants. The interviews will be audio recorded
using the shotgun microphones as the audio recording equipment and detailed notes will be taken
during the interviews. Diverse sample participants will be recruited, and these participants will
come from both the rural and urban communities in Washington State. Based on the
demonstration in the literature review that there exists challenges in the translation of cultural
competence into clinical practice behaviors, this action research study will capture reports from
diverse clinical social workers within the mental health practice, and these professionals will be
required to be those with the ability to provide behavior details specific to cultural humility and
intersectionality.
The two key concepts that this study will focus on are cultural humility and
intersectionality. Cultural humility pertains to the existence of awareness relating to power and
privilege that are often present in therapist-client relationships and the process of self-monitoring

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IN WASHINGTON STATE 46
to help in addressing the prevailing power imbalances (Tervalon & Murray-Garcia, 1998). In the
execution of professional roles, social workers are often automatically in positions of power with
the intention of influencing the clients’ lives (Danso, 2016). An obligation is created by cultural
humility on social workers to facilitate the recognition of their respective positions of power so
that they can be actively involved in the mediation of any existing imbalances when working
with the clients (Fisher-Borne et al., 2015).
The concept of intersectionality is explicitly grounded in the feminist theory, which
focuses on examining the inequalities affecting gender within the social and power structures
(Crenshaw, 1989). The intersectionality theory offers comprehensive explanation of multiple
cultural identities concerned with poverty, race, and gender to intensify the experiences of
discrimination and oppression by the clients in society (Ratts, 2017). Intersectionality is based on
the argument that the design of society often fuels the discrimination and oppression of the
marginalized groups, and, therefore, creates emphasis on the need to work towards social justice
and equity for all (Cho et al., 2013). The goal of this action research will be thus be tailor
maximum commitment on examining how cultural humility and intersectionality are
demonstrated by the clinical social workers, and how these professionals awareness of cultural
humility and intersectionality serve to influence the degree and effectiveness of assessment of
their respective clients’ mental health.

Methodology

Prospective Data
In this study, the focus will be to conduct zoom or telephone interviews. The interviews
will be semi-structured so that to help in keeping the interviewees attentive on the specific
desired topic and have the ability of adhering to the timeframe that will be planned to take about

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60-minutes per each session of the interview. The interviews will be audio recorded and will be
coupled with taking written notes of the responses provided by the participants. The use of zoom
or telephone interview method will be selected as the method for data collection because it is
usually the nature of interviews to provide the opportunity that can allow for exploring themes of
clinical behaviors in mental health practice within the much needed concepts and areas of
oppression, privilege, and power (Seng et al., 2012).
Participants in the Washington States rural communities will participate in the study. Due
to the current COVID-19 crisis, the interviews will be carried out online using the zoom or
telephone and planned time for the interview will be agreed upon by the participants and the
researchers via email prior to scheduling the interview. The interviews will be conducted during
the hours of business operation from 9 a.m. to 5 p.m. Confidentiality and privacy will seek to
ensure that data will not be compromised. There are several ways through which data can be
compromised, specifically in relation to researcher bias and electronic problems. When it comes
to researcher bias, the individual conducting this study might a social worker involved in the
clinical practice profession. Therefore, considering that the researcher is a person who is
professionally associated with the field of practice under study, there is the possibility of having
internal judgment and influence on the research process. To avoid the occurrence of researcher
bias, it will be imperatively necessary to write process recordings after the interviews. These
process recordings will involve the reflection on how the questions will be presented and
responded to by the study’s participants. The process will help in monitoring the researcher’s
worldviews and values that might be presenting the potential of affecting the interview and the
data that will be gathered. The additional possibility that might present the risk for compromising

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the process of data collection will be the problem associated with the shotgun microphones, as
the equipment that will be used for the audio recording activities.

Participants
Social workers providing mental health treatment will comprise the target population for
this study. Participants will be recruited from the Washington State Department of Health list of
approved social workers. Although the list is not all-inclusive of all the professionals practicing
social work in Washington State, the selected social workers on the list possess the license
permitting them to be qualified personnel for providing mental health services. The recruitment
of social workers from the Washington State Department of Health list will increase the chances
for sampling frame to meet the study’s criteria of eligibility, which will explicitly be the social
workers providing mental health services. The list of social workers across Washington is for
those who will possess independent licenses. The Washington State Department of Health list of
approved social workers is located on the website and is freely accessible to the public. The list
includes the names, emails, and phone numbers of the each of the social workers. From this list,
social workers will be selected to participate in the study and will entail a recruitment process
that will take duration of 30 days.
All necessary efforts will be made for recruiting participants across the Washington State
to ensure that the aspect of diversity is reflected by the sample, since this will be an important
consideration to facilitate the implementation of cultural awareness in the research process. The
participants will be required to complete demographic information, and this will help in ensuring
that data is organized in accordance with the number of year that the social workers has spent in

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providing mental health treatment services. The years that a social worker has been working in
mental health will be categorized on a 5-year range from below 4 years, 5 – 9 years, and 10 years
and above. The categorization will also consider the various mental health settings where the
social workers have been involved ranging from nonprofit, private practice, too small or large
agencies. The consideration of the participants’ diversity will contribute to the credibility of the
data that will be collected.
Recruitment
Recruitment emails will be sent to all the potential participants whose details shall have
been obtained from the Washington State Department of Health list of approved licensed social
workers. The emails will be sent through Mail Chip, an online software program that ensures
confidentiality in the situations where bulk emails are sent to numerous recipients. For the
participants, whose emails might bounce back due to invalidity problems, they will be mailed
standard letters through the Washington State postal services. The social workers who will
express interest in participating in the study will be sent follow-up emails. The social workers
will be sent these follow-up emails after being randomly sampled and selected to participate in
the study. The emails will include the consent form and demographic sheet. The demographics
that will be requested will be those based on the information gathered by the U.S. Census of
Bureau. The demographic sheet will ask the social workers about the day and time that they
would prefer to conduct the interview. Afterwards, another email will be sent to the social
workers sampled as the study’s selected participants to remind them that, as described in the
consent form, the summary of the findings of the study will be emailed to them upon approval of
the review committee, and they will also be gift cards as an expression of appreciation for their
willingness and efforts to participate in the study.

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Sampling
The study will use purposeful sampling. Purposeful sampling is a technique frequently
used when the researcher seeks knowledge from specific participants (Gentles et al., 2015). The
intention of using this sampling technique will be to help inn examining cultural humility and
intersectionality as the desired clinical behaviors in the treatment of mental health. The target
population will specifically be social workers providing mental health services. The recruitment
process will help in screening out the social workers who are not working in the mental health
through the use of the demographic information sheet. Purposeful sampling, after the social
workers have been screened, will contribute to thematic saturations owing to the consideration
that the participants will possess specific knowledge in the area intended to be studied. The size
will be 17 social workers who shall have met the eligibility criteria and will be professionals
from different locations across the Washington State. The eligibility criteria for the study will be
(a) social workers, (b) provision of mental health services, and (c) the participants will be from
different locations in Washington State.
The use of a small sample size will helps to reduce the transferability and generalization
of the data that will be collected (Hagaman &Wutich, 2017). The small sample size will be
interviewed using zoom or telephone interviews and this will provide the possibility to maximize
reaching thematic saturation by maintaining the integrity of individual interview. The
maintaining of integrity will be an important requirement since the sample participants will be
recruited purposefully to access diversity in the number of the social workers’ years of
experience, area of the state where they are practicing mental health treatment, types of the
employment agency, which will allow for the triangulation of data. The triangulation of data
helps to reach saturation (Guest, Bunce, &Johnson, 2006). As demonstrated by Guest, Bunce,

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and Johnson (2006), using zoom or telephone interviews for the collection of data and a sample
of 45 respondents and 60 zoom or telephone interviews, the study reached saturation after 12
interviews and meta-themes as early as after 6 interviews. Their study did involve systematically
assessing the saturation degree throughout the thematic analysis of 60 zoom or telephone
interviews.
Hagaman and Wutich (2017) conducted a study with 32 respondents using 25 zoom or
telephone interviews and demonstrated to have attained data saturation at the 5 th interview.
Therefore, based on these studies, it is recognized that that the key to allowing this action
research reach saturation is by using purposeful sampling. Purposeful sampling help gather data
from sources containing specific information that will be researched by the study, and this can be
facilitated by using a small population of respondents, which inspired the decision to use a small
sample size of only 17 as the study’s participants. Based on the understanding that this will be a
qualitative research, thematic saturation is the often the indicator of validity, and since the study
will gather data from a specific sample of population, it is necessarily imperative to ensure that
thematic saturation is achieved.
Instrumentation
The interview questions will be developed based on the literature review on cultural
humility, intersectionality, and mental health treatment. The questions will be specifically
organized in such a manner that allows for examining the areas of (a) concept of social workers
regarding cultural humility and intersectionality, (b) engagement, intervention, assessment, and
evaluation of social workers, (c) understanding of the social workers concerning the
incongruence state and worldview of the clients, and (d) input of the social workers. The
questions will provide for the opportunity to have open discussion and will be specific enough to

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facilitate the process of gathering information in regards toin regard to cultural humility and
intersectionality in mental health treatment so that it can allow for producing thematic saturation.
The design of the interview questions will be in such a manner that stimulates discussion guided
by the description of action research method by McNiff (2016) and Stringer (2013). In addition,
the questions will be designed from the principles of action research specifically geared towards
helping stimulate discussion so that they can foster the active engagement of the participants.
The capstone committee will review the interview questions to ensure that they have maximal
alignment with the formulated research theory and questions.
Data Analysis

The thematic analysis will be used for this study, which entails searching data and
identifying common patterns and themes. Cultural humility and intersectionality as the
framework for identifying semantic themes in clinical behaviors report of the social workers. The
study will use deductive theory. Deductive theory is based on previous research and knowledge
relating to cultural humility and intersectionality to deduce potential relationships (Fereday &
Muir-Cochrane, 2006).The thematic analysis will specifically focus on the essential themes that
will be reported by the participants as the embodiment of the clinical behaviors that they employ
in their mental health practice.
For the data analysis process, the following steps will be undertaken. NVivo computer
software will be used for this qualitative research to organize the collected data. The
chronological steps that will be used in the thematic analyses are (a) becoming familiar with the
data by going though it line-by-line, (b) generating initial codes using NVivo software, (c)
searching for themes, (d) reviewing the themes, (e) defining the themes, and (f) producing the
report. During the data analysis process, memoing will be used to demonstrate reflexivity in the

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analysis process. As reported by Birks, Chapman, and Francis (2008), memoing is a suitable
technique for data analysis when conducting qualitative research because it allows the researcher
to make conceptual leaps from the collected data to the specific abstractions explaining the
research phenomena in the context on which it is specifically examined.
The study will use zoom or telephone interviews, which, as reported by Robinson (2014),
is a common method used for data collection when conducting qualitative research. The rigor of
a qualitative study often starts with the research design and the associated techniques employed
in capturing and conveying the details of the research process (Shenton, 2004). The study, by
using zoom or telephone interviews will demonstrate rigor through integrity, criticality,
authenticity, and credibility.

Ethical Procedures

As required by NASW (2018), when conducting a research with human participants, it is
compulsory for ethical standards to be implemented. The study will follow standards aimed at
protecting the human participants by the National Institutes of Health. The core principle needed
to ensure the protection of human participants is the use of informed consent. In this study, the
participants will receive copies of consent forms before the interviews via email and other
additional copies will be made available during the interviews to ensure make it possible in
ensuring that the participants provide informed consent for their participation in the research.
The consent form will cover the information required to obtain the participants’ informed
consent. The consent form will provide the study’s participants with the information pertaining
to the following areas (a) describing the study’s purpose, (b) considering the expectations of the
participants, (c) allowing the right and freedom for the participants to stop their participation at
any time they desire to do by making the entire research process be voluntary, (d) ensuring that

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there is minimal risk associated with providing information by guaranteeing that being in the
study will not pose any threats to the participants’ wellbeing and safety, (e) providing contact
information that will allow the participants to seek clarification for any questions regarding the
study, (f) protecting confidentiality limits and statements, (g) explaining how data gathered will
be used, (h) providing the opportunity for submitting any concerns and grievances, (i) informing
about privacy, and (j) informing the participants how the study data will be used and how
information will be used.
In addition, as part of complying with the ethical procedures, the confidentiality
statement will be included in the consent form including the associated limitations for
participation. During each interview process, the participants will be reminded on how the
information that will be gathered will be used for this capstone project at the institution. The
reports that will come out of this study will not share the identities of the participants. To ensure
the protection of the participants’ information guided by the ethical standards obligation, the
personal information of the participants will not be used for any purposes that are outside the
jurisdiction of this research project. The data collected will be kept secure through the use of
password protection, data encryption, and applying numbers for the identification of the
participants in the information documentation. There will be no documentation of the personal
identities of the participants. However, to ensure easy identification on the consent form, audio
records and notes taken during the interviews and for data entry in NVivo, each of the
participants will be assigned a numerical number to ensure their confidentiality is protected by
concealing their personal identities. The data will be kept for a maximum of five years, based on
the requirements of the institution, after which all the paper records for the research will be
shredded and the information stored electronically will be erased.

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Summary

This capstone project will be an action research study that will specifically use qualitative
method, zoom or telephone interviews. Social workers specialized in the provision of mental
health treatment in Washington State will be recruited. The interviews will follow a semi-
structured guide to help in ensuring that the objectives of the research will be met during the
interview within duration of sixty-minute. Thematic analysis will be used in the analysis of data
to help with the identification of common themes in the discussions. A consent form will be
design in compliance with the ethical research standards of Walden University Institutional
Review Board (IRB) to allow the participants give their informed consents.

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Appendix A: Interview Outline

I. Introduction (5 minutes)
A. Greeting
B. Statement of purpose of the 60 – minute interview
C. Review Inform Consent and check for questions
II. Clarification of Terms (10 minutes)
A. Establish the knowledge base of key terms through questions
 What comes to mind when you hear cultural humility?
 What comes to mind when your hear intersectionality?
 In your opinion, how are the concepts of cultural humility and
intersectionality connected to NASW cultural awareness
standards?
B. Provide definitions of key terms
III. Interview questions (35 minutes)
A. Engagement, assessment, intervention, and evaluation

 During your initial contact with the client, what do you do to
demonstrate cultural humility? (Probe: How do you engage clients
to build rapport?)
 How do you incorporate intersectionality into the assessment
process? (Probe: How do you document power, privilege, and
oppression with marginalized clients)

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 How do you use interventions to demonstrate cultural humility
and awareness of intersectionality?
 How do you incorporate cultural humility and intersectionality
when evaluating treatment outcomes?
B. Client’s worldview and their state of incongruence

 How do you demonstrate cultural humility and intersectionality to
understand the situation and problem of the clients?

C. Participant input

 What are some of the challenges you have encountered in an
attempt to integrate cultural humility and intersectionality in
settings of mental health?
 Do you have any thoughts on what would make it much easier for
incorporating cultural humility and intersectionality in the aspects
of clinical practice relating to engagement, assessment,
intervention, and evaluation?
 Is there any person that might be having other comments or
questions concerning cultural humility and intersectionality?

IV. Wrap up (10 minutes)
A. Identify and organize the major themes from the responses of the participants

B. Member Check and accuracy of the gathered information

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Appendix B: Confidentiality Agreement

Name of Transcriber:………………………………………………………………………
During course of my activity in the collection of data for this research: Examining
cultural humility and intersectionality in mental health treatment: An action research
study in Washington State, I will have access to information, which is confidential and
will not be disclosed. I acknowledge that it is mandatory for the information to be kept
confidential since any improper disclosure of the existing confidential information has a
potential risk of damaging the participants’ privacy.
By signing this confidentiality agreement, I am in agreement that:

1. I will neither discuss nor disclose any confidential information about the
participants with others, either family or friends.
2. I will not sell, copy, release, divulge, destroy, loan, or alter any
confidential information except with prior authority.
3. I will not discuss any confidential information where others can overhear
the conversations. I have an understanding that it is unacceptable to hold
discussion of any confidential information even in the situations where the
names of participants are not used.
4. I will not make unauthorized purging, modification, inquiries, or
transmissions of confidential information.
5. I recognize that my obligations under this agreement will continue even
after the termination of the job I am performing.
6. I understand that the risk of violating this agreement has legal
implications.

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7. I will only use and access devices and systems that I have the official
authorization to access, and I will not demonstrate the functions and
operations of devices and systems to unauthorized persons.

The signing of this document is an acknowledgement that I have read and agreed to comply with
all the presented terms and conditions as stated above.
Transcriber Signature Date

Witness Signature Date

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Appendix C: Recruitment Email

Dear Colleague,
My name is Loretta Okeke. As a doctorate student at Walden University, I am interested in the
social work profession and committed to obtaining a bachelor’s degree to contribute to social
change in Washington State community.

I am, therefore, kindly inviting you to take part in this research study about cultural competency
in mental health settings. You are being invited to participate in this study because you have
been listed in the Approved List of Supervisors on the website of Social Work Examiners Boar.

The purpose of this study is to conduct an examination of how clinical social workers translate
cultural awareness into behaviors of clinical practice. The specific focus is on determining how
oppression, privilege, and power are addressed in the mental health treatment. The study will
consist of individual face-to-face interviews scheduled on times and days that are at your
convenience.

If you agree to participate in this study, you will be asked to:

 Communicate via email to complete forms and receive instructions and
information on the location and time and day for the interviews.
 Complete the geographical form
 Engage in one interview that will last for a duration of 60 minutes
 Receive a summary of the study outcomes via emails.

Here are some of the sample questions:

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 What comes to mind when you hear cultural humility?
 What comes to mind when you hear intersectionality?
 In your opinion, how are these concepts connected to NASW cultural competency
standards?

As an appreciation for your participation, you will receive a $10 gift card. If you are interested,
please email______ Or you can call, please leave a message stating your interest in the study
with a phone number where you can be reached.

I greatly appreciate taking the time to consider this opportunity.

Respectfully, Loretta Okeke

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Appendix D: Demographics

The demographics requested is based on the information gathered by the U.S. Census Bureau
(U.S. Census Bureau, 2016).
What county and city are residing or
employed in?
What is your race?
White, not Latino or Hispanic
African American
Native American
Asian
Native Hawaiian or Pacific Islander
Hispanic or Latino
Two or More Races
What languages other than English do you
provide mental health treatment?
What is your current age?
What is your gender?
What is the number of years working in
mental health?
4 years or less
5 to 9 years
10 years +

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What is your place of work?
Non-profit
Private for Profit
Private Practice
Government agency

INTERVIEW COORDINATION INFO
Please provide several dates and times you are
available the next 30 days to participate in the
interviews
The interview will be conducted online via
Zoom due to the current COVID-19 pandemic
that has restricted social interactions in an
effort to curb the crisis.

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Appendix E: Welcome Email

This email is an announcement that you have been selected to participate in this study.
You agree to an interview on………..date at…………time via online Zoom platform.

Here is a quick reminder regarding the day of the interview:

 The interview will be recorded
 The interview will be conducted online and will only take a maximum of 60
minutes

Reminder after your participation you will:

 Receive a gift card
 Receive a summary of the outcomes of the study via email after the approval of
the committee

Welcome to the study facilitated by Loretta Okeke, a doctorate student at Walden University,
School of Social Work.

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