Excerpted from chapter 1 of Your Values, My Values: Multicultural Services in Developmental Disabilities, by Lilah Morton Pengra, Ph.D.

Copyright © 2000 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

"I cut my hair."

Yes, I could see that. Only "cut" was not the word I would use. "Hacked" or chopped" would be more appropriate. Her beautiful hair hung in uneven lengths, with one tuft sticking out at the side. As I looked at Gloria sitting in my office at the developmental disabilities agency where I worked, I remembered the first time I had seen her hair. It had been matted with lice and ringworm and sticky with drainage from an infected eye and infected ears. She had been placed here by Indian Health Services because she had been neglected and abused since the recent death of her primary caregiver and protector. She had come so far since that terrible day 2 years ago when I first met her, when her eyes were flat black walls of anger and the planes of her face rigid with fear. How, she sat relaxed and assured, comfortable with the rightness of her action. Finally, my anthropological training kicked in.

"Did Martin die?"

I knew that some Lakota women, like Gloria, express grief at the death of a loved one by using a knife to cut off hanks of hair and sometimes even to slash their arms and legs with parallel lines of cuts (Powers, 1986; St. Pierre, 1991). This behavior, which a person who is not Native American might see as odd, excessive, or even abnormal, is seen as normal and is even expected in traditional Lakota culture.

Martin's death would be difficult for Gloria. He was from the same reservation as she and had moved to this off-reservation community to receive medical treatment at the Veterans' Hospital. Gloria met him not long after she moved out of a group home into an apartment of her own. He became her apartment mate, her friend, and her lover. They were inseparable.

"No. He die Sunday."

This was Thursday. Gloria was telling me that Martin was going to die on Sunday. I wondered whether this was one of the times I should gently redirect her to a more socially accepted response. Maybe I should try to explain, based on my supposedly more knowledgeable understanding of the world, that death is not predictable; the "right" way to approach the death of a loved one is to wait for it to happen and then cope.

This time I didn't have to wait for my anthropological self to surface. The response she needed and the only response I should offer as a helping professional intent on creating support services based on the values of the people using the supports — an approach I call values-based services — was obvious.

"Do you want Donna to help you pack and drive you home for the funeral?"

I do not have the right to question what Gloria knows to be true. My role as director of the agency providing values-based services to Gloria was to help her do what she knew she needed to do, not to judge or question her or act as if my understanding of the world is the correct one and superior to hers. Gloria has the right to live her life by her own values.

Donna, Gloria's community living coach, helped Gloria buy groceries for the wake, drove her to the reservation where the funeral was held, and picked her up 5 days later. And, yes, Martin did die on Sunday.

The Main Postulate of Values-Based Services

The main postulate of values-based services is that services should be designed in terms of the service receiver's values. Writers in other fields (e.g., nursing [Leininger, 1970], health care [Kleinman, 1980], policy science [Boone, 1991], mental health services [Pedersen, 1988], social work [Burgest, 1982], and education [Ross-Gordon, Martin, & Briscoe, 1990]) have long advocated that this principle should govern service provision because values-based services support pluralism and increase positive outcomes, including an enhanced quality of life.

Pluralism and Value Differences

Twenty-five years ago, when I lived in Alabama, I was the chair of a group working to decrease racism and sexism at our workplace. One day, we were waiting for out meeting to start when a visibly irritated white woman remarked that these meetings would be more successful if the black participants could just get there on time. She had very carefully used the term black rather than Negro to show that she was not prejudiced. To ease the tension that immediately arose, I turned the conversation to cultural differences in the ways that meetings are conducted, the issues that are considered to be important, and the way that time is perceived. Several opinions were expressed, but her next comment stands out in my memory.

"They're just late because that's a way of showing they're different from us."

Being fresh out of graduate school, I went into my teacher mode and admitted that impression management of symbols of ethnic affiliation might be involved. Being late, wearing a dashiki, or wearing one's hair in an Afro could be a way of consciously saying, "I'm black and I'm proud of it." But still, I continued, one should not lose sight of differences in values — values that give very different meanings to similar types of behavior, such as arrival time at a meeting. To decrease racism and embrace pluralism, I explained, we first have to understand each others' values. She cut me short.

"Values, nothing. If they just started getting ready earlier, they'd be on time."

The woman's response rejected the premise that values give meaning to behavior. Her view of behavior as simply the enactment of a set of skills that are unaffected by values allowed her to judge the behavior of others in terms of her own values. Her evaluation might lead to misunderstanding and prejudice if she thought, "They are late for my meeting because they are disrespectful and disorganized," and worse, to racism, if she concluded, "They are late for my meeting because they are lazy and irresponsible."

Values define how the world ought to be. They are the measures by which people distinguish right from wrong and judge themselves and others. If values are shared, these judgments maintain social order. When they are not shared, in order for society to muddle along, we must either embrace pluralism so that differences are tolerated, or we must legislate and enforce whose values will prevail.

People do not always realize when their values are in conflict with those held by others. Americans, in particular, generally assume that their values are shared (Bower, 1997) and proceed to apply them to others. Consequently, the non-Indian social worker at Indian Health Services who arranged for Gloria to receive support services off the reservation judged that it was more important for Gloria to be cared for than it was for her to live in her home community with members of her own ethnic group — a conclusion that would be rejected by most Lakota social workers. An interdisciplinary team member who concluded that Martin was exploiting Gloria by living off her disability check thought that the team should be protecting Gloria from this relationship. Other team members considered the joy and companionship the relationship brought her as more important than the impact on her finances.

Unlike Gloria's situation, if team members have similar cultural backgrounds, then fewer conflicts may arise because key values might be more fully shared. However, conflicts will likely still occur because values vary relative to ethnicity, class, religion, education, job, geographic location, age, gender, political persuasion, and life experiences, creating the potential for much misunderstanding and prejudice. Values-based services provide a way to support pluralism and decrease prejudice in the complex multicultural context of the United States.