Field Educator: A Scholarly Journal from the Simmons University School of Social Work

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Abstract

This qualitative study, informed by grounded theory, examined junior-level Bachelor of Social Work (BSW) students’ preparedness in cultural competence skills to treat clients with respect and uphold their dignity. The researchers used Hicks’ (2013) elements of dignity, along with questions related to cultural competency, to guide a focus group with students. Overall, the students expressed readiness in the classroom to serve clients. However, some expressed uneasiness with knowing how to apply the practice skills learned in the classroom when in their field practicum. Case studies and skill lab modules could support students’ real-life skills with clients.

Keywords: social work, client dignity, cultural competence, field practicum, BSW program

Every academic year, social work undergraduates enter Bachelor of Social Work (BSW) programs in the United States. The curricula at undergraduate schools of social work typically teach theories and practice regarding cultural competency skills essential for treating clients with respect and upholding their inherent dignity. Dignity is an especially critical idea that may be difficult to parse. Klein defined dignity as “a phenomenon including two aspects: guarding one’s self-respect and accommodating the self-respect of other” (as cited in Chan, 2004, p. 228).

Hicks (2013) developed a two-segment, theoretical model of dignity to help people understand the role that it plays in their lives and relationships: “The Ten Essential Elements of Dignity” and “The Ten Temptations to Violate Dignity.” Most pertinent to this study are the ten elements of dignity: (a) acceptance of identity, (b) inclusion, (c) safety, (d) acknowledgment, (e) recognition, (f) fairness, (g) benefit of the doubt, (h) understanding, (i) independence, and (j) accountability. These specific ten elements provide an assembly of dignity-enhancing skills with matching cultural competence skills. These are outlined in the two practicum courses’ syllabi as outcomes for the junior-level BSW students at the public college and school of social work where the study was conducted (see Appendix 1 for these elements with explanatory material). As articulated in the course syllabi, the knowledge-based instruction given to the students included such learning objectives as social work professional values and skills, as well as how to recognize systematic inequality with emphasis on social justice and cultural diversity. The alignment of the ten elements of dignity with cultural competence skills contribute to the context of practice and the courses’ learning objectives.

Cultural competency is a concept that encompasses the ability to uphold someone’s dignity. Lum defined cultural competency as “a set of knowledge and skills that a social worker must develop in order to be effective with multicultural clients” (as cited in Kirst-Ashman & Hull, 2012, p. 25). Indeed, according to Teasley, Baffour, and Tyson (2005), cultural competence is so important to the profession that the Council on Social Work Education has mandated social work educational programs to emphasize it at all levels. Hall and Lindsey (2014) similarly underscored the importance of social workers engaging in practice behaviors that fully account for the social justice mission of the profession. This need for social justice is especially crucial when social workers, even those engaging in direct services, are working with historically vulnerable and oppressed populations.

Schools of social work traditionally have explored within the curricula the importance of dignity as a cornerstone concept for culturally sensitive practice. They either develop specific course work that directly addresses culturally competent practice or they have included the subject in courses that focus on other topics. Social work instructors often use course assignments as a baseline measurement to determine students’ preparedness for culturally competent practice and their abilities to respect and uphold the dignity of clients. Such course assignments may provide some sense of whether social work students are able to comprehend theory and apply it to praxis. However, while classroom instruction and practice in cultural competence should translate to the field practicum, there is a lack of evidence that classroom social work instructors have succeeded in helping nascent social workers develop cultural competence and dignity-enhancing skills. The ability to master skills in the classroom is different from applying them in a field practicum, yet the latter undoubtedly is reliant on the former.

Therefore, the purpose of this study was to examine BSW students’ preparedness for culturally competent practice that indicates respect for clients and demonstrates dignity-enhancing skills. To do this, the authors adopted a cultural competency orientation for this work, focusing on long-standing social work values and skills necessary to treat clients with respect and uphold dignity as defined by Hicks (2013). The authors began by reviewing scholarly literature that addresses the cultural competence skills that BSW students should learn in the classroom. Informed by grounded theory, the authors used the qualitative method of a focus group to collect data addressing BSW students’ preparedness to engage clients with cultural competence and with respect that upholds their natural dignity. The authors then analyzed the data for themes and determined some strengths and deficits that students themselves suggested regarding their BSW educational preparedness.  These research processes and results are detailed in this article.

Literature Review

Cultural Competence Practice through Multicultural Social Work Education

Osteen, Vanidestine, and Sharpe (2013) conducted a study in which they used convenience sampling of 297 Master of Social Work (MSW) students from two different universities to determine the extent to which students were receiving multicultural education. The study’s results indicated that students who were required to take courses dedicated to multicultural studies were more appreciative and aware of cultural competence and racial differences than their peers who had multicultural information infused throughout the curriculum. This study also pointed to the value of multicultural coursework for awareness building that could naturally enhance cultural competence that revealed respect for clients and skills that upheld their dignity. By nature, social work is a field where students need to be open-minded and attuned to racial, cultural, and social disparities in the world. Osteen et al.’s (2013) study demonstrated that even students who self-selected for this profession benefited from multicultural-focused education.

Nadan and Ben-Ari (2013) contended that educating social work students for culturally sensitive practice is one of the most challenging and complex problems for social work educators. Indeed, Hoyt (2012) examined the teaching of multicultural education and discovered that how the subject is approached in academia may cause students to feel guilty and/or blamed because of their social status. Although student affect is a concern, as revealed in our study, it cannot be used to skip over emotionally difficult material. To help students grasp issues of multicultural education more completely, Hoyt (2012) suggested that social work instructors should strive to define and specify the differences among such topics as racism, class privilege, oppression, and race-based institutional oppression so that students fully grasp the intellectual understanding of each. The bottom line for training BSW students is that actual practice in cultural competence is foundational to social work (Teasley et al., 2005). According to the Code of Ethics (National Association of Social Workers [NASW], 2008) the “core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective: service, social justice, dignity and worth of the person, importance of human relationships, integrity and competence.” Students must learn these core values from both theory and practical experience.

Becoming Culturally Competent Social Work Students

Jackson and Samuels (2011) explored the NASW Standards for Cultural Competence in Social Work Practice and its role in supporting culturally diverse and sensitive learning within social work classrooms Jackson and Samuels (2011) suggested that being multiracial could place clients at greater risk than their non-multiracial peers to: experience discrimination, use drugs and alcohol, engage in violent behaviors, and struggle with mental health problems. Hence, social workers should understand how a multiracial person’s well-being and quality of life can be detrimentally impacted as a result of living in “a race conscious society that constructs a normative and healthy racial identity in terms of a single, mutually exclusive racial group” (p. 236). Nadan and Ben-Ari (2013) stated that:

Cultural competence is generally conceptualized as containing three major elements: (a) cultural awareness—referring to practitioners’ self-awareness of their own cultural values, beliefs, attitudes, prejudices, and emotional and cognitive processing of their cross-cultural encounters; (b) knowledge—the knowledge required for cultural competence usually concerns a specific cultural or ethnic group; and (c) skills—the skills inherent in cultural competence arise from the ability to combine awareness and knowledge in professional practice. (p. 1091)

To become culturally competent, BSW students must learn about and implement appropriate practices for diverse clientele.

Abrams and Molo (2009) discussed the “challenges raised regarding the delivery of effective cultural competence education including student readiness, teacher preparation, and possible resistance from both groups” (p. 248). BSW students and teachers enter the classroom with embedded beliefs and preconceived ideas about race, culture, and social differences that hinder how they present and/or receive information about cultural competence. Messinger (2004) stated that “when teaching cultural competence in social work practice, instructors must use a variety of means to challenge students to: (1) identify their biases about other cultures and groups, (2) think critically about their assumptions, and (3) open themselves to other perspectives” (p. 63) in order to meet the NASW Standards for Cultural Competence.

Despite these clear statements that BSW students must receive cultural competence training, precisely how to measure whether and to what degree the students have sufficiently integrated the teaching into their practice requires continued study. To this end, this study examined BSW students’ preparedness for culturally competent practice with the specific goal of learning how these students demonstrate respect for clients and use dignity-enhancing skills.

Research Method

Methodological Framework

This study used a grounded-theory informed method (Annells, 2006). According to Thornberg (2012), “informed grounded theory refers to a product of a research process as well as to the research process itself, in which both the process and the product have been thoroughly grounded in data by GT (grounded theory) methods while being informed by existing research literature and theoretical frameworks” (p. 249). Grounded-theory informed methodologies do not strictly adhere to the original tenets of grounded theory as espoused by Glaser and Strauss (1967), but instead rely upon important epistemological assumptions upon which grounded theory is based (Burke, Danquah, & Berry, 2015; Charmaz, 2014; Padgett, 1998; Pérez, Mubanga, Aznar, & Bagnol, 2015). Such an approach recognizes the importance of data as the primary source of theory building or themes, in the case of much grounded-theory informed research (Furman, Langer, Sanchez, & Negi, 2007). While grounded-theory informed research does not deny the importance of theory and literature in shaping research questions, it pushes researchers to privilege an open, inquisitive approach that is not driven by previously selected lexicons of themes. As such, grounded-theory informed research uses various data collection and analytical strategies in an inductive and theory (theme) building approach that relies primarily upon an inductive ground-up process. This contributing factor offers researchers the opportunity to represent an inductive process of analysis by inquiring an understanding of study participants’ experiences within the content of a situation such as in the present study (Baylis, Collins, & Coleman, 2011). Charmaz’s (2014) phenomenon of constructivist grounded theory acknowledges the parallel to grounded-theory informed with the “understanding of studied life and view theorist analyses as located in time, place, and the situation of inquiry” (p. 342). Strauss (1990) stressed that grounded theory is not entirely inductive; in so much as theory testing can indeed be a part of the grounded theory processes, the focus is on discovering findings inductively from one’s data (Berg, 2004).

Based upon this approach, the authors chose a primary data collection method of a focus group, in which research participants were encouraged to interact with each other while responding to scripted questions (see Appendix 2) based on the elements of dignity (Hicks, 2013) and the meaning of cultural competence.  The authors hoped that such interaction would inspire them to reveal their lived experiences while repressing and challenging researcher preconceptions, which are always evident in research no matter how much bracketing they do (Smith, Bekker, & Cheater, 2011). The authors’ thematic analysis did not formally use the original terms as conceptualized by Glaser and Strauss (1967), but instead used a form of “generic qualitative research” inspired by, and largely congruent with, grounded theory (Caelli, Ray, & Mill, 2003). While the notion of a generic qualitative approach may more accurately reflect the ways in which these approaches have deviated from the original conception of grounded theory, it is essential that the epistemological assumptions upon which they are based be carried into the research process (Atkinson, 2005; Furman et al., 2007). For this reason, many scholars prefer to consider the approach used in this present study as grounded-theory informed. A risk remains that researchers applying a flexibly practical approach to qualitative research neglect to attend to the methodological traditions from which they are based; the authors worked consciously to avoid this pitfall by considering the roots of their approach. Further, it should be noted, that these methods also are largely congruent with social constructivist methodologists who, given their relational focus, have made powerful contributions to the focus group method of data collection used in this study (Mills, Bonner, & Francis, 2006).

Sample

The authors conducted an IRB-approved study in a “Social Work Evaluation and Research” course at a public college that operates a school of social work with both BSW and MSW programs in the Northeast of the United States. BSW students are required to take this research course during their third academic year, as well as two practice courses entitled “General Practice” and “Helping Process.” The latter course serves as an anchor to the students’ field practicum in that it runs concurrently with their first semester of the eighteen-month practicum, assisting them in real time with practical client issues and interactions. The practicum itself starts in the spring of their junior year and concludes at the end of the spring semester of their senior year. Author 1 of this study is an assistant professor at the college and the instructor for the section of the research course under study. The authors chose this section of the course for reasons of scheduling convenience for Author 2, who is an assistant professor at a different college and school of social work in the Northeast.

Author 1 offered the opportunity to participate in the study to 20 BSW students who registered for this section of the course. He informed students who chose not to participate in the study that they would not be penalized for not attending class the day when the authors collected data. Author 1 collected informed consent first by apprising the students that their participation was voluntary, not required by the college or the school of social work, and not connected to their grades or status as students. Finally, Author 1 also informed them that they could change their minds about participating at any time with no negative consequences. Of the 20 students, (N=11) voluntarily participated in the study; one was male and 10 were females. The racial breakdown was White (1), Black (2), Hispanic (7), and Multiracial (1). Their ages were 20 (1), 21(2), 24(1), 26(1), 33(2), 40(1), 46(1), 52(1), and 55(1).

The study participants identified that the training sites for their social work field practicum addressed mental health (4), health services (1), school social work (2), child and family welfare (1), and no response (3). In addition, seven students indicated that their field practicum was located in an urban setting, while four students did not answer this question.

Data Collection

The authors used a qualitative focus group method to seek third-year BSW students’ opinions and attitudes about their cultural competence preparedness to serve clients with respect and to uphold their dignity during their field practicum. The authors’ rationale for using a focus group method was to learn how participants experienced these concepts both as individuals and as classmates who had received the same in-class training and experienced the practicum during the same time period, albeit at different social work venues. A two-hour window was available for the focus group to take place.

Before the group interview, the students received a manila envelope containing a consent form and a demographic questionnaire. The authors provided the students with 10 minutes to read, ask any questions, sign the consent form, and complete the questionnaire. Because the authors used Hicks’ (2013) “The Ten Essential Elements of Dignity” as a basis for the focus group questions, they gave the students a one-page document listing them as supportive material to the discussion. After the authors collected the necessary documents, the focus group began.

The focus group questions provided an operational exploration of the study participants’ self-perceived readiness to transition from classroom instruction to the field practicum. The authors expected the data to reveal how participants were experiencing their practicum regarding their learned cultural competence skills and their perceived ability to treat their clients by according them dignity (Tuckett, 2005). Author 2 was the primary interviewer asking the study participants questions. Although he and the students had not met previously, the students had been informed about him and appeared comfortable interacting with him. The authors audio recorded and automatically transcribed the responses to questions using Notability, an Apple iPad app. In addition, Author 1 took handwritten notes and occasionally asked for clarification from participants by rephrasing a response. There was not time in the allotted two hours to ask all of the 13 prepared questions, so some were chosen spontaneously as more pertinent than others.

Data Analysis

The data were organized and analyzed through stages. In the first stage, Author 1 verified the accuracy of the transcripts by comparing the transcriptions to his notes taken during the recording. In the second stage, the authors developed a process of color-coding to narrow and define patterns and themes connected to the study participants’ responses, which included notating in the page margins (Furman et al., 2007). These impressions assisted both in defining types of responses and in beginning the coding process. In the third stage of data analysis, the authors emphasized thematic categories, pinpointing common or uncommon experiences among the study participants. They used thematic data analysis to organize the findings by creating patterns and locating themes within the study participants’ dialogue that developed from the questions. Finally, during the fourth stage, Author 1 developed a chart to organize the data by inserting the students’ responses along with the thematic categories under each question to ensure accuracy, visual examination, and interpretation of common and uncommon experiences among the study participants. The authors sought to find and articulate a coherent narrative of students’ expressed experiences.

Results and Discussion

In addressing the question “What comes to mind when you hear the word dignity?” focus group participants expressed clarity about what the word dignity meant to them. They used such words, phrases, and statements as self-respect, respecting others, moral integrity, allowing people to feel empowered, allowing people to be who they are no matter the circumstances, and self-esteem. These words matched their instruction in the BSW practice courses and the Hicks (2013) handout.

Regarding the question “How do dignity and respect differ?” it was apparent that the participants applied the question to themselves by indicating how they would want someone to treat them with respect to their dignity, suggesting that they might treat others as they wanted to be treated themselves. Their indicators (i.e., empathy, understanding, and being sensitive) expressed a compassionate tone that demonstrated a sense of sensitivity and respect to key aspects of cultural competence. The participants also expressed unanimously that the BSW curriculum provided the basic fundamentals for them to be culturally competent whereby they learned to work respectfully with clients and uphold their dignity.

The next two connected questions “What is your understanding of the ten elements of dignity? How significant are they in working with clients?” used much of the focus group time as they addressed a number of Hicks’ (2013) elements of dignity. Specifically, students referred to and spoke of acceptance of identity, inclusion, acknowledgement, benefit of doubt, understanding, independence, and accountability.

For example, regarding the acceptance of identity, the first element of dignity, the participants acknowledged that as social work trainees they would willingly engage with clients who are socially and racially different from themselves. They articulated the extent to which they discussed this professionalism in their social work classes through either discussions or small group activities. The participants also stated that some social work instructors distributed and reviewed the Code of Ethics (NASW, 2008) in class to signify the importance of ethics in helping professionals working with diverse clients who do not always receive the respect that they deserve.

Even so, the study participants seemed to be stumped when considering inclusion, the second element of dignity. Their responses indicated they were connecting their cultural competence practice to upholding clients’ dignity. They expressed being comfortable discussing cultural dignity on a micro level, but when the discussion shifted to a macro level, they seemed challenged in seeing the bigger picture and the impact that macro to micro attention can have on people as members of a larger societal group. The practice concept for the micro level included how to address individuals, families, and groups; for the macro-level practice, it included communities, organizations, and institutions. The participants’ responses indicated that they did not see the same importance for macro-level practice as they saw for micro-level practice when upholding cultural differences, respect, and the dignity of clients who are members of marginalized and vulnerable groups. Their responses suggested a different level of cultural preparedness in addressing inclusion for micro- and macro-level practice. While understanding and employing effective macro-level practice might be a challenge for BSW programs in the classroom curriculum, it is nonetheless an important area for instruction and praxis.

The participants clearly were passionate regarding the fourth element of dignity, which arose during this question set discussion. They acknowledged clients’ cultural differences and expressed that they sought to foster client dignity regarding such difference. They articulated that if social work students maintain their preconception of a person’s cultural differences, it could hinder their professional relationship with the client by not upholding or sustaining the client’s dignity. One student voiced, “Once you listen to the client and they recognize that you are paying attention to them, instantaneously [this] changes their possible negative attitude towards the social worker completely and dignity is clearly present for them because of your interaction.” The participants articulated that the BSW curriculum and instruction stressed acknowledging cultural differences in their practice courses.

Societal injustices, prejudices, and stereotypes can cause persons to be unmotivated or unable to accomplish particular goals for themselves. When addressing benefit of doubt, the seventh element of dignity, participants revealed that they had been taught to be genuine and caring of a person who is culturally different from themselves. However, they also expressed that if the client did not fulfill his or her obligations in treatment with the social worker, the social worker should not doubt or judge the clients’ unwillingness based upon societal cultural norms and beliefs about the client. They seemed aware that a negative attitude of the social worker trainee toward clients could harmfully affect the dignity aspect of the client-social worker relationship

Participants also referenced the eighth element of the dignity model—understanding. They expressed that social work trainees must comprehend and appreciate the challenges and complexities of clients who are culturally different from themselves in order establish a positive professional helping relationship. The participants unanimously indicated that it is vital to hear, respect, and treat clients in a way that allows them to maintain their dignity. One student said, “As social work students, this is directly talked about within our practice courses a lot.”

In reference to independence, the ninth element of dignity, the participants interestingly expressed a strong willingness to do as much as they could for the client, an action that countered the approach of instilling the skills necessary for the client to be independent. There were several students who articulated such sentiments as, “Do whatever you have to do to get the clients motivated to change their behavior.” However, social work instructors who teach the importance of giving clients a sense of independence, which in the end will affirm feelings of self-worth when confronted by challenging situations, tend to frown upon this attitude. Besides being a formula for burnout and inappropriate boundaries, in this scenario the social work student is working harder than the client, which can be considered an ethical dilemma and problematic for the client’s eventual success. Although students may have good intentions, their inexperience precludes their using skills that they have learned in their practice courses to teach clients how to self-advocate and maintain independence. In addition, these participant responses suggested an element of helplessness. Some students may have been taught a societal belief that multicultural clients are unable to take care of themselves. This attitude emerged both in the White social work trainee and in those of color.

The data referenced that participants were sensitive to the element of accountability, the tenth element of the dignity model. One participant framed the cultural competency aspect of accountability by saying, “A client that would not be accountable for his or her actions—I would probably need to be understanding because their cultural ways are more acceptable to them as to how they are behaving.” Multiple participants affirmed this viewpoint. They indicated that the Generalist Practice course introduced them to engaging with individuals who are culturally different from themselves. They mentioned that their reading assignments and instructions emphasized that the cultural competency and accountability of clients would be different from their own. Participants indicated that some Americans do not always embrace the cultural differences and beliefs of others. They expressed that this attitude can overshadow the respect to and the upholding of cultural differences in the United States. They also communicated that it is important to understand, recognize, and acknowledge a person’s cultural beliefs and to not have the person assimilate into the predominantly White culture of this country.

The participants then responded to the question “Please discuss your comfort level in working with clients from a different racial group than your own.” Their comments about cultural competency were frank and insightful. The only White female student who participated in the study stated: “I love it! I am more comfortable talking to Black or Hispanic persons than I am with another White woman. I don’t know why. I think it is because you learn so much from people of other races.” A Hispanic woman in the group stated: “As a Hispanic, I like working with other Hispanics. It is a learning experience definitely.” Another Hispanic woman in the group agreed. Each further agreed that they “do not look at color, maybe because of being Hispanic” themselves. Both Hispanic women mentioned that they were concerned about the stories of clients, “especially when it comes to their culture and why they do certain things and why it is that way for them culturally.” All of the participants seemed to understand the importance of listening to their clients’ stories instead of connecting with them racially. The White female and two Hispanic women social work trainees identified their approach with clients as cultural allies, which is in keeping with Brown and Ostrove’s (2013) statement that “allies are people willing to take action, either interpersonally or in larger social settings” (p. 2212).

The next question set that asked was “What is your understanding of cultural competence? How important is it to have an understanding of cultural competence when engaging with clients?” Multiple participants expressed the attitude of, “If you don’t know, find it out!” They indicated that they needed to do their homework to familiarize themselves with cultural differences so that they could be competent in their work with clients.

In response to the question “What do you think might or will be the biggest challenge of taking the curriculum instruction regarding diversity, cultural competence, and dignity from the classroom to the practice of your field educational practicum?” the participants discussed the potential challenges of applying their course work regarding cultural competence and dignity to their field practicum. They responded: “Not sure until it happens”; “Scared of giving wrong information to the client”; “What do I do then?”; and “Feeling fearful.” When asked about their responses, the participants clearly stated that they were not worried about being culturally competent social workers because they strongly believed that the BSW program had prepared them sufficiently for their role. However, multiple participants seemed uneasy when asked about applying theory and practice from the classroom to crossing the threshold of the field practicum. They expressed that they felt safer in the classroom with their classmates and instructors where they could rely on each other. In their field practicum, they were trying to apply theory and practice skills in what they called “real life” experiences. Educationally, at their institution, there are no operational skills lab modules incorporated in the practice courses’ syllabi to examine and test their readiness for the field practicum experience. The actual movement from theory to practice requires using skills that BSW students acquired from classroom instruction and their student participation which translates through written assignments and the occasional in-class case studies. The participants articulated that building on the learned material and in-class practice skills would benefit them and possibly relax their uneasiness regarding the practicum experience.

Summary

This study’s findings suggest that the BSW student participants were culturally competently prepared on an intellectual level to serve clients with respect and to uphold clients’ dignity. It revealed that they were enthusiastic that the BSW program instructors had articulated this agenda across the required courses within the curriculum, especially within the practice courses. However, the data suggested that the BSW program was not preparing students well for moving from intellectual to real-life skills. Given stated concerns about practicing their skills regarding cultural competence with clients and using actual dignity-enhancing skills, the findings suggest that participants wanted or might benefit from a dedicated required course that primarily concentrates on cultural competence perspectives. These perspectives should focus on client dignity by addressing issues of race, racism, and social justice where the use of case studies and skill lab modules could be primary instructional methods. They indicated that a course of this type would strengthen the BSW program and enhance students’ learning objectives among courses.

Limitations

During the focus group, the authors were not able to address all 13 questions designed for the focus group, nor did they address all 10 elements of dignity. The authors asked only six out of 13 questions because they ran out of time. Seven out of 10 elements of dignity were addressed, leaving out safety, recognition, and fairness. Not being able to ask all 13 questions or to address all 10 elements of dignity may have limited a full response to the purpose of the study and affected the study outcomes. A pilot focus group might have helped to avoid this problem by revealing necessary time allowance.

The sample size for this study was small. A study conducted by Marshall, Cardon, Poddar, and Fontenot (2013) examined the justifications of 83 qualitative research studies; they recommended that “grounded theory qualitative studies should generally include between 20 to 30 interviews” and that more than “the maximum [30] [is] where additional interviews fail to produce substantial new insight” (p. 20). Had all 20 students eligible for this study consented to participate, the study would have been better positioned to avoid challenges of insufficiency. Unfortunately, the voluntary nature of this study left us with no explanation for why nine students chose not to participate and time allowances precluded querying a second focus group from another class.

Finally, the demographics of the (N=11) students indicated one White female student who voluntarily participated in the study. The authors observed that the White female participant appeared hesitant to respond at times; therefore, there is the question of whether she might have contributed more comfortably if there had been another White participant in the focus group. Author 1 observed the student to be a shy person in previous classes. Had the data-gathering method been individual interviews, this study participant might have felt more comfortable and contributed more or differently. Similarly, the authors wonder whether the participants of color might have responded differently to the questions had there been more diversity in the focus group overall (which would have happened had the all 20 students participated). It is also reasonable to assume that sexual orientation and other demographic diversity would have provided different, and perhaps more nuanced, results.

Implications for Practice

It seems ineffective to send BSW students into practice with genuine clients when they have adequate theory yet limited practical experience of cultural competency, respect, and dignity-enhancing training. They likely do not have sufficient education and practical skills to address these sensitive topics flexibly and thoughtfully. Such students might feel too disempowered and insecure to advocate proactively for diverse or culturally at-risk clients who naturally are entitled to the basic human needs of life and dignity.

In addition to cultural competency training for BSW students, it is important that the concepts of respect and dignity be promoted not just theoretically but also experientially in social work education. Experientially, they should have the opportunity to consider case studies and to role play social injustice scenarios as social justice agents with their peers and instructor observing and offering feedback. This experiential learning would help the students to foster practical acceptance of the racial, cultural, and social differences of people in America’s diverse society. It is important to acknowledge differences positively as an opportunity to grow and learn something new. Cultural respect and dignity violations occur in our society daily. As social work students—and later as fully enfranchised practitioners—they can be pivotal in the healing process and can help to correct societal instances of bias and unfairness.

Implications for Future Research

This study offers data that address cultural competence preparedness for BSW students to serve clients with respect and to uphold dignity. Research is needed to examine BSW students throughout their social work education instead of waiting until the 3rd (junior) and 4th (senior) years of their studies when they enter a field practicum setting. A longitudinal qualitative study that uses the method of a focus group to assess each year of an incoming freshmen cohort through their senior year could benefit faculty in establishing benchmarks in the curriculum and to continuously address the need for skills to serve culturally diverse clients with respect and dignity.

The analysis revealed that additional research is needed to address why the BSW students in this study expressed being sufficiently culturally prepared after completing micro-level practice courses that address individuals and family. For this study, micro-level practice courses seemed to better teach BSW students to be culturally prepared than macro-level courses regarding larger communities and society as a whole. Questions remain. Are some BSW programs more concerned with micro-level than macro-level courses that address communities, neighborhoods, and organizations where the composition of individuals and families on a micro-level are their makeup? Are some BSW macro-level curricula not placing enough emphasis on the interrelationship between macro and micro levels? To address such questions, future research should consider the need for students to practice their skills concurrent with learning about them in order to avoid uneasy reactions when they begin their field practicum. It is important to explore these and other questions to understand the disconnect evidenced in this study with the lack of macro-level readiness for BSW students between cultural competence and dignity enhancement instruction and how both micro- and macro-levels can be addressed interrelatedly.

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Appendix 1

“The Ten Essential Elements of Dignity” (Hicks, 2013, pp. 25-26)

1. Acceptance of Identity Approach people as being neither inferior nor superior to you. Give others the freedom to express their authentic selves without fear of being negatively judged. Interact without prejudice or bias, accepting the ways in which race, religion, ethnicity, gender, class, sexual orientation, age, and disability may be at the core of other people’s identities. Assume that others have integrity.

2. Inclusion Make others feel that they belong, whatever the relationship—whether they are in your family, community, organization, or nation.

3. Safety Put people at ease at two levels: physically, so they feel safe from bodily harm, and psychologically, so they feel safe from being humiliated. Help them to feel free to speak without fear of retribution.

4. Acknowledgment Give people your full attention by listening, hearing, validating, and responding to their concerns, feelings, and experiences.

5. Recognition Validate others for their talents, hard work, thoughtfulness, and help. Be generous with praise, and show appreciation and gratitude to others for their contributions and ideas.

6. Fairness Treat people justly, with equality, and in an evenhanded way according to agreed-on laws and rules. People feel that you have honored their dignity when you treat them without discrimination or injustice.

7. Benefit of the Doubt Treat people as trustworthy. Start with the premise that others have good motives and are acting with integrity. 

8. Understanding Believe that what others think matters. Give them the chance to explain and express their points of view. Actively listen in order to understand them.

9. Independence Encourage people to act on their own behalf so that they feel in control of their lives and experience a sense of hope and possibility.

10. Accountability Take responsibility for your actions. If you have violated the dignity of another person, apologize. Make a commitment to change your hurtful behaviors.

Appendix 2

Prepared Focus Group Questions

1. What comes to mind when you hear the word dignity? [Asked in the study]

2. How do dignity and respect differ? [Asked in the study]

3. What is your understanding of the ten elements of dignity? How significant are they in working with clients? [Asked in the study]

4. Considering the ten elements of dignity, which of them do you think would be difficult to engage with when working with clients culturally and racially different from yourself?

5. Please discuss your comfort level in working with clients from a different racial group than your own? [Asked in the study]

6. Do you address racial differences when working with clients? If so, how? If not, why not?

7. What is your understanding of cultural competence? How important is it to have an understanding of cultural competence when engaging with clients? [Asked in the study]

8. Are you culturally competent in working with clients? If so, how? If not, why not? What is holding you back?

9. How do cultural competence and diversity differ? Do you feel that they differ or overlap in meaning?

10. How do you address issues of oppression, power, prejudice, discrimination, racism and privilege in your work with clients? Are you comfortable with having these discussions? If so, explain. If not, why not?

11. How would you engage in and demonstrate upholding the dignity of your clients that are culturally and racially different than you?

12. What are the challenges you face in upholding the dignity of your clients? How would you embrace this challenge?

13. What do you think might or will be the biggest challenge of taking the curriculum instruction regarding diversity, cultural competence, and dignity from the classroom