Cultural Competency and Diversity Task Force
From the Coordinating Center description.
Citations are also on the web site.
Consumers from diverse ethnic and cultural backgrounds demand that both research and
service programs proactively seek out ways to adopt a culturally competent orientation
towards mental health outcomes (Rogler et al., 1987; Neighbors, et al., 1992; Snowden,
1996). Mental health programs, including those demonstrated to be effective when delivered
according to standard protocols, often have to be reformed to be sensitive to
sociocultural issues.
Certain culturally-related characteristics are pertinent: (1) expression of symptoms in
terms of indigenous systems of belief (Landrine & Klonoff, 1994); (2) willingness to
use alternative providers, including religious and folk healers (Snow, 1993); somatic
complaints to express mental health suffering (Escobar et al., 1987); (3) stigmatizing
perceptions of mental health problems (Silva de Crane & Spielberger, 1981; Pape et
al., 1983); (4) interpersonal sensitivity and specialized norms regarding respect, trust,
and authority (Uba, 1994); (5) common sociocultural backgrounds shape a common outlook
(Cheung & Snowden, 1990); and (6) culturally distinctive patterns of family burden,
responsibility, and satisfaction (Uba, 1994).
Claims of cultural sensitivity in service delivery are difficult to evaluate, and often
amount to little more than encouragement of ethnic and language matching. When Lopez and
Hernandez (1986) reviewed reports of cultural accommodations to clinical practice, it was
impossible to tell whether the changes contributed to consumer improvement. While rigorous
research could provide clear empirical documentation of ethnic differences in utilization,
mis-diagnosis, or poor outcomes, the quality of research on outcomes permits no strong
conclusions about the effectiveness of mental health service delivery programs (Neighbors
et al., 1992). Snowden (1996) reviewed efficacy studies and found relatively weak effects
in programs that evaluated the impact of (1) standard interventions implemented to
incorporate ethnocultural elements (Torres-Matrullo, 1982; Comas-Diaz, 1981), (2) ethnic
matching and language matching of provider and consumer (Flaskerud & Liu, 1990; Ying
& Hu, 1994); and (3) enrollment of ethnic minority consumers in minority oriented
service programs (Snowden & Clancy, 1990).
The lack of culturally competent instruments to measure the outcomes of mental health
services presents a problem. Differences among diverse populations in language, beliefs,
and experience may produce inappropriate or misunderstood questions (Hines, 1993).
Therefore, some have called for separate development of instruments among culturally
diverse groups, while others propose methods for developing instruments with
cross-cultural validity or equivalence (Flaherty et al., 1988). Neighbors et al. (1992)
offer recommendations for improving mental health service delivery to ethnic minorities
that could be applied to this CA including: development of training modules to make
non-minority providers aware of the cultural values and practices of ethnic minority
groups, and obtaining consultant expertise in these areas.
