In the counseling profession, clinical supervision is utilized to facilitate the personal and professional development of counselors in training (Bernard and Goodyear, 2014). Within this supervisory relationship, supervisors must adhere to the 2015 ACA Code of Ethics, which describes the need for infusing cultural competence into both counseling and supervision practices. This emphasis is warranted; as the population of the United States is growing more diverse and cultural sensitivity in counseling will be needed in order to best serve clients. Both qualitative and quantitative research in various allied fields and settings suggest that supervisor cultural competence positively impacts the supervision working alliance (i.e., Ladany, Brittan-Powell and Pannu, 1997; Ancis and Marshall, 2010; Wong, Wong and Ishiyama, 2013). However, research conducted from the perspective of supervisors working in community settings is limited. This study sampled 78 community supervisors to address the dearth in the counselor education literature concerning the relationships between supervisor cultural competence and the working alliance. Results indicated an overall positively correlated relationship between supervisor multicultural competence and the working alliance. Additionally, the results suggested that supervisor cultural knowledge and supervisor cultural skills are the greatest predictors of a strong working alliance, while supervisor multicultural relationship and supervisor multicultural awareness accounted for some additional variance. The results support the trend away from a competency-based model of cultural sensitivity and attention in counseling and toward a model of cultural humility. / Ph. D.

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Psychotherapist multicultural competence has been given increasing attention in the field of psychology since the 1970s. However, individuals and communities who are Black, Indigenous, or People of Color are still less likely to attend psychotherapy and often drop out earlier than White clients. These trends highlight the importance of the ongoing research on therapist multicultural competence. There are many multicultural competencies, however, the current study focuses on therapist cultural humility. Specifically, we systematically searched all the current research on the association between cultural humility and client experiences and outcomes in therapy. Our literature search yielded eight studies that met our search criteria. Next, we synthesized the data by conducting a meta-analysis using the metric of Pearson's r as the effect size. In addition, we aggregated average item-level therapist scores and the reliability coefficient of the Cultural Humility Scale (CHS; Hook et al., 2013). We found a moderate positive correlation between client perceptions of therapist cultural humility and client experiences and outcomes in therapy of r = .39 (p < .05). Furthermore, we found the average item-level score to be 3.86 out of a maximum score of 5 (SE =.086), which corresponds with the rating of "mildly agree," indicating that clients typically perceive therapists to demonstrate cultural humility. Finally, we found CHS to be reliable across studies, with an average alpha coefficient of .91. These finding suggest that cultural humility is an important aspect of the psychotherapeutic relationship. Furthermore, they suggest that the CHS is a reliable measure and should continue to be used in future studies. Finally, because our review yielded only eight studies, more research on this relationship is needed.

This capstone project examined social workers’ knowledge, values, and beliefs as related to the concept of cultural humility to determine how hospice care professionals treat patients’ cultural preferences and traditions with respect and sensitivity at the end of life; as such practices have the ability to improve the hospice experience. Research questions addressed in the study (a) how social workers in Nevada define cultural humility in the context of hospice social work practice, (b) the values or principles hospice social workers in Nevada consider most important in providing culturally appropriate care to hospice patients, and (c) the ways hospice social workers in Nevada implemented a cultural humility stance within their practice. To obtain data for this project, connections with the local hospice care community were used to recruit interested individuals directly involved in service delivery through a convenience sampling method. Participant data was collected via a focus group with 9 participants, which was then recorded, transcribed, and analyzed. The method of analysis was thematic exploration and estimation of the prevalence of identified themes. Five major themes were identified through analyses: (a) individualized culture, (b) respect for others, (c) team-oriented approach, (d) implementation of cultural humility, (e) lack of formal training and integration of hands-on experience. Findings contribute to the generic hospice services knowledge base, working in synergy with previous research findings to help encourage future research studies on this topic.

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With racism driving perinatal health disparities, antiracist tools and trainings are necessary for WIC nutrition professionals who serve as frontline providers for Black and Indigenous families of color. Black families, in particular, are the most likely to experience harms from discrimination in health care and health services, even from well-intentioned providers in caring professions. This thesis investigates the role of racism, both interpersonal and structural, and how it may influence WIC enrollment, participation and culture of care. After providing a basic overview about WIC including recent participation and demographic statistics and trends, I share my own ethnographic observations and reflections on my positionality in the WIC clinic setting. I review research on the most commonly identified barriers to and benefits from WIC participation, including how those benefits intersect with contributing factors in the crisis in Black perinatal health in the United States, and make the case for including experiences of bias and racism as an overlooked barrier. With a focus on improving the client experience, I use an urban bioethics lens to inform strategies (including antiracism training for WIC staff) to increase and sustain WIC participation and the concomitant benefits participation can incur, particularly for Black mothers and birthing people and their families. I review the literature that informed our training, describe key components of the training, and summarize the findings from the evaluation and assessment of the WIC nutrition professionals who attended. Lastly, I posit how the convergence of COVID-19 and the racial justice uprisings of 2020, both accelerated the acceptance of the need for innovations in how WIC is implemented, and created the conditions to facilitate rapid changes towards more equitable policies and procedures at both the local and federal level. Many of these changes were previously thought to be desirable but unattainable, and I reflect on the need to seize this opportunity to intentionally build upon that progress by applying a racial equity framework to envision a post-pandemic WIC. / Urban Bioethics

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The nursing profession perpetuates an outdated model that fails to address the health concerns of racialized gender-diverse people. Evidence supports that this population experiences poorer health outcomes, care-avoiding habits, and incompetent healthcare providers. A literature review illuminated gaps in the nursing lens when considering gender-diverse identities outside of Whiteness. An intersectionality framework and cultural humility were used to explore the contexts in which nurses provide care. To fill this knowledge gap, the proposed research question was: How prepared are nurses to provide care to racialized gender-diverse people? A questionnaire was developed by modifying three pre-existing instruments. The online questionnaire served as a pilot feasibility study to collect preliminary baseline descriptive cross-sectional data about Ontario nurses' training, education, knowledge, attitudes, and beliefs about racialized gender-diverse people. Findings indicated potential gaps in training and education that may affect racialized gender-diverse peoples' healthcare. Recommendations are provided for future research and interventions.

Culturally diverse clients often face barriers to accessing and using health and education services, which may affect the clients’ performance outcomes and impact the quality of services. These barriers include practitioners’ insufficient cultural competence and humility and an ineffective health care system. The Cultural Humility program aims to train and educate occupational therapy practitioners to gain confidence and improve their cultural humility and practical communication skills to maintain, establish, and manage therapeutic relationships. The program duration will be twelve 2-hour biweekly sessions over 6 months, in person at clinical settings or on a virtual platform. The program includes learning modules, such as lectures, simulation or video modeling, and discussion sessions with brain-based learning for occupational therapy practitioners. The program will provide meaningful opportunities for practitioners to reflect on their practice attitudes, gain confidence, change their mindsets, and learn practical communication skills for use with clients from various cultural backgrounds. The aim of the Cultural Humility program is to apply these practical techniques related to cultural humility, bringing synergy and authenticity to practitioners’ daily practice, and improving their clients’ performance and outcomes.