ERIC ED377611: Developing Culturally Competent Organizations.

29 Pages·1994·1.1 MB·English

by  ERIC

DOCUMENT RESUME
EC 303 538
ED 377 611
Developing Culturally Competent Organizations.
TITLE
Portland State Univ., Oreg. Regional Research Inst.
INSTITUTION
for Human Services.
National Inst. of Mental Health (DHHS), Rockville,
SPONS AGENCY
MD.; National Inst. on Disability and Rehabilitation
Research (ED/OSERS), Washington,
PUB DATE
94
NOTE
29p.
Viewpoints
Serials (022)
PUB TYPE
Collected Works
(Opinion/Position Papers, Essays, etc.)
(120)
Focal Point; v8 n2 Sum 1994
JOURNAL CIT
MF01/PCO2 Plus Postage.
EDRS PRICE
*Agencies; Cross Cultural Training; *Cultural
DESCRIPTORS
Differences; Cultural Influences; Cultural Pluralism;
Delivery Systems; *Emotional Disturbances; Ethnic
Groups; Family Involvement; *Human Services; Juvenile
Justice; *Mental Health; Minority Groups;
*Organizational Development; State Programs
Leigh (James); Pennsylvania; South Carolina
IDENTIFIERS
ABSTRACT
This special issue examines multicultural aspects of
services provided by agencies concerned with children's mental
health. The lead article is titled "Developing Culturally Competent
Organizations" by James L. Mason. This article uses the cultural
competence model to discuss an organization's self-evaluation and its
planning in the areas of attitudes, practices, policy, and structure.
Examples of innovations in this area are provided in "Cultural
Competence: New Frontiers," (James L. Mason). Next, using focus
groups to identify areas for materials development, and building
trust among local organizations are encouraged in "Outreach Efforts
To Involve Families of Color in the Federation of Families for
Children's Mental Health" (Barbara Huff and Mary C. Telesford).
"South Carolina Department of Mental Health Cultural Competence Plan"
(Dolores Van Rensalier Macey and Jerome Hanley) provides a
description of the plan's policy, administration, clinical services,
human resources development, community relations and research.
Dorothy Williams then reports in "Cultural Competence: Building a
State' Level System of Change in Pennsylvania" that, in order to
develop a statewide infrastructure, the staff would have to integrate
cultural competence into the design. Additional articles include:
"Research Frontiers in Building a Culturally Competent Organization"
(Marva P. Benjamin); "Cultural Competence and the Juvenile Justice
System: Irreconcilable Differences?" (Mareasa Isaacs-Sockley); and
"My Grandma's House: Reaching Out To Underserved Families of Children
and Youth with Neurobiological, Emotional or Behavioral Differences"
(Deifina Pena Roach). Excerpts from an interview with Professor James
Leigh of the University of Washington complete the issue. Individual
articles contain references. (DB)
SUMMER 1994
A
DEVELOPING
CULTURALLY COMPETENT
ORGANIZATIONS
There is an increasing awareness of the role culture
The word "minority" has been so bandied
about in
plays in the delivery of health and human services
recent years that it has lost some meaning. Is the refer-
(10, 30, 32). One recent response in the
area of
ence to members of the cultural groups of color
children's mental health, has been
African Americans? Asian Ameri-
the emergence of the Child and Ado-
cans/Pacific Islanders? Native
lescent Service System Program's
Americans? Hispanic- or Latino-
(CASSP's) cultural competence
Americans? Alternatively, Atkinson
model. This concept emerged as a
and Hackett (1) use the term
non-
response to the goal of providing
ethnic cultural groups to refer to other
culturally-appropriate services to
minority populations such as lesbi-
children with mental, emotional or
ans and gays, elders, women, people
behavioral disorders and their fami-
with disabilities, religious minorities,
lies (18). The emergence of the cul-
and others.
tural competence construct recog-
While cultural groups of color
41.
nizes: (:1) the increasing cultural
t:and non-ethnic cultural groups share
and racial diversity of consumer
t
some common ground, the distinc-
populations (28); (b) the role cul-
tions between the two in terms of
ture plays in help-seeking behav-
;
respective vulnerabilities is little
un-
iors (10, 23, 25); (c) the differential
derstood. However, what is critical is
service utilization rates of various
that systems and organizations should
cultural and racial groups (8, 22,
specify who is the target of a given
31); (d) diverse perspectives on the
multicultural or minority initiative.
origins or etiology of behaviors,
Mixing the two groups may result in
emotions or thoughts that the domi-
an initiative that serves neither well
x) nant culture describes
as mental
and ultimately deflates the
concern
t4,-) health problems (14, 32) and, (e)
culturally relevant
for cultural diversity. In any event, differences
between
services may differ from services that ignore
cultural
and within cultural groups of color and non-ethnic
cultural
o
differences (9, 27, 29, 34).
groups must be considered.
For example, ethnic groups of color
have historically
Identifying the Thrget Population
Cs(-)
been at the bottom of the economic, social,
and political
One important concern involves the
target of the
order. They are represented in disproportionate
numbers
C) agency's
interventions. It is of little use to identify
an
among the poor, the uneducated, the unemployed, the sick,
.1k agency's target population as the minority community.
and the homeless (14). The U.S. President'
s Commission
U.S. DEPARTMENT OF EDUCATION
Office ol Educational Research
and improvement
The Bulletin of the Research and Training
Center
EDUCATIONAL. RESOURCES
INFORMATION
CENTER (ERIC)
on Family Support and Children's Mental Health
*Xis document
has been teproducs0 as
received horn the person or organization
of
iginateng it
O Minor changes have bean
mad* to ttripfove
reproduction Quality
VOLUME 8 NUMBER 2
Points ot view Of opitaiont stated
in DatI dOCu
ment do not necessarily cal:tempt oak*
DERI positron or poIrcy
2
BEST COPY AVAILABLE
Culturally Competent Organizations
The motivation or value base to modify systems
must also
be developed. Ozawa (26) suggests the populations
continued from page 1
create
an imperative that requires service system modification
on Mental Health observed that children and youth of color
from the middle-class service orientation;
Hodgkinson
were particularly at risk because of low socioeconomic
(15) ties the rationale for the changes to the
professional's
status, residence in stressful environments, and lack of
self-interest; and Cross, et al. (4)
enumerate a list of
access to mental health services. Arguably, these condi-
systemic values that support such system changes.
tions have not abmed, and these children and
youth are still
Children and youth who are non-ethnic minorities
with
vulnerable by virtue of their ethnicity,
poverty, and social
disabilities, or lesbian and gay, or poor,
or female, of the
isolation (6). Other factors worthy of both
consideration
dominant culture have different sets of issues
to deal with
and assessment include educational attainment,
teenage
than their peers whorespectivelydo
not have disabili-
pregnancy, suicide, substance abuse, and out-of-home
ties, are heterosexual, or are middle class,
however, they
placements including psychiatric and juvenile
detention
may still derive the benefits of being "white" (12). There-
facilities.
fore, agency staff must attempt to discern
how a given
It is projected that children of color will
approximate
group is vulnerable in American society. By taking
a broad
30% of the nation's youth by the
year 2000 (28) which
brush approach, agency efforts to improve
services to
heralds many challenges. However,
°lie must endeavor to
culturally diverse groups (whether
groups of color or non-
find good information as to irow to
serve these populations.
ethnic groups) can be hogged down. Certainly
some agency
RESEARCH AND TRAINING CENTER
Families in Action Project
REGIONAL RESEARCH INSTITUTE
Regional Research Institute for Human Services
Nancy M. Koroloff, Ph.D., Principal Investigator
FOR HUMAN SERVICES
Portland State University
William H. Feyerherm, Ph.D., Director
P.O. Box 751
Empowering Families: A Policy Analysis
John Poertner, D.S.W.
Portland, Oregon 97207-0751
NATIONAL ADVISORY COMMITTEE
[phone]
Mary Hoyt, M.S.W., Chair, Special Assistant
to the
Inter - Professional EdneatiOn Project
National Clearinghouse
Administrator, Oregon Children's Services Division
Barbara J. Friesen, Ph.D., Principal Investigator
[phone] TDD [phone]
Pauline Jivanjee, Ph.D., Project Manager
Danny Amrinc, J.D., Tuba, Oklahoma
Copyright 0 1994 by Regional Research
Katie H. Schultze, B.S.
Ridiard Angell, M.D., Department of Psychiatry,
Institute for HutnatiServices. All rights reserved.
Oregon Health Sciences University
National Evaluation of Statewide
Permission to reproduce articles may be obtained
Family Networks
by contacting the editor.
William Anthony, Ph.D., Center for Rehabilitation
Nancy M. Koroloff, Ph.D., Co-Principal Investigator
Research and Training in Mental Health, Boston
The Research and Training Center
Harold Briggs, Ph.D., Co-Principal Investigator
was
University
established in 1984 with funding from the
Soils Carmel:, MS., M.F.A.
William Arroyo, M.D., Assistant Director. Chihli
National Institute on Disability and Rehabilita-
Adolescent Psychiatry, Los Angeles County
Case Management Project
tion Research (NIDRR) in collaboration with the
USC Medical Center
Barbara J. Friesen, Ph.D., Principal Investigator
National Institute of Mental Health (NIMH). The
content of this publication does not necessarily
John Poertner, D.S.W., Co-Principal Investigator
Marva Benjamin, M.S.W., CASSP Technical
Katie H. Schultze, B.S.
reflect the views or policies of the funding
Assistance Center, Georgetown University
agencies.
Resource Service and National Clearinghouse
Cleopatra Caldwell, Ph.D., African-American
on Family Support and Children's
We invite our audience to submit letters
Mental Health Research Center, University of
Mental Health
and co:nments.
Michigan, Institute of Social Research
Marilyn C. McManus, J.D., M.S.W., Manager
Beth Dague. M.A., Stark County Mental Health
Colleen Wagner, M.S.W., Family Resource
Board, Canton, Ohio
RESEARCH AND TRAINING CENTER
Coordinator
Barbara J. Friesen, Ph.D., Center Director
Cory Dunn, M.S.W., Student Support Services,
Denise Sclunit, Publications Coordinator
Paul E. Koren, Ph.D., Director of Research
Katie H. Schultze, B.S.
Linn-Benton Education Service District, Albany.
Oregon
FOCAL POINT
Family Caregiver Survey
Glenda Fine, Parents Involved Network, Mental
Marilyn C. McManus, J.D., M.S.W., Editor
Thomas P. McDonald, Ph.D., Principal Investigator
Health Association of Southeast Pennsylvania
Paul E. Koren, Ph.D., Co-Principal Investigator
Center Associates
Bud Fredericks, Ed.D., Teaching Research, Inc..
Viki Bigler, B.S.
Western Oregon Stale College
Chan Sik-Yin, M.S.W.
Multicultural Initiative Project
Karen DePriest
Paula Goldberg, PACER Center, Inc., Minneapohs,
William H. Feyeriterm, Ph.D., Principal
Minnesota
Iris Garvilles
Investigator
Lyn Gordon, B.A.
James L Mason,
.D., Project Manager
Jody Lubreda, Ph.D., Mental Health Project
Shad lessen
Sarah Lewis, B.S.
Manager, Idaho Department of Health and Welfare
Korinna Moore, B.A.
Brenda Lyles, Ph.D., Houston, Texas
Supporting Families: A Strengths Model
Sue Newell, B.A.
Kate Poland, M.S.W.
John Poertner, D.S.W., Principal Investigator
Phyllis Magrab, Ph.D., Director, Child Develop-
Marilyn Page, M.S.W.
E. Darcy Shell, B.S.
ment Center, Georgetown University
Ravi Velayunthatu, B.S.
Families as Allies Project
Larry Phut. M.D.. Office of the Regional 'lean!)
Kim Vorasai
Neal DeChillo, D.S.W., Principal Investigator
Administmtion.ILS Public Health Services.
GRADUATE SCHOOL OF SOCIAL WORK
Tracy Williatns-Murphy, B.A.
Region IX
James 14. Ward, Ph.D., Dean
2 FOCAL. POINT Summer 1994
47
BEST COPY AVAILA311
efforts will involve coalitions around overlapping issues,
towards cultural competence. The decision to move in this
and culturally-specific approaches for problems facing a
direction should not be solely a response to political
specific group.
correctness, or a marketing ploy to enhance utilization, or
As mentioned above, it is also important to pay atten-
to comply with the requirements of an accrediting or
tion to within-group diversity (27, 28, 32). The typical
funding body. The decision to proceed in this direction
terms used to describe the four groups of color reveal very
should be a coll aborative effortinvolving group-specific
little in terms of important char-
natural helpers and leaders, par-
acteristics such as income, edu-
ents and family members, and
cation, cultural identity, national
advocatesto empower children,
origin, or social history. Agen-
youth, families, and communi-
cies must avoid the propensity to
ties of color. Moreover, staff must
51
."1/
re-stereotype the various groups
recognize culture as a force in
based on new information that
how problems are defined, in-
may reflect only upon a subset of
cluding attribution of cause (10,
a given groupfor example
32), help-seeking (9, 23), how
working class but not middle class
credible providers and services
Hispanics, urban and not reser-
are defined (25, 34), and even
vation Native Americans, or refu-
how services are evaluated (29).
gee and not immigrant Asians.
As a beginning step, Woody
While the distinctions appear
(33) outlines the following self-
James L Mason (right) with
minor, they can be quite signifi-
John VanDenBerg.
assessment questions concerned
cant when providing services, ad-
with developing a rationale for
vocating on behalf of a given client, and in promoting
cultural competence:
systemic changes.
1. What is the organization's responsibility in meet-
On an ongoing basis it is important for agencies to stay
ing the service needs of minorities? This area of self-
abreast of changing demographics (28), ecological per-
study is the organizational foundation that moves an orga-
spectives of problems and solutions (14), and the corre-
nization towards cultural competence. It is here that the
sponding quality of life indicators (e.g., infant mortality,
respective target groups are identified. Additional discus-
educational attainment, employment rates) by each cul-
sions will establish for agency staff why it is focusing on
tural group. This is particularly relevant where agencies
cultural diversity and will simultaneously send a message
pursue community education, program development. or
to the community. It is at this phase that mission or goal
class advocacy efforts. When agencies and systems advo-
statements and hiring or outreach policies may be revised.
cate on behalf of a given community for the necessary
Similarly, the organization's advocacy strategies may shift.
changes that will empower diverse communities they must
It is also an appropriate time to ir,volve, or at least update,
pay attention to the environmental or psychosocial stres-
board members, volunteers, and program advocates.
sors that befall specific groups (17).
To build such a framework, agency personnel (includ-
For example, the provision of mental health treatment
ing board members and volunteers) may need to be made
is made difficult when children and their families are
aware of: cultural differences as they concern changing
hungry, cold, besieged by urban crime, or are poorly
demographics and demographic differentials between
portrayed in media accounts (6). Over-representation of
majority and non-majority cultures (28); railturally-spe-
children and youth of color in more restrictive settings is an
cific perspectives of illness and health (10); culturally-
issue (4, 18, 19). These circumstances highlight potential
specific program characteristics and components (17); and
areas where agencies can play a viable role in community
research concerning service delivery to culturally diverse
empowerment. Such efforts should be conducted in a spirit
communities (25, 29, 34).
of collaboration and not well-intentioned yet inadvertent
2. How can the presence of minority and majority
paternalism. A key goal is to develop leadership and self-
workers who are skilled in providing services to minor-
determination as opposed to community dependence on
ity populations help an organization accomplish its
external voices and leaders.
mission? The benefits of culturally competent staff and
agencies should be delineated in terms of their impact
upon
The Importance of Developing a Value Base
clients, professionals, the diverse communities and the
It is critical for the members of any given agency or
community-at-large. This question invites sharing
among
system to know why they are embarking on the path
staff in the form of brown bag discussions, sharing of
Summer 1994 FOCAL POINT 3
4
Culturally Competent Organizations
be developed and widely disseminated. While workers'
apprehension about being displaced must be addressed.
continued from page 3
from an organizational change perspectiveadministra-
cross-cultural insights, and generally using the often over-
tors, staff, and others must see the mutual benefits that
can
looked human resources of a given agency or system. Bear
he derived from a diverse work force and a work
environ-
in mind that cultural competence is a developmental
pro-
ment conducive to diversity.
cess based upon the belief that all individuals can make
3. How might services necessarily be different
when
progress with proper instruction, support and rewards.
provided in an appropriate context to the
minority
Further, this area is very sensitive as many members of
community? This question recognizes thatdifferent
groups
the dominant community are convinced that hiring diverse
may have slightly different needs. It may be appropriate for
staff threatens their employment security. Morebver,
ex-
some groups to provide services in satellite offices (25, 34)
isting staff may view new staff as less competent and hired
and, for other groups, services may he provided in other
to fill a quota requirement (7, 33). Win-win scenarios must
languages (10). It may he necessary with some
groups to
CULTURAL COMPETENCE SELF-ASSESSMENT
QUESTIONNAIRE
miinority Cultural Initiative Project staff at the
ern state. In all instances, however, the assessment goal
Portland Research and Training Center devel-
was to improve services to ethnic groups of color and
oped the Cultural Competence Self-Assess-
other culturally diverse populations. The CCSAQ has
ment Questionnaire (CCSAQ) to assess cross-cultural
also proven useful in workshops and consultation meet-
training in human service agencies. The goal is to help
ings in various states including: California, New York,
.
social and human services agencies continue movement
North Carolina, Oregon, Pennsylvania and Washington.
toward the positive end of the cultural competence
Preliminary assessment of the CCSAQ's psychomet-
continuum. A great deal of information has been learned
ric properties has been very encouraging; the instrument
since this document was first mentioned (Focal Point,
will continue to be refined. Given the great demand for
Summer 1988, 2(4), p. 6) and, as a result, this tool has
the CCSAQ from various systems, it will be published
undergone several significant changes.
this fall complete with guidelines outlining its
use. The
The tool involves an agency-based process of identi-
tool allows an agency to measure its growth
over time.
fying training needs and, based on these needs, develop-
Thus, by comparing pre- and post-measures,
an agency
ing site-specific training or other interventions that
en-
can view how it has grown and in which areas continued
hance cultural competence. The CCSAQ also contains
a
growth is still needed. This is particularly important
sheet to collect demographic data on a given work force.
because achieving cultural competence involves
a de-
Once this information is collected and aggregated,
agen-
velopmental process designed around the belief that
cies often discover hidden cross-cultural attributes
or
given proper instruction, support, and motivation,
agen-
experiences of their staff. For example, agencies might
cies and professionals can change.
take advantage of this in-house resource to learn
more
There are two versions of the questionnaire:
one
about diverse languages, communication styles, belief
version for administrative personnel and the other
ver-
systems, religions and other cultural information.
sion for direct service staff. Project staff have field-
The CCSAQ was designed for programs that
serve
tested a version for consumers and family members and
children and youth who have serious emotional disabili-
one for non-paid staff (e.g., board members, volunteers,
ties. The questionnaire has been field-tested
at various
advocates). While the initial responses
are encouraging,
levels and among different service disciplines in widely
these latter tools will not be published until further
diverse sites across the country. Various sites have used
testing of psychometric properties is completed.
the tool including: a western state mental health division
For additional information on the questionnaire
con-
management team, a mid-western state multi-service
tact: James L. Mason, A.B.D., Project Manager,
agency (containing mental health and child welfare
Multicultural Initiative Project, Research and Training
programs), a county juvenile justice system in
a western
Center on Family Support and Children's Mental Health,
state, an eastern region child and adolescent mental
Portland State University, P.O. Box 751, Portland, Or-
health system, a southern state mental health bureau-
egon 97207-0751; [phone].
cracy, and a county mental health system in a northeast-
. POINT
4
)(' Al
Sununu
NI)
BEST CH
AMLABLE
work to overcome a history of distrust (32); while others
positive interaction among group members as well
as
may require class- or system-advocacy efforts (6, 19).
ensures that interaction with other groups is respectful in
Generally, this is an opportune time to involve knowl-
nature.
edgeable. members of the various communities who can
5. How can one know if the goal of serving minority
assist in developing a rationale for identifying group-
clients has been achieved? This remains the ultimate
specific needs and prospective interventions (16, 17).
question for the cultural competence concept. As
agency
Once enlisted in the initial phases of activity, it is likely that
staff begin to develop plans, they must simultaneously
these local key informants may be more willing to offer
identify measurable goals and objectives (24). Goals
or
their support to the process. This is also a critical period to
milestones can be designed in measurable, incremental
involve parents and family members who are often the
phases. While there are few standardized tools to
measure
most under-utilized resource (2).
cultural competency (5, 14, 21), staff can review those that
4. What is the vision of services to the minority
are available and adapt them as necessary to meet agency
community? This is an opportunity to design system
or
needs. Task forces or work groups can be convened to
organizational refinements. It is particularly important to
review emerging scales and measures that might be used
or
involve members of the diverse communities in creating
adapted for more quantitative analysis. Exit interviews,
the vision. This is the key opportunity to both envis:cin the
focus groups, and consumer satisfaction measures
may be
system as it should be and to identify ways of funding such
employed to generate an initial data set that can be
re-
a system. Moreover, by involving natural helpers and
assessed over time to discern where the program has
grown
leaders, parents and family members, key informants, and
and where additional growth is needed.
others, community-based supports and resources
may be
brought to bear. This may also yield greater support for the
The Cultural Competence Model: Planning Issues
program in various ways such as: assisting with staff and
and Implications
board recruitment, encouraging in-kind donations, identi-
Several areas of knowledge have been developed with
fying advocacy resources, and promoting parent
or com-
respect to the CASSP cultural competence model. The
munity education and support groups.
theoretical foundation for the model is set forth in the
This is a time to consider the concept of "culture" quite
monograph, Towards a Culturally Competent System of
broadly. Accordingly, the planning group should have
Care (4). A second monograph, Towards
as
a Culturally
members representatives of the targeted groups. Cultural
Competent System of Care: Programs Which Utilize Cul-
diversity within a given group should be strongly consid-
turally Competent Principles (17), identifies and describes
ered. For example, it is hard for one member of
any group
several programs that exemplify various aspects of the
to represent the wide range of beliefs, practices, and
model. As the latter publication demonstrates, there is
no
customs within that group. Empowering members of
a
single approach to developing cultural competence. Even
specific cultural group to help envision or otherwise design
when the cultural group and service discipline
are identi-
system improvements should result in greater relevance of
cal, programming may vary from site to site.
services and service delivery approaches. Thus, if the
There are five basic principles that undergird the cul-
target population are groups of color, they
may be a
tural competence model, namely: Valuing Diversity, Con-
majority of the planning body. To use existing personnel
ducting a Self-Assessment, Understanding the Dynamics
with a few minorities sprinkled in may hint at tokenism.
of Difference, and Adapting to Diversity. These principles
Similarly, simply identifying people of color
may not be a
undergird the model and the its application. Contained
guarantee that they represent or are aware of the cogent
within the Adapting to Diversity principles
are the follow-
cultural issues. Hence, selecting cultural key informants
ing four primary elements: (a) attitudes; (b) practices; (c)
for this process is a time-consuming yet critical
step.
policies; and (d) structures (4).
Certainly parents, family members, and
consumers need to
Attitudes refers to the thoughts, beliefs, and biases
be involved.
people have as they regard culturally diverse
groups. This
Attention to group processes such as problem-solving,
area responds to the issue that many people have been
decision-making, and conflict management is critical dur-
negatively influenced by news media
accounts, public
ing this phase (35). A good group
can be decimated by
education and social learning, and cultural
conveyances
internal differences that remain unaddressed
or by friction
(movies, books, jokes, folklore) about culturally
diverse
with other work groups that is ignored. Work with
groups
groups. As a result, deficit models with respect to ethnic
is often difficult. While diversity is a strength, untended,
it
groups of color have resulted in very negative biases about
can be a strain. Anti-bias and subsequently cultural com-
the respective realities faced by
groups of color (10).
petence training may be a primary activity that facilitates
Shedding these biases is very hard
even for the most well-
FOCAL POINT 5
Summer 1994
6
Culturally Competent Organizations
office decor, program name, location, even what is avail-
able in the waiting room to read).
continued from page S
Hence, cultural competence is a set of congruent atti-
intentioned individual. Often people are very unaware of
tudes, practices, policies, and structures that come together
their own cultural and racial biases, yet they must be
in a system or agency and enable professionals to work
acknowledged in order to be supplanted with cultural
more effectively in cross-cultural situations. The model is
strengths perspectives. This element typically comes in the
best viewed in the context of a continuum with a negative
form of cultural sensitivity and awareness models, also
and a positive pole. Because the model is developmental in
some of the emerging anti-bias
nature, organizations must
models can help set the founda-
continually strive to work to-
tion for learning more about
wards the positive end of the
cultural competence.
continuum with respect to spe-
The practices element con-
cific populations. Moreover,
cerns clinical skills such as as-
since culture is a dynamic phe-
sessment, treatment planning,
nomenon and subject to
resource development, out-
change, arriving at the most
reac.i, and advocacy for direct
positive end of the confirm=
service staff; while for admin-
is an ideal state requiring a
istrative personnel it will con-
lifelong commitment. The ca-
cern such things as recruitment
veat, however, is that an
and retention, networking with
organization's staff may be pro-
leaders from diverse commu-
ficient with one given cultural
1
nities, conflict management and
group but may need to work on
mediation, program develop-
enhancing their abilities to
ment, staff and board development, and program imple-
work with emerging or other existing groups within their
mentation and evaluation. The rapidly growing body of
catchment area. Similarly, agencies with demonstrated
knowledge in the theoretical and research literature re-
credibility with a given population may need to consider
garding service delivery practices for culturally diverse
the varying contexts in which group members reside. For
populations should prove helpful. With respect to this
example, programs that effectively serve Latinos in Hous-
dimension, there exist two under-tapped resources that can
ton may not be appropriate for serving Latinos in Omaha
be very helpful to consult: (a) research and theory describ-
or Miami. Other considerations include such factors as
ing programs that exemplify aspects of the cultural compe-
national origin, socioeconomic status, social history, rural-
tence model (17), and (b) key informants such as consum-
urban continuum, levels of assimilation and acculturation.
ers, family members, and parents of children with emotional
Simply put, the racial categories currently used often lack
or behavioral disabilities (20).
the necessary details to comprehend and effectively meet
The policy element is an often overlookedyet very
the needs of children, youth, and their families.
importantarea. While many programs have culturally
Planning Implications
competent characteristics, these may not be supported by
policy. Given the possibility of budget cutbacks, staff
In efforts to move an organization towards the positive
turnover, or other occurrences, it is important that good
end of the spectrum, staff must: (a) identify the target of the
practice become routinized by virtue of policy. Examples
change efforts (e.g., one specific cultural group, groups of
include such things as mission statements, program goals,
color, non-ethnic cultural groups, or others); (b) assess
hiring practices, outreach and advocacy efforts. Culturally
their cross-cultural training needs; (c) identify barriers to
competent staff attitudes and program practices need to be
serving the identified groups effectively; (d) develop goals
upheld by policy lest they ebb and flow on the trends of the
and implementation steps for achieving them; and (e)
times.
develop approaches for measuring success. Diversity should
The structure aspect of the model is twofold: (a) it
be considered in all aspects of the organizationnot just
refers to the diversity and cultural competence of the
clinical practice. Certainly parents and family members of
agency's governing structures (e.g., board advisors, direc-
children and youth of color who have serious emotional
tors, consultants, and policy- or decision-making bodies
disabilities are an underutilized resource. Additional re-
generally); and (b) considers the cultural appropriateness
sources include natural helpers, elders, clan and tribal
of the physical plant (i.e., in terms of access, artwork and
leaders, and members of spiritual communities.
6 FOCAL POINT'
Summer 1994
7
Timing is important. Since planning groups need to
References
have some sense of accomplishment to sustain momentum
Atkinson, D.R. & Hackett, G. (Eds.) (1988). Counseling non-ethnic
I.
minorities. Springfield, IL: Charles C. Thomas.
and interest, tasks should be: identified as short-, medium-
2. Carrasquillo, A. (1986). The parent factor in teaching language skills to
or long-term in duration; divided into manageable incre-
limited English proficient learning disabled students. In A.C. Willig & H.F.
Greenboeg (Eds.), Bilingualism and learning disabilities: Policy and
mental steps; and, described in terms of whether personal
practice for teachers and administrators, (pp. 53-68). New York: Ameri-
or organizational resources are needed. The persons re-
can Library Publishing Co.
Chin, J.L. (1983). Diagnostic considerations in working with Asian
3.
sponsible for specific tasks should be identified and the
Americans. American Journal of Orthopsychiatry, 53(1), 100-109.
methods for measuring progress should be carefully delin-
Cross, T.L., Bazzon, B., Isaacs, M.; Dennis, K. (1989). Towards a culturally
4.
eated. As much as possible, local communities should be
competent system of care. A monograph on effective services for minority
children who are severely emotionally disturbed. Vol.!. Washington, D.C.:
involved and empowered to have influence into a process
Georgetown University Child Development Center, CASSP Technical
which is ultimately for their benefit.
Assistance Center.
5. D'Andrea. M. & Heck, R. (1991). Evaluating the impact of multicultural
counseling training. Journal of Counseling & Development. 70, 143-150.
Conclusion
6. Edelman, M.W. (1987). Families in peril: An agenda for social change.
Cambridge, MA: Harvard University Press.
There are many culturally-informed service delivery
7. Fernandez, J.P. (1991). Managing a diverse work force. Lexington, MA:
models emerging in various fields. Most contemporary
Lexington Books.
8. Flaskerud, J.H. (1986). Diagnostic treatment differences among five ethnic
models are concerned with more than worker cognition of
groups. Psychological Report, 58(1), 219-235.
differences. Therefore, any approach adopted should in-
9. Gary, L.E. (1987). Attitudes of black adults toward community mental health
clude a focus on organizational attitudes, policies, and
centers. Hospital and Community Psychiatry, 38(10), 1100-1105.
10. Green, J.W. (1982). Cultural awareness in the human services. Englewood
structures. The target population needs to be identified and
Cliffs, N.J.: Prentice-Hill, Inc.
barriers to effective service delivery addressed (language,
11. Grier, W., & Cobbs, D. (1968). Black rage. New York: Basics Books.
12. Hacker, A. (1992). Two nations: Black and white, separate, hostile,
access, trust, lack of diverse staff); environmental stressors
unequal. New York: Charles Scribner's Sons.
should also beer .bored and ways to mitigate against such
13. Ho, M.K. (1987). Family therapy with ethnic minorities. Newbury Park,
CA: Sage Publications.
factors considered (e.g. poverty (6), institutional bias or
14. Ho, M.K. (1992). Minority children and adolescents in therapy. Newbury
racism (16)) culminating in a sense of mutual benefit; and,
Park, CA: Sage Publications.
15. Hodgkins6n, li. (1990, May). Non-white demographics. A speech deliv-
a value base for why this is being developed should be
ered at the Second Annual Conference on Racial and Ethnic Violence on
disseminated. In particular, this information should be
Campus, Norman, Oklahoma. In M.K. Ho, Minority children and adoles-
cents in therapy. Newbury Park, CA: Sage Publications.
widely disseminated to staff, volunteers, board members,
16. Isaacs, M. (1986). Developing mental health programs for minority youth
and relevant members of the targeted community. Plan-
and their families. Washington, D.C.: Georgetown University Child De-
ning should be conducted in a spirit of collaboration
velopment Center, CASSP Technical Assistance Center.
17. Isaacs, M.R. & Benjamin, M.P. (1991). Towards a culturally competent
utilizing as many culturally- or community-based resources
system of care. Vol.!!. Washington, D.C.: Georgetown University Child
as possible. The possibility of subcontracting with indig-
Development Center, CASSP Technical Assistance Center.
18. Katz-Leavy, J., Lourie, I., Kaufmann, It. (1987). Meeting the mental health
enous people may be an initial way of creating a symbiotic
needs of minority children and adolescents with severe emotional disabili-
relationship (27). Lastly, one should recognize the years of
ties: A national perspective. Children Today, 16(5), 10-14.
19. Knitzer, J. (1982). Unclaimed children: The failure of public responsibility
mis-education with respect to diversity and how many
to children and adolescents in need of mental health services. Washington.
services delivered to groups of color are steeped in deficit
D.C.: Children's Defense Fund.
models (10, 27, 32).
20. Lynch, E.W. & Stein, R.C. (1987). Parent participation by ethnicity: A
comparison of Hispanic, black, and anglo families. Exceptional Children,
There is enough work to go around. While much of the
54(2), 105-111.
work in cross-cultural service delivery has focused upon
21. Mason, J.L. (1988). Revisiting the ethnic dilemma. Focal Point 3(1).
Portland, OR: Research and Training Center on Family Support and
clinical interventions, additional work is needed in such
Children's Mental Health. pp. 4-5.
areas as: management information systems, recruitment
22. Meinhardt, K. & Vega, W. (1987). A method for estimating underutilization
of mental health services by ethnic groups. Hospital & Community Psy-
and retention of diverse staff, community education and
chiatry, 38(11), 1186-1190.
advocacy strategies, outreach techniques, and fund raising
23. Neighbors, H.W. & Taylor, R.J. (1985). The use of social service agencies
among black Americans. Social Service Review, 59, 258-268.
approaches. Ultimately, society will change and become
24. Orlandi, M. (Ed.) (1992). Cultural competence for evaluators. A guide for
darker in complexion. The challenges facing contempo-
alcohol and other drug abuse prevention practitioners working with
rary human service professionals are vast; however, so are
ethnic/racial communities. Rockville, MD: Office for Substance Abuse
Prevention, U.S. Department of Health and Human Services.
the benefits to the children and youth with serious emo-
25. ()wan, T.C. (1982). Neighborhood-based mental health: An approach to
tional disabilities, their families, and their communities.
overcome inequities in mental health services delivery to racial and ethnic
minorities. In D.E. Riegel & A.J. Naparstek. (Eds), Community support
systems and mental health: Practice, policy, and research, (pp. 282-300).
James L. Mason, A.B.D., Project Manager, Multicultural
New York: Springer Publishing Co.
26. Ozawa, M. (1986). Non-whites and the demographic imperative in social
Initiative Project, Research and Training Center on Fam-
welfare spending. Social Work, 3 t, 440-446.
ily Support and Children's Mental Health, Portland State
27. Pinderhughes, E.B. (1989). Understanding race, ethnicity, and power: The
key to efficacy in clinical practice. New York: Free Press.
University, Portland, Oregon.
Summer 1994 FOCAL POINT 7
8
32. Sue, D.W. & Sue, D. (1990).
References for Culturally Competent Organizations cont.
Counseling the culturally different: Theory
(2nd ed.). New York: John Wiley & Sons, Inc.
and practice.
28. Ponterotto, J.G. & Casas, J.M. (1991). Handbook of
racial/ethnic minority
33. Woody, D.L. (1992).
Recruitment and retention of minority workers in
Illinois: Charles C. Thomas.
counseling research.
Washington, D.C., National Institute of Mental
mental health programs-.
29. Slaughter, D.T. (1988). Programs for racially and ethnically diverse
Health, Human Resource Development Program.
American families: Some critical issues. In H.B. Weiss & F.H. Jacobs
34. Zane, et al. (1982). Service system models for ethnic minorities. In D.E.
(Eds.),
Evaluating family programs,
(pp.461-476). New York: Aldine De
Hiegel & A.J. Naparstek (Eds.),
Community support systems and mental
Gruyter.
health: Practice, policy, and research,
(pp.229-257). New York: Springer
30. Solomon, B.B.
New York: Columbia Univer-
(1976). Black empowerment.
Publishing Co.
sity Press.
35. Zastrow, C. (1985).
Social work with groups.
Chicago, IL: Nelson-Hall
31. Solomon, P. (1987). Racial factors in mental health service utilization.
Publishers.
Psychosocial Rehabilitation Journal,
11(2), 3-12.
CULTURAL COMPETENCE: NEW FRONTIERS
The Child and Adolescent Service System cultural
sity is the growing number of journal articles and books
competence model emerged in the mid-1980's as
that address the topic. Agencies and organizations are
many systems and agencies redoubled their efforts
beginning to develop their own libraries, as well as biblio-
to enhance services to culturally diverse populations. This
graphic and other instructional materials that promote
increased interest in improving services to culturally di-
greater competence.
verse groups is attributable to a variety of factors includ-
For example, the Office for Substance Abuse Preven-
ing: (a) changing demographics; (b) greater acknowledg-
tion has launched the first in a series of cultural compe-
ment that culture is a factor in the helping process; and (c)
tence publications "to promote the development and dis-
recognition that many professionals are not trained to
semination of a s,:ientific knowledge base that assists
provide service to diverse populations. Accordingly, vari-
prevention program evaluators and practitioners in work-
ous child and youth service delivery systems have mobi-
ing with multicultural communities" (Orlandi, Weston &
lized to provide specific activities to promote cultural
Epstein, 1992, p. iii).
competence.
In the field of child welfare, the Child Welfare League
Professionals in the child welfare field now recognize:
of America developed and published the Cultural Compe-
the need for more foster and adoptive homes of color, that
tence Self-Assessment Instrument (Child Welfare League
children of color often end up in more restrictive settings,
of America, 1993) to help agencies assess their own
and that children are allowed to drift in foster care and not
progress. Once 100 assessments are completed by member
be permanently placed (Edelman, 1987). The juvenile
agencies, an analysis of aggregate data will be published
justice field is dealing with such issues as minority over-
(Child Welfare League of America, 1994).
representation in that system, more violent offenses being
With respect to training, the Maternal and Child
perpetrated by youth (often involving firearms), and the
Health Bureau has convened training activities that are
increased prevalence of female offenders (Mann-Richey,
very responsive to the cultural realities and needs of
1993). Maternal and child health professionals are work-
mothers and young children of color. The Juvenile Justice
ing to: lower infant mortality rates, reduce the abuse of
and Delinquency Prevention Office has initiated demon-
alcohol and other drugs by expectant mothers and families,
stration projects and other activities to inform both profes-
better understand culturally diverse help-seeking prac-
sionals and non-professionals alike in how one begins to
tices, eliminate recalcitrant childhood diseases (e.g., polio,
reclaim children leaning toward youth gangs or otherwise
tuberculosis), and acknowledge diverse perspectives of
delinquent activity.
health and illness (Randall-David, 1989).
In many communities across the country little-known
In children's mental health, the issues include: the
resources exist in the form of Pow Wows, Cinco de Mayo
development of culturally appropriate diagnostic and treat-
celebrations, Martin Luther King holiday observances,
ment approaches, identification of effective outreach ef-
and Asian New Year festivals. Moreover, places of wor-
forts to culturally diverse communities and utilization of
ship are also key locations at which good information and
culturally diverse natural helpers, eradication of over-
expertise about a given cultural group can be sought.
representation in more restrictive settings (including juve-
The caveat, however, is evident in the acknowledgment
nile justice settings), and the evaluation of culturally
that cultural competence is not new. It still needs to be
competent services and programs. Clearly, everyone has
infused into the fabric of many of America's key institu-
their work cut out for them.
tions. For example, there are few mandatory courses on
One exciting development in the area of cultural diver-
diversity at colleges and universities at either the under-
8 FOCAL POINT Summer 1994
9
graduate or graduate levels. Many systems are still strug-
sionally ethical and personally employable as America
gling to recruit, hire and retain workers of color. And,
grows ever more diverse.
research has only scratched the surface with respect to
References and Additional Sources of Information:
groups of color in terms of within group diversity. Much of
American Humane Association, Children's Division (1992). An annotated
our thinking about diversity is based on media portrayals
bibliography of resources on cultural competence and cultural diversity in
of pathology in families and not empirically validated
child welfare-/child protection services. Englewood, CO: American Hu-
mane Association, Children's Division.
strengths and coping techniques.
Anderson, M. & Goldberg, P,(1991). Cultural competence in screening and
There is a great deal of work to be done as this society
assessment. Implications for services to young children with special needs
ages birth through five. Minneapolis: PACER Center, Inc.
enters the twenty-first century. Beyond the many
Child Welfare League of America (1993). Cultural competence self-assess-
systemwide or disciplinary-specific activities, many local
ment instrument. Washington, DC: Child Welfare League of America.
Child Welfare League of America (1994). Cultural competence self-assess-
opportunities exist to promote cultural competence. Some
ment. It's your turn. Children's Voices, 3(4), 25-26.
agencies have initiated efforts that can involve natural
Edelman, M.W. (1987). Families in peril. An agenda for social change.
Cambridge: Harvard University Press.
helpers and leaders, as well as diverse professionals, con-
Juvenile Justice and Delinquency Prevention Office, Department of Justice,
sumers and family members to further this agenda. Agency-
633 Indiana Avenue N.W., Washington, D.C. 20531; [phone];
or bureau-based task groups and cultural competence com-
[phone] (fax).
Lynch, E. & Hanson, M. (1992). Developing cross-cultural competence. A
mittees are emerging offering those interested a role to play.
guide for working with young children and their families. Baltimore: Paul
Lastly, we all have to remain vigilant in assessing
H. Brookes Publishing Company.
Maat, J. & Harrison, D. (1993). Black Network in Children's Emotional Health
our personal biases in the organizations and institutions
resource directory of culturally competent and African-centered services
in which we work. While conditions for groups of color
for families of youth with or at risk for emotional/behavioral problems.
and other cultural groups are arguably at a critical
1993-95 edition. Chicago: Black Network in Children's Emotional Health.
Mann-Richey, C. (1993). Unequal justice. Indianapolis: Indiana Press.
juncture, we all have a role to play in assuring that the
Maternal and Child Health Bureau, Department of Health and Human Services,
issues do not get lost or trivialized. Now is a good time
5600 Fishers Lane, Room 1805, Rockville, Maryland 20857; (301) 443-
2170; [phone] (fax).
to develop the commitment and dedication needed to
Orlandi, M., Weston, R., Epstein, L. (Eds.) (1992). Cultural competence for
eliminate barriers to culturally competent service deliv-
evaluators. A guide foralcohol and othzr drug abuse prevention practitio-
ners working with ethnic/racial conununities. Rockville, MD: U.S. Depart-
ery to children, youth and their families that assures that
ment of Health and Human Services; Public Health Service; Alcohol, Drug
their culture, race and class are taken into account.
Abuse, and Mental Health Administration (ADAMHA); Office for Sub-
stance Abuse Prevention; Division of Community Prevention and Training.
Becoming more aware of service delivery issues affect-
Randall-David, E. (1989). Strategies for working with culturally diverse
ing diverse populations is a way of staying both profes-
communities and clients. Washington, DC: Association for the Care of
Children's Health.
WHY NOT?
As society becomes
more diverse there is increased concern over the diversity of decision-making bodies. One, two,
oroccasionallymore people are added to an existing board to give it the representation necessary. The debate
as to what is tokenism and what is critical mass related to diversity has not been concluded (maybe not yet even
convened). Some argue that two new members are needed, suggesting if one new member could not attend a meeting
the other one will be available; others say three, indicating that if one canna, attend there arc still two people attending
for mutual support--a minimum of three makes sense. Yet, the token issue may still he with us.
Given our diverse and democratic society, board membership should reflect the diverse interests. Why not think
of boards in terms of multiples of five, given that there are five major cultural groups in our society (European-,
African-, Asian-, Hispanic-, and Native American)? Diverse groups can then he equally represented, this is perhaps
more reflective of our democratic principles. Voting may emerge around common interests and not so much around
a sense of group survival. Disproportionate power will not always accrue to the same groupthe dominant
population. If equity and good ideas irrespective of their origin is a concern, why not consider equal re; esentation
in this manner? Coalitions can develop around issues and not cultural groups; thus, in addition to the board having
divergent views perhaps around cultural lines, it will also have convergent views as well. Moreover, it eliminates
any concerns about tokenism. Similarly, around parent representation, we want parent and professional interests
being met, this requires we add two more or seek people who can wear multiple hats. In some cases an individual
might represent a culturally diverse group, a parent or family member, and even a specific service discipline. It
certainly sounds weird, but is this not one group, one vote? J.L.M.
,,tuna
Editor's Note: Readers are invited to submit contributions. not to eAceed 250 words, for tht Wit\ Not '
Summer 1994 FOCAL POINT 9
BEST CCM AVAILABLE