Program evaluation for organizational cultural competence in mental health practices.

Mental health practices that lack cultural competence prevent diverse clients from receiving the care they deserve. As providers and program administrators, psychologists currently have a responsibility to ensure high quality of care for diverse clients at the clinic level. This article deciphers extant empirical research, organizational theory, public policy literature, and best practices to identify which recommendations are most relevant for those in small mental health practices and clinics. The authors present 10 components for culturally appropriate care, ranging from policies and procedures to needs and satisfaction level of clients. This overview can be used to help evaluate and develop a mental health practice's ability to meet the needs of diverse clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuing education in cultural competence for community mental health practitioners.

Continuing education in cultural competence is a key strategy for enhancing provider effectiveness in working with culturally diverse clients. In the mental health field, a majority of published works address training issues related to students in graduate programs. Few articles, however, discuss specific models or methods of continuing education for practitioners working in community-based settings. The authors present a case example of an interactive workshop in cultural competence for community mental health practitioners. They discuss key modules of this workshop, including (a) cultural competence and outreach principles, (b) cultural identity and worldview, (c) stereotyping and automatic thinking, (d) dynamics of difference, and (e) application exercises. Recommendations are offered for administrators, direct care staff, trainers, and researchers who may be interested in undertaking or participating in cultural competence continuing education efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward cultural competence in child intake assessments.

As cultural diversity within the U.S. population increases, cultural competence in service delivery to children, youths, and families is a growing necessity. This article presents a process for integrating assessment of cultural data with the traditional intake assessment in children's mental health. The purpose and process of integrating cultural assessment throughout the child intake are presented. By using the cultural formulation guidelines proposed in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), the content of a culture-integrated assessment is conceptualized and organized. The purpose of this article is to assist child, youth, and family psychologists with developing applied cultural competency skills in the context of the intake assessment with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture.

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Healthcare provider cultural competency: Development and initial validation of a patient report measure.

Objective: Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. Design: Samples of predominantly African American patients (N = 310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. Main Outcome Measures: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. Results: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. Conclusion: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist's therapist: A replication and extension 20 years later.

How do mental health professionals choose their own psychotherapists? This study replicates and extends a 1987 national survey of psychotherapists regarding the selection criteria and sociodemographic characteristics of their personal therapists; 608 psychologists, counselors, and social workers participated. Therapists' therapists tended to be middle aged and White (94%) but equally female and male. Their most frequent theoretical orientations were integrative, eclectic, cognitive, and psychodynamic (but rarely behavioral or systemic). Psychology was their most prevalent profession, followed by social work, counseling, and psychiatry. Topping the list of therapist selection criteria were competence, warmth, experience, openness, and reputation. The prototypical positive features of personal treatment that therapists repeated with their own patients all concerned cultivation of the therapeutic relationship. The 2007 results are tentatively compared with those obtained in 1987, thus chronicling the evolution of therapists' therapists over the years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analogue study of the effects of asian cultural values and counselor multicultural competence on counseling process.

One-hundred-and-sixteen Asian American college students viewed analogue videotapes in which an actress portraying a European American female "counselor" expressed cultural values that were either consistent or inconsistent with Asian culture to an actress portraying an Asian American female "client." In addition, the counselor either acknowledged racial differences or did not acknowledge racial differences with the client. The results showed that when the counselor expressed values that were inconsistent with Asian culture, the counselor who acknowledged racial differences was perceived to be more cross-culturally competent than the counselor who did not acknowledge racial differences. Also, the results showed that observer-participants' adherence to the value of conformity to norms was positively associated with their ratings of counselor credibility and crosscultural counseling competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence: A new way of thinking about integration in therapy.

This article, based on a keynote speech delivered to the 2009 conference of the Society for the Exploration of Psychotherapy Integration, offers a model for understanding cultural competence as a strategy for psychotherapy integration. Paradigms for what constitutes cultural competence in psychotherapy are explored, and the development of an epistemology of cultural competence that includes understandings of therapist bias and both therapist and client intersectionalities of identity are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and linguistic competence: Welcome challenges from successful diversification.

The increasing numbers of ethnically diverse professionals is filling a need for service provision in agencies that provide mental health services for a diverse clientele. However, the rapid shift in professional demographics provides a sharp generational contrast; these emerging psychologists are placed in potentially ethically charged positions before their careers truly begin as a result of the gap between institutional resources (materials and supervisors) and trainees' specialized needs. The lead article reviews a broad array of points to consider when a supervisee is providing services in the native language of the client and does not know that language. The three invited commentaries highlight (a) the role of language in emotion and subsequent implications for treatment and supervision, (b) the slow institutional development to meet the training needs of emerging therapists that will treat ethnically diverse clients, and (c) the importance of following decision-making models to inform ethical supervisory practice when there is a language mismatch. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helping African American clergy and churches address minority disaster mental health disparities: Training needs, model, and example.

Using an action participatory research approach, the authors conducted qualitative interviews with 41 African American clergy 1 year after Hurricane Katrina in severely affected areas of south Mississippi. These interviews revealed how mental health professionals can work with African American clergy and their churches by providing training that targets minority disaster mental health disparities. A 3-tier training model for equipping African American clergy and churches to respond to disasters in hopes of reducing minority disaster mental health disparities is offered. Identified training needs and suggested training delivery formats are discussed. A sample outreach and educational training project designed to equip African American clergy and churches in their response to minority disaster mental health disparities is also highlighted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Racial/ethnic minority research in the Journal of Counseling Psychology: A content analysis and methodological critique.

A content analysis was conducted of all racial/ethnic minority-focused research appearing in the Journal of Counseling Psychology over the 11-year period from 1976 to 1986. During this period 934 articles and brief reports were published, of which 53 (5.7%) had a racial/ethnic minority focus. The 53 articles were systematically reviewed for their sample characteristics and methodological considerations. The sample characteristics that were examined included ethnic groups studied, general populations sampled, and geographic breakdown of samples used. Methodological design characteristics that were investigated included general research designs incorporated, examination of within-group differences, outcome measures used, cultural sensitivity of instrumentation, acknowledgment of sample generalizability limits, and presence of conceptual or theoretical frameworks in developing research hypotheses. Data accumulated in the report were used as a base within which to examine major research methodology criticisms that have consistently appeared in recent ethnic minority literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervising international students: Relationship between acculturation, supervisor multicultural competence, cultural discussions, and supervision satisfaction.

The purpose of this study was twofold: (a) to explore the relationship between international trainees' acculturation level and cultural discussion on supervision satisfaction and (b) to examine the mediating effect of cultural discussions on the relationship between perceived supervisor multicultural competence and trainee satisfaction with supervision. One hundred and four international students from several clinical programs who have received clinical supervision participated in the study. Results revealed that students who had lower acculturation levels but greater cultural discussion showed more satisfaction with supervision. Furthermore, cultural discussion partially mediated the relationship between the perceived supervisor cultural competence and satisfaction with supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic differences in breast cancer outcomes among older patients: Effects of physician communication and patient empowerment.

Objectives: To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. Methods: A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). Results: Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. Conclusion: Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)