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Notes from a Roundtable on Conceptualizing and Measuring Cultural Competence

Appendix C : Assessing Cultural Competence in Mental Health Service Delivery

Joseph M. Ponterotto, Ph.D.
Counseling Psychology Program
Fordham University-Lincoln Center

December 1998

As the "demographic face" of America continues to evolve, there is little doubt that our mental health system will be challenged to meet the mental health needs of an increasingly culturally diverse clientele (Sue, Parham, Santiago, 1998). It is fair to say that at present, the majority of mental health service administrators and providers are mono-lingual Anglo Americans who have not received adequate multicultural training (Atkinson, Brown, & Casas, 1996). My personal view is that the mental health system in this country is not equipped nor prepared to meet the needs of a culturally and linguistically diverse client base (Ponterotto, 1998).

There is an abundance of professional literature that speaks to the need for mental health service providers to increase their multicultural competence. Two questions we must address at this time are: a) what is cultural competence? and b) how can it be measured? In this brief paper I will cover these two points and also highlight the need for a non-static approach to competency assessment.

Defining Multicultural Competence

The counseling/therapy relationship is quite complex; and this relationship is even more complex when the members involved represent different cultural groups. It has taken scholars in the field 15 years to develop a comprehensive definition and profile of multicultural competence. Fortunately, thanks to the pioneering work of Derald Wing Sue and his colleagues, the profession has at its disposal a good working definition of cultural competence in individual and organizational contexts. I assume that the members of this roundtable are familiar with the cross-cultural competency reports that are being increasingly recognized and endorsed by our professional associations, namely the American Psychological Association and the American Counseling Association. Therefore, in this paper, I just want to reference these reports as WICHE has them available for closer scrutiny: Arredondo et al. (1996); Sue et al (1982); Sue, Arredondo, & McDavis (1992); and Sue et al. (1998). The latest report, Multicultural Counseling Competencies: Individual and Organizational Development (Sue et al., 1998), provides the most comprehensive profile of the culturally competent provider and organization currently available, and I suggest this source be used as a base for further instrument development and refinement.

Assessing Multicultural Competence: Quantitative and Qualitative Perspectives

Quantitative Assessments. Quantitative measures of multicultural counseling competence have dominated the professional literature. There are currently four paper-and-pencil instruments that are being used regularly in mental heath research. Three of the instruments are provider self-report measures, and one is used as a supervisor's evaluation tool. These four instruments have been discussed and critiqued extensively in the literature, and only the references are provided below.

The evaluator's form is the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise, Coleman, & Hernandez, 1991). The clinician self-report surveys are the Multicultural Counseling Inventory (MCI; Sodowsky, Taffe, Gutkin, & Wise, 1994), the Multicultural Counseling Awareness Scale (MCAS; Ponterotto et al., 1996), and the Multicultural Awareness-Knowledge-Skills Survey (MAKSS; D'Andrea, Daniels, & Heck, 1991). Critical reviews of these instruments (Ponterotto & Alexander, 1996; Ponterotto, Rieger, Barrett, & Sparks, 1994; Pope-Davis & Dings, 1995) indicate that though promising, they need further validation work. Furthermore, any paper-and-pencil measure, particularly self-report, is limited with regard to assessing accurate levels of cultural competence in providers. The latest version of the Multicultural Counseling Awareness Scale was recently re-titled the Multicultural Counseling Knowledge and Awareness Scale (MCKAS).

Qualitative Assessments

Very recently, qualitative assessments, particularly Portfolio Assessments, have received attention in the professional literature. I find the work of Coleman (1996) particularly promising in this regard. Portfolio Assessments provide trainees and providers with greater opportunity for self-reflection and more specific avenues for needed "cultural growth." The Portfolio Assessment I developed and use with master's and doctoral level counseling psychology students is based on the 31 Sue et al. (1992) competencies. Since the competency list was recently expanded to 34 competencies (Sue et al., 1998), I will be updating the portfolio next semester.

Organizational Assessments

The assessments described above focus primarily on individual assessments of multicultural counseling comfort and competence. Recently, organizational measures have been developed and include the Multicultural Competency Checklist (Ponterotto, Alexander, & Grieger, 1995) and the Multicultural Environment Inventory (Pope-Davis & Lui, 1995). These measures are designed for academic training programs in the mental health professions, but could be adapted for mental health delivery systems. Reference the Multicultural Competency Checklist.

The Need for Non-Static, Ongoing Evaluations of Multicultural Competence

Often times the nature of assessment is perceived as static -- once a competency is met, it is met for life. I believe strongly that the development of cultural competence is a life-long, evolving activity. Therefore, it would be beneficial if assessment procedures tapped this perspective and encouraged continued reflection and growth in the multicultural arena. I believe, qualitative approaches, such as Portfolio Assessments, constitute the most comprehensive assessments of developing competence. Portfolio assessments can be designed for any level of professional or organizational service. Understandably, augmenting portfolio assessments with periodic paper-and-pencil objective measures would allow for method triangulation and will increase the validity of the assessment process. Of course, quantitative assessments would allow for much larger sampling evaluations.

In summary, we are at the forefront in defining, operationalizing, and measuring multicultural competence. The outcome of this Roundtable will have significant impact on a national level, and follow-up work and discussion will be important. We are at a critical juncture in establishing reliable, valid, and convenient measures of cultural competence. I expect these topics will also constitute an important focus for the upcoming First Annual Multicultural Conference and Summit to be held January 28-29, 1999 in Newport Beach, California. I hope WICHE will be involved in this landmark conference.

References

Arredondo, P., Toporek, R., Brown, S. P., Jones, J., Locke, D. C., Sanchez, J., & Stadler, H. (1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42-78.

Atkinson, D. R., Brown, M. T., & Casas, J. M. (1996). Achieving ethnic parity in counseling psychology. The Counseling Psychologist, 24, 230-258.

Coleman, H. L. K. (1996). Portfolio assessment of multicultural counseling competence. The Counseling Psychologist, 24, 216-229.

D'Andrea, M., Daniels, J., & Heck, R. (1991). Evaluating the impact of multicultural counseling training. Journal of Counseling and Development, 70, 143-150.

LaFromboise, T. D., Coleman, H. L. K., & Hernandez, A. (1991). Development and factor structure of the Cross-Cultural Counseling Inventory - Revised. Professional Psychology: Research and Practice, 22, 380-388.

Ponterotto, J. G. (1998). Charting a course for research in multicultural counseling training. The Counseling Psychologist, 26, 43-68.

Ponterotto, J. G., & Alexander, C. M. (1996). Assessing the multicultural competence of counselors and clinicians. In L. A. Suzuki, P. Meller, & J. G. Ponterotto (Eds.), Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications (pp. 651-672). San Francisco, CA: Jossey-Bass.

Ponterotto, J. G., Alexander, C. M., & Grieger, I. (1995). A multicultural competency checklist for counseling training programs. Journal of Multicultural Counseling and Development, 23, 11-20.

Ponterotto, J. G., Rieger, B. P., Barrett, A., Harris, G., Sparks, R., Sanchez, C. M., & Magids, D. (1996). Development and initial validation of the Multicultural Counseling Awareness Scale. In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural Assessment in Counseling and Clinical Psychology (pp. 247-282). Lincoln, NE: Buros Institute of Mental Measurements.

Ponterotto, J. G., Rieger, B. P., Barrett, A., & Sparks, R. (1994). Assessing multicultural counseling competence: A review of instrumentation. Journal of Counseling and Development, 72, 316-322.

Pope-Davis, D. P., & Dings, J. G. (1995). The assessment of multicultural counseling competencies. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of Multicultural Counseling (pp. 287-311). Thousand Oaks, CA: Sage.

Pope-Davis, D. P., & Lui, W. (1995). The Multicultural Environment Inventory. Unpublished manuscript, Department of Psychology, University of Maryland, College Park, MD.

Sodowsky, G. R., Taffe, R. C., Gutkin, T., & Wise, S. L. (1994). Development of the Multicultural Counseling Inventory: A self-report measure of multicultural competencies. Journal of Counseling Psychology, 41, 137-148.

Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural competencies and standards: A call to the profession. Journal of Multicultural Counseling and Development, 20, 64-88.

Sue, D. W., Bernier, J. E., Durran, A., Feinberg, L., Pedersen, P., Smith, E. J., & Vasquez-Nuttall, E. (1982). Position paper: Cross-cultural competencies. The Counseling Psychologist, 10, 45-52.

Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., Ivey, A. E., Jensen, M., LaFromboise, T. D., Manese, J., Ponterotto, J. G., & Vazquez-Nuttall, E. (1998). Multicultural Counseling Competencies in Individual and Organizational Development. Thousand Oaks, CA: Sage.

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