Cultural Competence

Course Description

A culture is broadly defined as a common heritage or set of beliefs, norms, and values shared by a group of people. People who are placed, either by census categories, or through self-identification, into the same racial or ethnic group are often assumed to share the same culture; however, not all members grouped together in a given category will share the same culture. There is great diversity within each of these broad categories and individuals may identify with a given racial or ethnic culture to varying degrees. Others may identify with multiple cultures, including those associated with their religion, profession, sexual orientation, region, or disability status.

Culture is dynamic. It changes continually and is influenced both by people’s beliefs and the demands of their environment. Immigrants from different parts of the world arrive in the United States with their own culture but gradually begin to adapt and develop new, hybrid cultures that allow them to function within the dominant culture. This process is referred to as acculturation. Even groups that have been in the United States for many generations may share beliefs and practices that maintain influences from multiple cultures. This complexity necessitates an individualized approach to understanding culture and cultural identity in the context of mental health services.

The culturally competent system of care is made up of culturally competent institutions, agencies, and professionals. Five essential elements contribute to a system’s, institution’s, or agency’s ability to become more culturally competent. The culturally competent system values diversity, has the capacity for cultural self-assessment, is conscious of the dynamics inherent when cultures interact, has institutionalized cultural knowledge, and has developed adaptations to diversity. Further, each of these five elements must function at every level of the system. Attitudes, policies, and practices must be congruent within all levels of the system. Practice must be based on accurate perceptions of behavior, policies must be impartial, and attitudes should be unbiased. Unbiased does not mean color blind; rather it means acceptance of the difference of another.


Learning Objectives

1. Identify various goals of cultural competence.
2. Identify steps that should be taken to put cultural competence into practice.
3. Distinguish between minority and diversity, and between race and ethnicity.
4. Describe the six points along the cultural competence continuum and their characteristics.
5. Describe the five essential elements that contribute to an agency’s ability to become more culturally competent.
6. List 24 attributes, knowledge areas, and skills that are essential to the development of cultural or ethnic competence.

Table of Contents

I.Statement on Cultural Competence

  • What Is Culture, and How Does It Affect Care?
  • Why Cultural Competence?
  • What Is Cultural Competence?
  • How Is Cultural Competence Related To Evidence-Based Practices?
  • How Can Cultural Competence Be Put Into Practice?
  • Case Studies of Cultural Competence
  • Vignette 1—Dual Diagnosis
  • Vignette 2—Assertive Community Treatment
  • Vignette 3—Supported Employment
  • Vignette 4— Medication Management
  • Vignette 5— Illness Management and Recovery Skills
  • Vignette 6— Family Psychoeducation
  • Some Thoughts on Four Cultural Concepts
  • Minority versus Diverse Groups
  • Race versus Ethnicity
  • References
  • Shift in Goal From Assimilation to Biculturalism
  • Critical Aspects of Cultural Competence
  • Selected Resources on Cultural Competence

II. The Cultural Competence Continuum

  • Cultural Destructiveness
  • Cultural Incapacity
  • Cultural Blindness
  • Cultural Pre-Competence
  • Cultural Competence
  • Cultural Proficiency

III. The Culturally Competent System of Care

  • Valuing Diversity
  • Cultural Self-Assessment
  • Dynamics of Difference
  • Institution of Cultural Knowledge
  • Adaptation to Diversity
  • A Value Base for Cultural Competence

IV. Developing Cultural Competence

  • Policymaking Level
  • Administrative Level
  • Practitioner Level
  • Consumer Level
  • Service Adaptations
  • Intake and Client Identification
  • Assessment and Treatment
  • Communication and Interviewing
  • Case Management
  • Out-Of-Home Care
  • Guiding Principles

V. Cultural Competence Standards in Managed Care Mental Health Services:
Four Underserved/Underrepresented Racial/Ethnic Groups

  • Demographic and Health Profile
  • People of African Descent
  • Demographic and Health Profile
  • Historic Patterns of Mental Health Service Use
  • Managed Behavioral Health Care and Race: Implications
  • Asian and Pacific Islander People
  • Asian Pacific Islander American Mental Health Issues
  • Asian Pacific Islander Mental Health Service Delivery Issues
  • American Indian, Native Alaskan, and Native Hawaiian Populations
  • Demographic and Health Profile
  • Managed Care in the Delivery of Mental Health Services
  • References

VI. Mental Health Needs of Hispanics

  • The Mental Health Needs of Hispanics in the United States
  • Demographic Background
  • Mental Health and Substance Use Problems
  • Use of Mental Health Services
  • Addressing the Service Gaps
  • Conclusion
  • References

VII. Cultural Competence in Serving Children and Adolescents with Mental Health Problems

  • Goals and Principles of Cultural Competence
  • Developing Cultural Competence

VIII. Achieving Cultural Competence:
A Guidebook for Providers of Services to Older Americans and Their Families

  • Purpose
  • Introduction
  • What is Culture?
  • Factors that Influence Culture
  • What is Cultural Competence?
  • Barriers to Service Access
  • Structural Barriers
  • Cultural Barriers
  • Research on Cultural Competence
  • Why is Cultural Competence Important?
  • Introduction
  • Demographics
  • Racial and Ethnic Disparities Education Level
  • Living Arrangements
  • Poverty
  • Life Expectancy
  • Death Rates by Condition
  • Self-Rated Health Status
  • Access to and Satisfaction with Health Care
  • Principles of Cultural Competence
  • Values and Attitudes
  • Communication Styles
  • Community/Consumer Participation
  • Physical Environment
  • Policies and Procedures
  • Population-Based Service Delivery
  • Training and Professional Development
  • Creating Programs That Work
  • The Three M’s
  • Characteristics of Culturally Competent Service Delivery
  • People Profiles
  • Program Profiles
  • Illustrative Examples