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Examining Cross-Cultural Child Welfare Practice Through Simulation-Based Education

Abstract

Simulation-based learning is an emerging pedagogical approach in social work education that is expanding to specialized areas of practice. This research examines the intersection of cross-cultural practice and child maltreatment investigations. Thirty-one (N = 31) BSW and MSW social work students participated in a three-hour voluntary child welfare simulation workshop and engaged with one of three child welfare scenarios: (1) an immigrant Chinese family, (2) an Indigenous family, and (3) a White youth. Drawing upon the concept of cultural agility, a theoretically-informed mixed methods approach was used to analyze the data. Fisher’s exact test and independent samples T-tests were used to examine participants social work education and experience, perceived competencies, acknowledgment of the simulated client’s culture, and evaluation of the simulation experience. Qualitative analysis examined participants’ critical reflection of their cross-cultural exchange with the simulated clients regarding allegations of child maltreatment. Statistical differences were noted among participants who engaged with each of the three child welfare scenarios. All participants expressed positive learning benefits through simulation, however, statistical differences were found between participants who acknowledged the client’s ethno-cultural identity versus those who did not with respect to their overall learning benefits, meta-competencies, and procedural competencies. Participants demonstrated various aspects of the cultural agility framework as they reflected upon their practice. Simulation-based learning offers the opportunity for students to critically examine and reflect upon the ways they operationalize culture and child maltreatment, and how to manage the complexities of working across difference. Future recommendations for research and practice are discussed.

The disproportionate representation of Black, Indigenous, or Person of Colour (BIPOC) children and youth throughout the child welfare systems of the Global North is disconcerting and ongoing (Child Welfare Information Gateway [CWIG] 2016; Fallon et al. 2016; Lee et al. 2016; Owen and Statham 2009; Tilbury 2009). Explanations for this disparity have included the impacts of colonization, ongoing oppressive policies, socio-economic conditions, professional bias, and cultural variations in family and community support, and maltreatment reporting (Drake et al. 2011; Fluke et al. 2011; Haight et al. 2019; Lee et al. 2017; Sedlak and Broadhurst 1996; Tamburro 2013). Worker uncertainty in practicing across ethno-cultural difference has also been raised as a potential issue (Egonsdotter et al. 2018; Kourgiantakis and Bogo 2017; McPhatter and Ganaway 2003), resulting in the incorporation of cross-cultural practice models into the theoretical and pedagogical frameworks of social work curricula. This paper examines cross-cultural child welfare practice across ethno-cultural difference through the use of simulation-based pedagogy.

According to the most recent Canadian Incidence Study of Reported Child Abuse and Neglect, an estimated 235,842 maltreatment investigations were conducted by child welfare organizations across Canada (Public Health Agency of Canada [PHAC] 2010). For Black children compared to White children, an investigation was 40% more likely, substantiation of the concerns was 18% more likely, and removal from home during the investigation was 13% more likely to occur (Fallon et al. 2016). For Indigenous children compared to White children, an investigation was 130% more likely, substantiation 15% more likely, and removal from home 168% more likely to occur (Fallon et al. 2016). Conversely, Asian children are under-represented relative to White children in Canada, the United States, and the United Kingdom (CWIG 2016; Lee et al. 2014; Lee et al. 2016; Owen and Statham 2009).

In response to the systematic unequitable access and social service usage by BIPOC children and families (Memon et al. 2016; Scheppers et al. 2006), Canada, Australia, the UK and the US have all implemented cross-cultural competency requirements into their practice standards (Canadian Association for Social Work Education [CASWE] 2014; Council on Social Work Education [CSWE] 2015; Harrison and Turner 2011). Requirements established in such standards necessitate demonstrable indicators of cross-cultural competence (Matsumoto and Hwang 2013). Initially, these indicators tended to focus on skill or knowledge acquisition about specific populations, reflecting a technical-rational framework of competence (Schön 1987). However, such frameworks overlooked the importance of introspection on one’s own social location, belief systems, and values (Leake et al. 2010). Holistic competency frameworks have emerged over the past ten years to address such concerns. Bogo et al.’s (2014) model of holistic competence differentiates procedural competence, or the performative aspect such as the observable skills and knowledge, from meta-competence, the introspective aspect including critical thinking, self-reflection, and self-regulation. Academics and organizations alike have recognized the importance of holistic competence in training students to practice effectively across cultures (Bogo et al. 2014; CSWE 2015; Kourgiantakis et al. 2020a, b; National Association of Social Workers [NASW] 2015). However, in order for a practitioner to recognize the value of such training, they first have to acknowledge the presence and importance of cultural background in all interactions (Bender et al. 2010). Culture includes, but is not limited to, a range of factors such as gender identity or expression, sexual orientation, ability, socio-economic status, age (NASW 2015). This study focuses on culture in respects to race and ethnic identity. This study investigates whether there are differences in participants’ acknowledgement of culture via ethno-racial identity and child maltreatment when working with simulated clients from Chinese, Indigenous, and White ethno-cultural backgrounds. It identifies educational differences between students who acknowledge ethno-racial identity versus those who do not, and how students conceptualize and reflect on ethnic culture in their interactions with simulated clients.

Literature Review

Cultural Competence

Cultural competence can be identified in early works on ‘intercultural effectiveness’ (Hammer et al. 1978) which focused on obtaining information about an ethno-culturally different group which could be used to facilitate interactions. This early formulation has been critiqued as oversimplified and essentialist, implicitly supporting the notion that cultural groups have static behaviours and traits which can be superficially known and emulated (Azzopardi 2020; Hollingsworth 2013). During the 1980s and 1990s, cultural sensitivity and awareness emerged as either components of cultural competence or as concepts in their own right (Bennett 1986; Chen and Starosta 1997, 1998). Sensitivity refers to the capacity to appreciate and comprehend cultural differences, while awareness is defined as the ability to understand how culture influences thought, behaviour, and interaction (Chiu et al. 2013). These two concepts shifted cultural competence from ethnocentrism towards a position which embraces cultural parity (Bennett 1993; Chiu et al. 2013). Tervalon and Murray-Garcia (1998) also introduced the idea of cultural humility, which highlights the need to examine the helping professional’s contribution to the working relationship. Shifting the focus to the worker underscores the need for self-reflection on power, respect, partnership, and the impact of colonial histories on thought processes (Chao et al. 2011; Tervalon and Murray-Garcia 1998). This shift from the other to the self and from static knowledge to ethnorelativism requires a different type of learning that emphasizes humility, sensitivity and self-examination (Azzopardi and McNeill 2016).

Kourgiantakis and Bogo (2017) observe that social work students often struggle to conceptualize and respond to cultural factors within their clinical interactions. Early career professionals in counseling psychology and social work alike have expressed feeling unprepared to work with ethnic minority clients despite regularly working with or expecting to encounter diversity in practice (Allison et al. 1994; Logie et al. 2015). This struggle may be related to an unspoken norm of ‘Whiteness’ and subsequent ‘othering’ (Krumer-Nevo and Sidi 2012), a process through which moral codes of inferiority are attached to difference, typically to exclusionary effects. Othering is often associated with Eurocentrism and racism, with distinct social groups being perceived homogenously (Riggins 1997) and non-White children and families being problematized (Chand 2008; Christie 2010). For example, Tufford et al.’s (2015) findings reveal that social work students found it difficult to conceptualize a case with a new immigrant mother because of “the client’s ‘otherness’, as evidenced by participants’ descriptions of the client as ‘foreigner’, ‘different’, ‘this [newcomer] population, and ‘accent [English]’.” (p. 236). The authors suggest that this may impede the student’s ability to attend to all aspects of the client’s experience as unfamiliarity was a source of uncertainty and discomfort. Such responses led the researchers to question if participants may have been more comfortable attending to the client’s experiences, including the potential need for child protection, had the client been locally born (Tufford et al. 2015).

Tascón and Ife (2019) argue that social work must be critiqued for the way its knowledge has been constructed from a western White lens that marginalizes other worldviews. While engaging across difference can produce discomfort, students who do not engage with and process these reactions may end up ignoring them or assume that they are performing better with minority clients than they actually are. Lu et al. (2011) found that social workers rated their own level of cultural empathy higher than external raters such as facilitators or trained actors. Social work students assessed as having the highest cultural empathy scores during simulation-based learning were rated highest in their performance by simulated clients. The cultivation of culturally empathetic skills is necessary in social work education to adequately prepare students for the complexities of practice in ways that acknowledge and challenge othering and Whiteness. Students who fail to acknowledge that culture is a relevant factor in all professional social work interactions regardless of the client’s ethno-cultural background, and who are not reflexive about how their own cultural lens influences their practice, are susceptible to reductionist or stereotyped thinking. Thus, the opportunity to identify gaps in one’s cultural practice requires active experiential learning over passive classroom instruction (Egonsdotter et al. 2018).

Simulation-based Learning in Child Welfare and Cross-Cultural Practice

Simulation is a type of experiential learning intended to connect intellectual knowledge to the spontaneous application of professional skills (Kolb 2015; Roberson 2019). Simulation is an emerging pedagogy in the area of child welfare that has promising outcomes (Bogo et al. 2014). It has been used to teach as well as assess critical child welfare competencies like motivational interviewing (Peckuconis et al. 2016), client engagement (Rawlings and Blackmer 2019), and the development of evaluation instruments targeting child welfare related practice skills (Havig et al. 2020). Simulation is congruent with competency-based education frameworks (Kourgiantakis et al. 2020a, b) and has been used to promote cultural sensitivity (Hardy and Bobes 2016). Moreover, it has been shown to enhance awareness of cultural identities by having students consider their own and their client’s’ cultural selves and how cultural factors manifest in interviews (Kourgiantakis and Bogo 2017). Simulation allows cross-cultural competence to be assessed along dimensions such as student assumptions, intentionality, use of self, self-awareness, and reflexivity (Bogo et al. 2014). Thus, simulation offers a promising tool for students to learn to understand and respond appropriately to the comprehensive cultural contexts of clients and comprehend the complex effects of intersectionality and worker position.

Unfortunately, Kourgiantakis et al.’s scoping review (2020a, b) reveals a dearth of simulation research focused on promoting effective practice with culturally diverse clients in a child welfare context. They found that 38% of all simulation study designs explicitly addressed diversity and culture, including 19% within their vignettes, 16% in their assessment tools, and 6% in the course curricula. This finding echoes a prior critical appraisal of standardized client simulation use in social work education identifying that most scenarios were not developed to prepare social work students to competently address diversity issues (Logie et al. 2013). Such findings are congruent with the recommendation of the extant body of research that more simulation research is needed to train social workers to work across multiple areas of diversity (Leake et al. 2010). Simulation has been found to be beneficial when incorporated into multicultural curricula because it can include access to diverse, standardized simulated clients, reduce risk of client marginalization, and offer opportunities for outcomes-based assessment of culturally relevant service delivery (Benjamin et al. 2019). Moreover, Leake et al. (2010) found that simulation raises participants’ awareness of the language barriers and challenges faced by immigrant families, increases empathy and engages emotion while providing new knowledge and motivation for further learning. What has yet to be examined is whether there are differences between acknowledgement of culture as a relevant practice factor when the client is White or non-White. It is essential to examine whether students understand culture to be important in all encounters with social work clients in child welfare, regardless of their ethno-cultural background, and how they demonstrate reflexivity on how culture permeates the assessment of child safety with all families.

As a starting point, social work students need to be able to identify a client’s cultural identity and understand that it is relevant to practice. Students who can acknowledge culture in practice will then employ the skills necessary to effectively navigate the space of difference between themselves and their clients (Bender et al. 2010). Next, students need to be able to identify differences in multicultural situations so that they can respond appropriately. Thus, a unifying framework is necessary to target how professionals approach, process, and respond to clients from diverse ethno-cultural backgrounds. Cultural agility is considered as an appropriate theoretical framework for this purpose and is used to guide this study.

Theoretical Framework—Cultural Agility

Caligiuri (2012) defines cultural agility as the practice of reading cross-cultural and/or multicultural situations; assessing any differences in attitudes, values, and behaviours; then responding successfully within the cross-cultural context. The cultural agility competency framework is comprised of twelve distinct competencies under four domains. Competencies affecting behavioural responses include (1) cultural minimization, which emphasizes standardization and maintaining consistency and control over expectations irrespective of culture, (2) cultural adaptation, which involves suspending judgements and adjusting behaviour to cultural differences to accommodate culturally others’ norms, and (3) cultural integration, which involves creating new norms based on collaboration and finding commonalities, associated with an open mind and a collective space that allows the co-creation of solutions.

Competencies affecting individuals’ psychological ease cross-culturally include (4) tolerance of ambiguity, which refers to the internal gauge people possess to suppress their discomfort in the presence of ambiguity, (5) appropriate self-efficacy, or an appropriate level of confidence professionals have in their skills and ability to succeed in cross-cultural situations and humility with respect to one’s own skills, and (6) cultural curiosity and desire to learn, which refers to interest in learning manifest in asking questions, independently seeking information and knowledge. Competencies affecting individuals’ cross-cultural interactions include (7) valuing diversity, or ease of being with those who do not share common life experiences and the ability to comfortably associate with individuals from different cultures, (8) ability to form relationships, or an interest in connection at a personal level and seeking opportunities to connect across cultures, and (9) perspective-taking, the ability to see from various perspectives and reassign meaning to behaviours.

Finally, competencies affecting decisions in a cross-cultural context include (10) knowledge and integration of cross-national/cultural issues, including factual knowledge of historical, political, economic and religious factors interconnecting different countries, (11) receptivity to adopting diverse ideas, which refers to willingness to explore and adopt solutions or practices originating from atypical sources, and (12) divergent thinking and creativity, the capacity to generate multiple responses to a given situation in a resourceful way (Caligiuri 2012). The first level emphasises those critical skills and cross-cultural competencies that will facilitate psychological ease, promote relationships, and lead to effective decisions in cross-cultural contexts. The second level consists of leveraging the three cultural responses: cultural adaptation, cultural minimization, and cultural integration, as appropriate. The final level describes successes in cross-cultural tasks, jobs, and roles by accurately assessing and effectively responding to situations where the cultural context will affect the outcome.

The diversity of both workers and populations served by child welfare workers in North America is growing (Brimhall et al. 2014; Ortega and Faller 2011). Social workers who do not consider culture as relevant during their interactions with clients may miss pertinent information and thereby conduct incomplete assessments for safety and intervention planning. The lack of ability to navigate cultural differences may result in miscommunication and misinterpretation of the client’s strengths, needs, and definitions of healthy child-rearing and well-being. Simulation presents the opportunity to strategically structure and target specific learning outcomes pertaining to cross-cultural practice. However, there has been little research examining how social workers navigate ethno-cultural differences between themselves and clients during simulated scenarios with ethnically diverse children and families. This study seeks to contribute to this knowledge gap.

Methodology

Research Design

The purpose of this study is to examine how students engage in cross-cultural child welfare practices through the use of simulation-based social work educational research methodology. We explore how participants engage in cross-cultural practice with simulated clients that may be from a different ethno-cultural background than themselves. The study investigates the following questions: (1) Are there differences in participants’ acknowledgement of culture and child maltreatment across the simulated scenarios? (2) What are the educational differences between participants who acknowledged the client’s ethno-racial identity versus those who did not in the simulation? and (3) What aspects of cultural agility was used in participants’ cross-cultural social work practice?

A theoretically-informed mixed methods approach (Hesse-Biber 2018) was used in the study. The cultural agility framework (Caligiuri 2012) served as an organizing structure (Evans et al. 2011) to examine the concept of cross-cultural competency and to frame the research questions and analysis. A mixed methods approach enables the ability to quantitatively identify differences between participants’ and qualitatively explore how they navigate the cultural space between themselves and the simulated clients with whom they interacted during the simulated child welfare scenario. The acknowledgement of client’s ethno-racial identity was used as a starting point of engaging with difference and the cultural agility framework guided the qualitative analysis to provide a more in-depth contextual understanding of how participants attempted to engage in cross-cultural practice.

Development and Testing of the Vignettes

Research ethics approval was obtained by the researcher’s university. Three child welfare vignettes were developed by the first author and tested for face validity with six subject matter experts (SME). The SMEs indicated that the vignettes represented typical information in a child welfare referral. The vignettes were further refined and enhanced during training with the standardized actors. The following is a summary:

  1. 1)

    Chinese Family Mr. Jason Choy and Mrs. Ruth Choy are Chinese immigrants and have two children. A concern was raised by 8-year-old Sophie’s school after she reported scholastic pressure from her parents, including her mother calling her ‘lazy’ and ‘stupid’ and hitting her hands with a ruler if she did not practice the piano. The family has had no prior involvement with child protection services.

  2. 2)

    Indigenous Family Ms. Sarah Wilson, an Indigenous woman, co-parents 7-year-old Tyler with her ex-partner Mr. George Andrews, a White male, and has full custody of 10-year-old Joshua from a previous relationship. Ms. Wilson had extensive child protection involvement throughout her childhood and brief involvement when Joshua was a baby. A police report shows that Ms. Wilson called while intoxicated stating that Mr. Andrews had taken her children. Mr. Andrews had attended Ms. Wilson’s home earlier that night to find the front door unlocked and the two boys alone. He took the children back to his home after failing to reach Ms. Wilson.

  3. 3)

    White Youth Liam Markeson, a 16-year-old White male, is living in a home marked by intimate partner violence between his parents. He was referred to a youth counselling service after taking his parents car without consent and crashing it. Liam has no prior involvement with child protection services.

Simulation Workshop in Child Welfare

The research was conducted over two years (Fall 2018–Fall 2019). Five voluntary workshops were held: two for 3rd year BSW students, two for 4th year BSW students, and one for advanced standing MSW students. Only one vignette was presented per workshop. Participants were not informed of the vignette scenario in advance. Participants were matched to the simulated scenario by convenience. The workshops were approximately three hours in duration and included the following components in sequence: (1) a pre-workshop Demographics Form and Direct Practice Self-efficacy Questionnaire, (2) a 20-min lecture focused on child welfare policies and practices, (3) a 15-min assessment planning session in small-groups, (4) a two-hour simulation session with standardized actors using a peer-coaching model, (5) a 10-min collective feedback, and (6) a post-workshop Post-performance Reflection Questionnaire and Standardized Client and Workshop Feedback Form.

The focus of the workshops was child welfare policies and practices. The cultural agility framework and cross-cultural practice was not explicitly present in the workshop content. For the Chinese and Indigenous family scenarios, students assumed the role of a child protection social worker and were instructed to conduct an unannounced home-visit investigation. Students had the opportunity to interview the adult and child standardized actors in a simulated one-bedroom apartment. For the White family scenario, the context was a youth counselling session with only Liam present. For all scenarios, a peer coaching format was used where participants engaged in the simulation individually for 5 to 8 min before receiving feedback from the standardized actor, research team, and peers regarding their performance.

Recruitment and Sample

A convenience sample of 3rd year BSW, 4th year BSW and MSW students were recruited from a Canadian social work school through posters, emails via the school’s list-serv, and class presentations. Students who expressed interest in participating received a study information letter and signed a consent form. Thirty-one students (N = 31) participated in the simulation workshops; however, due to the voluntary nature of the research, some questionnaires were incomplete, resulting in different sub-sample sizes in the analyses. Of the 27 participants who provided demographic information, four identified as male, 22 identified as female, and one ‘prefer not to say’; eight identified as White and 19 identified as BIPOC (nine East Asian, four South Asian, four Indigenous, one Black, and one multi-racial). Participants were not matched with particular scenarios to create a cross-racial dyad in the simulation, but rather, the cross-racial dyads were noted in the data collected and analyses were completed to explore this unique situation.

Measurement

Quantitative and qualitative data were collected through an online Qualtrics survey comprised of the following instruments: (1) Demographics Form (created by the research team for this study): Eleven multiple choice and short answer questions regarding the participant’s educational training and social service/work experience, (2) Direct Practice Self-Efficacy Questionnaire (adapted from Rawlings 2008): Seventy-two Likert-type scale questions on participants’ confidence to perform various social work practice behaviours, with responses from 0 (no confidence at all/cannot do at all) to 9 (complete confidence / certainly can do), (3) Post-Performance Reflection Questionnaire (adapted from Bogo et al. 2014a, b): Twelve open-ended questions to facilitate a deeper critical reflection of the participants’ practice during the simulated session, and (4) Standardized Client and Workshop Feedback Form (created by the research team for this study): Twelve multiple choice and short answer questions regarding the simulation experience.

Analysis

A theoretically-informed mixed methods approach (Hesse-Biber 2018) was used to analyze the data. The cultural agility framework served as an organizing structure to examine cross-cultural practices. Fisher’s exact test and independent samples T-tests were conducted in SPSS version 26 to examine differences between participants who did or did not acknowledge their client’s cultural identity. Fisher’s exact test for normality and Levene’s test for equality of variance were conducted and both assumptions were met. Additional sensitivity testing was conducted to examine whether there were statistical differences between BIPOC and White participants. No significant differences were found between the groups when significance level was set at p < 0.10.

Three cycles of qualitative coding were conducted along with thematic analysis (Braun and Clarke 2006) in NVivo version 12. The first cycle involved holistic coding (Saldaña 2013) in which the research team thoroughly reviewed all qualitative data multiple times to gain familiarity with the participant’s reflective responses. The second cycle involved magnitude coding to determine whether participants acknowledged the client’s cultural identity and labelled the child maltreatment concerns as abuse or neglect. The third cycle involved descriptive coding (Saldaña 2013) and a constant comparison method (Boeije 2002) to elicit initial coded themes between participants who did or did not acknowledge their client’s culture and identity. The cultural agility framework (Caligiuri 2012) provided “start codes” and themes for qualitative analysis (Evans et al. 2011). Finally, thematic analysis was conducted to identify when participants enacted aspects of cultural agility (Caligiuri 2012) while working with culturally diverse clients. Codes and themes were agreed upon through consensus and an audit trail of memos and annotations was used to enhance trustworthiness of the qualitative data analysis.

Results

Acknowledging Culture and Child Maltreatment

Over half of the participants for each vignette (Chinese family, n = 6, 60.0%; Indigenous family, n = 4, 57.1%; White family, n = 2, 66.7%) identified as BIPOC (Table 1). The majority of the participants that worked with the Chinese family (n = 8, 80%) acknowledged the client’s ethno-racial identity. “The mother grew up in Hong Kong and was raised in ways that are very different to what I have experienced”. Even participants who incorrectly identified the client’s cultural background acknowledged the need to bridge across the difference: “Because they came from a North-West Asian background, I think we struggled to know how to inquire about their upbringings and expectations for fear of coming across culturally insensitive, because none of us as interviewers are of the same ethnicity as the family”. On the other hand, few participants who worked with the Indigenous family (n = 2, 28.6%) and White family (n = 1, 16.7%) acknowledged the client’s ethno-racial identity. Participants indicated that diversity was either “not applicable” or did not necessitate unique considerations: “The actor was a White male so I did not use an anti-racist approach”. For one participant, it was an afterthought as they reflected upon their practice: “One thing I forgot to even discuss with the family is culture… Especially when working with Indigenous families, being aware of traditional practices of culture that are outside of ‘mainstream culture’ are so important as a way to possible build rapport with clients”.

The majority of the participants that worked with the Chinese family (70.0%) identified the concerns as child maltreatment, while about a third of the participants that worked with the Indigenous family (n = 2, 33.3%) and White family (n = 2, 40%) identified the concerns as child maltreatment. Participants who worked with the Chinese family often conflated culture and child maltreatment, while demarking such disciplinary practices as unacceptable: “In Asian culture, it might be normal to discipline a child through physical harm, but in western culture, it’s not acceptable”, “[they think] they’re doing something great for their children because it teaches them discipline. [However] in terms of living in Canadian society, any abuse against a child is illegal”. In contrast, participants who worked with the Indigenous mother only described the child maltreatment concerns as situational and did not make connections to the role of culture or the colonial impacts on Indigenous communities. This was demonstrated by statements such as: “Sarah’s one time ‘partying’ situation”, “The fact that the mom was leaving them unsupervised to go drinking at night with the door unlock on top of it. The kids are not at an age where they can be home alone and not at night”. In the vignette with the White youth, less than half the participants recognized child exposure to intimate partner violence as a concern. Participants had a challenging time assessing the impact on the child and naming the maltreatment: “…his dad’s anger came up in the conversation…The children and mother had not experienced physical abuse but emotional abuse was very possible…The client was also unsure that his dad would never hurt him because of verbal threats”.

Table 1 Proportion of participants who identified as BIPOC, acknowledged client’s ethno-racial identity, and identified maltreatment by simulated child welfare scenarios

Working Cross-Culturally Through Simulation-Based Learning

Overall, half of the participants acknowledged the client’s culture during the simulated session (Table 2). Among the participants who identified as BIPOC, 33% (n = 4) acknowledged the client’s ethno-racial identity, while 66.7% (n = 8) did not acknowledge the client’s ethno-racial identity. A higher proportion of participants who identified as White acknowledged the client’s ethno-racial identity (n = 6, 75%), compared to only a quarter (n = 2, 25%) of participants who identified as White who did not. A higher proportion of 3rd year BSW students (n = 8, 80%) acknowledged the client’s ethno-racial identity, while a higher proportion of 4th year BSW (n = 7, 77.8%) and advanced MSW students (n = 3, 75%) did not acknowledge the client’s ethno-racial identity. The majority of participants who acknowledged the client’s ethno-racial identity had no social work experience (n = 6, 66.7%) and experience conducting face-to-face interviews (n = 7, 77.8%) or assessments (n = 8, 88.9%). Among those who had specialized training in interviewing and/or assessing children and families, none acknowledged the participant’s ethno-racial identity. As novice social worker students, participants recognized their limitations and need for further professional development: “I think I tried my best but there is so much more I can learn. Being more self-aware. Being okay with uncomfortableness. Thinking on the spot. Being prepared and knowing what to do when people are unwilling to provide information I need”.

Table 2 Acknowledgement of client(s) ethno-racial identity by participant ethno-racial identity, education and practice experience

While all participants expressed positive learning benefits through simulation, statistical differences were found between the two groups (Table 3). Participants who acknowledged the client’s ethno-racial identity indicated that the simulation-based learning was more beneficial to their overall learning [M = 5.00 vs. M = 4.75, t (21) = − 1.92, p = 0.08], perceived the simulation-based learning to be more beneficial than peer role-play [M = 5.00 vs. M = 4.65, t (21) = − 2.35, p = 0.04], and found the workshop facilitator feedback to be highly supportive to their learning [M = 4.91 vs. M = 4.58, t (21) = − 1.83, p = 0.08], compared to participants who did not acknowledge the client’s ethno-racial identity. In regards to the meta-competencies achieved through simulation, participants who acknowledged the client’s ethno-racial identity self-rated higher in their perceived ability to practice professional judgement [M = 4.00 vs. M = 3.50, t (17.57) = − 1.83, p = 0.08] and self-awareness [M = 4.91 vs. M = 4.58, t (21) = − 1.83, p = 0.08] compared to participants who did not acknowledge the client’s ethno-racial identity. Statistical differences were also found regarding perceived procedural competencies, with participants who acknowledged the client’s ethno-racial identity self-rating higher for interviewing skills [M = 4.55 vs. M = 4.00, t (21) = − 2.03, p = 0.06], ability to ask open-ended questions [M = 4.55 vs. M = 3.83, t (20.78) = − 2.22, p = 0.04], and manage resistance [M = 4.18 vs. M = 3.58, t (20.35) = − 2.02, p = 0.06], compared to participants who did not acknowledge the client’s ethno-racial identity.

Table 3 Independent sample T-tests of the learning benefits for participants who acknowledged client’s ethno-racial identity during the simulation workshop

Using the Cultural Agility Framework to Work Across Culture

The qualitative data were analyzed using a cultural agility framework (Caligiuri 2012). According to this framework, there are three competencies pertaining to affective behavioural responses: (1) cultural minimization, (2) cultural adaption, and (3) cultural integration. These three responses are particularly salient as social workers navigate the tensions between child protection legislation, professional ethical obligations, and respect for client autonomy and self-determination. While participants attempted to use cultural minimization techniques, they expressed challenges to provide a standardized approach across cultural differences. A participant indicated that they attempted to “stick to the purpose which was to assess whether the children were safe”. Another participant explained: “I had a really difficult time confronting the mom and dad about the disciplining”. On the other hand, attempts to use cultural adaptation to suspend judgement and accommodate was also difficult in the social work role. A participant explained: “I found it most challenging to not be judgmental with the parents, while still explaining that hitting the children with the ruler was wrong and illegal. I didn’t really go into the fact that it was wrong or illegal, but spent the time to try and understand where it was coming from and why”. Participants found the cultural integration approach of finding a common ground between the child protection and client’s standpoint to be most optimal. A participant indicated:

Diversity impacted my approach while interviewing this family because I had to cater to the cultural practice of the family … in Asian culture, it might be normal to discipline a child through physical harm, but in western culture, it’s not acceptable. I had to put my biases aside, and try to understand their family dynamic as much as I can while sticking to the code of ethics.

In the cultural agility framework, three competencies affecting individuals’ psychological ease to working cross-culturally include: (1) tolerance of ambiguity, (2) appropriate self-efficacy, and (3) cultural curiosity and desire to learn. In child protection investigations where workers are balancing a multitude of immediate tasks such as introducing the purpose of the meeting, building rapport, understanding the client situation and context, and managing emotions; the competencies to navigate across these demands are significant. The simulation workshop presented opportunities to test participant’s tolerance of ambiguity. A participant indicated, “I learned that interviewing people is much more harder than I thought. It is not as simple as having a form and checking off the boxes. People are surprising. I am surprised by how much I learned in these interesting conversations with the actors”. While dealing with ambiguity, participants displayed humility but also a sense of self-efficacy in their practice. “I learned that I still need a lot of practice and confidence with actors but I also realized that I have come a long way from where I started. I think my questions were not as bad as I thought they were”. Participants also suggested using critical reflection as a tool to navigate these feelings of uncertainty and develop confidence in their abilities: “I would need to be self-aware of my own experiences and biases and reflect on those for sure” and “processing my past experience would help [me] develop cultural sensitivity, and understanding why the parents behaved the way they did in the simulation interview”. Participants also demonstrated cultural curiosity and desire to learn: “I’m not sure exactly what ‘cultural agility’ means but I’ll be looking this up once I get home”.

In the cultural agility framework, three competencies affecting individuals’ cross-cultural interactions include: (1) valuing diversity, (2) ability to form relationships, and (3) perspective-taking. The most prominent competency affecting individuals’ cross-cultural interactions displayed by participants was perspective taking. Participants expressed the need to understand the client’s perspective and hold multiple ways of knowing. One participant indicated that they: “Acknowledged that all individuals had their own values and ways of looking at the situation. Based on individual’s own cultural difference and personal experience, the parents and children shared their thoughts on the event of physical abuse, based on their own beliefs”. Another participant explained: “By asking the dad what his childhood was like I was able to better understand his ideas about raising children as well as cultural differences”.

In the cultural agility framework, three competencies regarding the decisions in a cross-cultural context include: (1) knowledge and integration of cross-national/cultural issues, (2) receptivity to adopt diverse ideas, and (3) divergent thinking and creativity. The simulation workshop did not elicit very many opportunities in which participants engaged in these practices, however, participants discussed critical reflection and divergent thinking as ways to work cross-culturally. One participant noted, “this experience evoked my cultural background. I am an immigrant, and the education system in my home country also reinforced the caregivers to discipline a child for the child’s own good. However, I stand on the other side of this cultural value, and have been criticizing the culture the way adults treated children”. A participant who was faced with “The resistance and vagueness from both parents. We dealt with this by directing our attention more towards the children instead of trying to exhaust ourselves over the parents”.

Discussion

The current study examines cross-cultural child welfare practice through the use of simulation-based education. Thirty-one participants engaged in one simulation workshop and reflected upon their performance. The research sample was somewhat unique in that the majority of participants (70%) identified as BIPOC, however, this did not determine whether participants acknowledged the client’s ethno-racial identity during the child welfare simulation. Interestingly, a higher proportion of participants who identified as BIPOC (66.7%) did not acknowledge the client’s ethno-racial identity, while a higher proportion of participants who identified as White (75%) did acknowledge the client’s ethno-racial identity. This finding suggests that perhaps participants who identify as White may be sensitized to acknowledge difference and attempt to bridge this gap with their clients. In Bender et al.’s (2010) study, the majority of participants identified as White, and recognized their privileged racial identity and the importance of acknowledging ethno-racial identity within the therapeutic process with clients from a different ethno-racial background.

A higher proportion of participants acknowledged culture in their Post-Performance Reflection Questionnaire when they interacted with the Chinese family (80%) than when they interacted with the Indigenous (29%) or White (16%) family. This may be attributed to the perceived or visible difference of whether the client is BIPOC or White. In other words, the difference in the level of cultural acknowledgement between the Chinese and White scenarios could be due to racial difference being equated with cultural difference, and White being perceived as the cultural norm in the context of a colonial environment. In the Indigenous scenario, the father was White and the children had multiracial heritage. It is possible that the father’s White ethno-racial identity contributed to the lower levels of cultural acknowledgement due to the same ‘majority cultural norm’ argument. In addition, the father’s White ethno-racial identity may have partially obscured participants’ identification of the Indigenous identity of the mother and children. It may also have led to a preference to attend to the father’s perspective, as similarly found in the study by Tufford et al. (2015).

Maltreatment was identified in the Chinese family by 70% of respondents, compared to 33% for the Indigenous family and 40% for the White family. This finding is interesting because neglect and exposure to intimate partner violence represent the largest proportion of substantiated investigations (34% each), followed by physical abuse (20%) (PHAC 2010). In using a cultural agility perspective, participants may be more sensitive to cultural difference and therefore more likely to acknowledge it in situations where they believe it is relevant to the alleged maltreatment being investigated. Lee et al. (2014, 2016, 2017) identified that, despite being under-represented in child protection populations overall, Asian-Canadian children are over-represented in investigations for physical abuse and that physical discipline is assumed by social workers to be typical in Asian families. Our results align with such findings, with participants blurring the line between culture and physical abuse for the Chinese family. Such cultural essentialization is problematic. Research demonstrates that the relationship between culture and maltreatment is indirect, with the expression of maltreatment also being a product of factors such as poverty, community resources and discrimination (Bywaters et al. 2017; CWIG 2016). Therefore, attributing a form of abuse or neglect directly to a particular culture can perpetuate racist assumptions (LeBraun et al. 2016; Sawrikar 2019).

While child maltreatment concerns were not explicitly stated in the White scenario, which could have contributed to a lower level of identification, they were made explicit in the Chinese and Indigenous scenarios. That a higher proportion of participants labelling the Chinese parents as “physically harming” and “abusing” their children might suggest a bias against BIPOC families as found in other research (Egonsdotter et al. 2018; Keddell and Hyslop 2019; Lee et al. 2017). However, this does not explain the low acknowledgment of maltreatment in the Indigenous scenario. Participants may have been anxious to avoid labelling the concern as child maltreatment in the Indigenous scenario for fear of stigmatising the family, due to their awareness of social work’s colonial history and legacy in Canada. This is in-line with the cultural agility framework, as participants use and integrate knowledge of historical, political, and social factors while working in a cross-cultural context.

Our results suggest that it is difficult for participants to meaningfully and consistently translate education-based knowledge into face-to-face practice with Indigenous families. As a further example, most study participants deemed concerns in the Indigenous scenario to be situational and did not show the same curiosity regarding the underlying contributions of culture to maltreatment as they did in the Chinese scenario. This is important given findings by Kourgiantakis et al. (2020a, b) that approximately half of the students in their study indicated culture and diversity did not impact their interviews with simulated clients. Simulation-based learning provides the opportunity to recognize, assess for and reflect upon this disconnect. Our findings indicate that participants used the constructs of perspective-taking and cultural integration from the cultural agility model to try to navigate the investigation process while respecting the family’s views. Cultural integration in particular offers a promising framework to help students learn to collaborate with families by maintaining openness, curiosity and humility and seeking shared understandings.

Participants who were earlier in their educational training and had little to no social work experience (3rd year BSW), acknowledged ethno-racial identity more often than 4th year BSW and MSW participants. This finding may have been an artifact of which scenario participants were assigned to: 3rd year BSW participants conducted the simulation exclusively with the Chinese family while MSWs participated exclusively with the Indigenous family and 4th year BSWs with both the Indigenous and White families. However, this distinction could also suggest less interest or flexibility in regards to exploring the cultural context surrounding a child protection concern for more advanced students, who employ a focused approach that primarily examined the maltreatment allegations. That three out of four advanced MSW-level participants (who already hold a social work degree) did not acknowledge ethno-racial identity during their simulation with an Indigenous family is unfortunate and could indicate the need for continuous cross-cultural training, including training that focuses on translating Indigenous history and knowledge into practice, at all levels of social work education.

In our study, 3rd year BSW students rated themselves higher on some of their perceived competencies than participants who were further in their education or career. This could reflect the fact that 3rd year BSW students had little to no workplace experience, meaning that their self-evaluations had not been significantly tested and may have been more aspirational. It is important to note that confidence in ability does not equal competence and that overconfidence can be problematic (Bogo et al. 2013; Bogo et al. 2006), a conclusion which supports the use of externally evaluated simulation procedures such as the Objective Structured Clinical Exam (OSCE) (Bogo et al. 2014). The critique of Kourgiantakis et al. (2020a, b) could be addressed by developing OSCE simulations focused on cultural diversity alongside a cultural agility assessment framework that promotes effective practice.

Holistic models that expand beyond technical-rational competence may be enhanced by the incorporation of cultural agility frameworks. Cultural agility aligns with the interpersonal dimensions of meta-competencies of engaging with clients like reflection, self-awareness, and self-regulation (Bogo et al. 2012). Participants in our study, for example, used simulation as an opportunity to explore their cross-cultural queries and tolerance of ambiguity, both of which are posited to facilitate psychological ease in cross-cultural working. Participants who were earlier in their education more often acknowledged ethno-racial identity and were more positive in their feedback about the impact of simulation on their learning, suggesting an initial readiness or openness to cross-cultural training via this medium. Once social work students graduate and find employment, both the time and support for the kind of critical self-examination underpinning holistic models of competence may be reduced (Harrison and Turner 2011). New social workers may also become so immersed in their workplace culture that they absorb the prevailing practice standards rather than retaining the lessons from their cross-cultural instruction (Robichaud et al. 2020). It is therefore critical that continuous learning regarding the complexities of practice with cultural groups that are different from one’s own is encouraged. We suggest further research is needed on how to best support advanced students and social work professionals already in practice to develop and maintain their cultural agility.

Limitations

Several limitations are noted in the current study. First, participants self-selected for the workshops which may have positively skewed participants’ ratings and potentially dissuade those who might feel discomfort performing in front of peers. Second, data were collected via convenience sampling which in this case consisted mainly of younger females, potentially limiting generalizability. Third, the size of the sample may reduce study power and increase margin of error, necessitating that quantitative findings be interpreted with care. Fourth, variations in workshop characteristics, such as which simulated family was presented, the duration of the participant’s direct interaction with the simulated client, and the number of identity of peers present, may have contributed to variance. Fifth, the overt educational content of the workshop focused on child maltreatment and not cross-cultural practice, leading us to wonder if students may have performed differently if working across cultures was an explicit learning objective. Sixth, this study was cross-sectional with responses being conducted through survey, negating opportunities for further clarification or elaboration. Finally, we used self-report measures to examine both meta and procedural competencies, which are susceptible to response biases. Alternative research methodology may lend to different results.

Recommendations for Research

Congruent with Lu et al. (2011), our results suggest that more research is needed that conceptually delineates and specifically focuses cultural agility from clinical skill. Student discomfort at broaching discussions about culture was evident in our sample and indicates a need for research that explicitly prioritizes cultural agility in its learning objectives. Simulation-based methodology can be used to promote and enhance cross-cultural practice across ethno-cultural differences. Simulated scenarios can incorporate various situations that target the development of culturally agile practice like when language is a barrier or when there are disagreements between multi-generational families pertaining to cultural values and appropriate behaviours. In addition, the meaning of culture in this study was specific to only ethno-racial components. Culture viewed holistically includes not only this aspect of identity but gender identity, sexual orientation, ability, socio-economic status and more (NASW 2015). Future research could therefore examine the application of cultural agility to a broader conceptualization of culture in child welfare practice. The cultural agility framework was used in the current study to provide insight and guide understanding of how cross-cultural practices were enacted. Future research can consider theory development to expand the conceptualization of cultural agility and cross-cultural competence in the field of child welfare.

Based on our observations of participants conflating culture with maltreatment for the Chinese family, we suggest future research incorporate into simulation-based learning activities opportunities for participants to reflect on how their own cultural lenses enter their decision-making processes. The formulation of said activities should be guided by ongoing community and agency consultation (Leake et al. 2010). Students who do not acknowledge and challenge their cultural beliefs may reproduce essentializing tendencies that may constitute a significant contributor to the disproportionate representation of minority groups in child welfare systems (Egonsdotter et al. 2018).

Recommendations for Policy/Practice

Cross-cultural competence that focuses on individual functioning obscures the responsibility for organizations to address institutional oppression, shifting this burden to the front lines of practice (Abrams and Moio 2009; Azzopardi and McNeill 2016). Our finding that participants with specialized interview training did not acknowledge the client’s ethno-racial identity suggests the importance of ongoing and regularly updated cultural agility training for new and experienced workers alike. Our findings revealed that participants working with the Indigenous mother did not acknowledge child welfare involvement as a consequence of oppressive, systemic colonial forces (Tamburro 2013). Students, especially those in Canadian child welfare systems, who cannot make the connection risk repeating harm to Indigenous children and families in practice. The promotion of awareness of the cultural strengths of traditionally othered worldviews into simulation-based learning may help mitigate any perceived deficits that new child welfare social workers might bring into practice (Haight et al. 2019). Our qualitative findings identified challenges in using cultural minimizing and adaptation approaches in child welfare practice. As such, a cultural integrated approach is recommended which recognizes child protection mandates, all the while creating space for client input and agency in the process. Our study is the first attempt to examine the utility of the cultural agility framework which originated in the field of business, to determine whether aspects of the theory could be applied in social work and specifically a child protection context. The cultural agility framework offered a useful perspective in understanding how cross-cultural practice could be advanced in child welfare practice and policies.

Conclusion

Rather than a checklist, cross-cultural competence may be better conceptualized as the synthesis of relevant knowledge and sensitivity, critical reflexivity and emotional regulation, and metacognition, or the ability to think about one’s own thought processes, consistent with holistic competence models. Simulation-based learning is a promising pedagogy because it offers the opportunity for students to engage with their discomforts and enter a space where they can safely query their assumptions. Future simulation-based learning efforts, therefore, must explicitly target in their learning objectives competencies like reflection on how one’s own social location contributes to how students frame differences with clients, and how assumptions about difference can manifest in practice. Social work is a profession filled with uncertainty, and the humility to ask questions and the skill of not knowing (De Jong and Berg 2013) may reflect a higher level of competence than assuming one knows more than they actually do.

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Funding

We gratefully acknowledge the financial support for this project provided by the University of British Columbia students via the Teaching and Learning Enhancement Fund.

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Lee, B., Ji, D. & O’Kane, M. Examining Cross-Cultural Child Welfare Practice Through Simulation-Based Education. Clin Soc Work J 49, 271–285 (2021). https://doi.org/10.1007/s10615-020-00783-8

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Keywords

  • Cross-cultural
  • Child welfare
  • Child maltreatment
  • Simulation-based learning
  • Social work education
  • Cultural agility