Community Support
Notes from a Roundtable on Conceptualizing and Measuring Cultural Competence
Appendix C: Measuring Cultural Competency for Evaluation of Mental Health Service Systems
Just how one might measure cultural competency is not clear. Presumably it ought to be reflected in understanding of cultural issues, which might include both general and specific sensitivities. That is, part of cultural competency should be a general sensitivity, and part of it should be knowledge of and sensitivity to local cultural concerns. A question of no small importance is how and to what extent cultural competence should be related to outcomes of services. There tends to be an assumption that cultural competence should result in increasing access to and satisfaction with services, as well as more appropriate diagnosis and treatment. Presumably those are mediators by which there will be increasing compliance and subsequent improved outcomes. In that case, successful service delivery programs, i.e., as manifested by good outcomes, may be taken to be by definition culturally competent. If, however, service outcomes are less successful than seems acceptable, then issues of cultural competence and the necessity to measure them come to the fore.
We have taken note of the WICHE outcome measures and benchmarks to assess "cultural competence," which include the following:
- Consumer, family and stakeholder satisfaction with services (90%)
- Consistency of service authorizations (benchmark: comparable across ethnic groups; increasing over time)
- Frequency of diagnostic revisions resulting from failure to respond to treatment (benchmark: comparable across ethnic groups and decreasing over time)
- Clinical and functional assessment scales that are validated across cultural boundaries and that can be considered equivalent (see Canino and Bravo, 1994)
Measures we have identified that are likely to be particularly useful in studies of ethnic and cultural factors in mental health services research are given in an appendix to this paper.
References
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22, 723-742.
Fox, J., Merwin, E., and Blank, M. (1995). De facto mental health services in the rural south. Journal of Health Care for the Poor & Underserved, 6, 434-468.
Lopez, S. R., Blacher, J. B., & Shapiro, J. (in press). The interplay of culture and disability in Latino families. In I. Tan Mink, M. L. de Leon Siantz, & P. Berman (eds.) Ethnically Diverse Families and Childhood Disability: Theory, Research, and Service Delivery. Washington, D. C.: American Association of Mental Retardation.
Page, J. M. (1993) Ethnic identity in deaf Hispanics of New Mexico. Sign Language Studies, 80, 185-222.
Terrell, M. D. (1993) Ethnocultural factors and substance abuse: Toward culturally sensitive treatment models. Psychology of Addictive Behaviors, 7, 162-167.
WICHE. (1997). Cultural Competence Standards in Managed Mental Health Care For Four Underserved/Underrepresented Racial/Ethnic Groups. Boulder: WICHE Publications.
Appendix
Scales for Measuring Ethnic and Cultural Variables
Ethnic identification and acculturation
1. Acculturation Rating Scale for Mexican-Americans (ARSMA)
(Cuellar, Harris, & Jasso, 1980)
What theory (if any) does the scale test? What is the purpose?
The scale attempts to measure the adaptation of Mexican Americans into the dominant American culture.
Examine the Face Validity of Subscales and Individual Items:
The ARSMA consists of items assessing (1) preferences for language usage, relationships, entertainment, and food, (2) ethnic identification and origin, (3) generational proximity and (4) bilingual abilities.
Cuellar, I., Harris, L. C., & Jasso, R. (1980). An acculturation scale for Mexican-American normal and clinical populations. Hispanic Journal of Behavioral Sciences, 2, 199--217.
2. Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA)
(Suinn, Rickard-Figueroa, Lew, & Vigil, 1987)
What theory (if any) does the scale test? What is the purpose?
The scale attempts to measure the adaptation of Asian Americans into the dominant American culture.
Examine the Face Validity of Subscales and Individual Items:
The SL-ASIA consists of 21 items in a multiple choice questionnaire format. The scale contains topics related to language, identity, friendships, behaviors, generational/ geographic background, and attitudes.
Suinn, R. M., Richard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn-Lew Asian Self-Identity Acculturation Scale: An initial report. Educational & Psychological Measurement, 47(2), 401-407.
3. Multidimensional Measure of Cultural Identity for Latino and Latina Adolescents
(Feliz-Ortiz, Newcomb, & Myers, 1994)
What theory (if any) does the scale test? What is the purpose?
Collecting information along several dimensions provides a better understanding about individual acculturation, in which individuals affiliate and identify with one or more groups. This scale quantifies the individual's sense of familiarity with both American and Latino(a) cultures.
Examine the Face Validity of Subscales and Individual Items:
The cultural identity scales contain items that assess (1) language use, (2) behavior and familiarity with aspects of American and Latino(a) culture, and (3) specific Latino(a) values and attitudes.
Feliz-Ortiz, M., Newcomb, M. D., & Myers, H. (1994). A multidimensional measure of cultural identity for Latino and Latina adolescents. Hispanic Journal of Behavioral Sciences, 16(2), 99-115.
4. Multidimensional Scale of Cultural Difference
(Martinez, Martinez, Lomedo, & Goldman, 1976)
What theory (if any) does the scale test? What is the purpose?
constructed to measure level of "acculturation" to predict group membership, i.e. Hispanic or Anglo.
Examine the Face Validity of Subscales and Individual Items:
Items measure language familiarity and usage, nationality, and occupational status
Martinez, J. L., Martinez, S. R., Lomedo, E. L., & Goldman, R. D. (1976). The semantic differential technique: A comparison of Chicano and Anglo high school students. Journal of Cross-Cultural Psychology, 7(3), 325-333.
5. Cultural Information Scale (CIS)
(Saldaņa, 1988)
What theory (if any) does the scale test? What is the purpose?
The CIS provides an assessment of demographic and psychological factors associated with acculturation.
Examine the Face Validity of Subscales and Individual Items:
The 23-item scale consists of two subscales aggregated to measure acculturation. Questions in the demographic index assess generation level in the U.S., current language preference, fluency in Spanish, and ethnicity of childhood friends. The psychological index includes items tapping behavioral preferences, cultural integration and ethnic loyalty.
Saldana, D. H. (1994). Acculturative stress: Minority status and distress. Hispanic Journal of Behavioral Sciences, 16(2), 116-128.
6. Cultural Adaptation Pain Scale
(Sandhu, Portes, & McPhee, 1996)
What theory (if any) does the scale test? What is the purpose?
The scale is constructed to assess cultural adaptation and psychological pain associated with the acculturation process.
Examine the Face Validity of Subscales and Individual Items:
Scale consists of 55 counterbalanced statements, reporting on a 5-point Likert scale. The items measure pain and distress: sense of being alienated; learned helplessness: pessimism concerning limited options in life; positive adaptation: sense of belonging, identity, functioning; bigoted: promotion of ethnic stereotypes and slurs.
Sandhu, D. S., Portes, P. R., & McPhee, S. A. (1996). Assessing cultural adaptation: Psychometric properties of the cultural adaptation pain scale. Journal of Multicultural Counseling and Development, 24, 15-25.
7. Ethnic Self-Identification
(Phinney, 1990)
What theory (if any) does the scale test? What is the purpose?
The conceptual framework is drawn from research review and attempts to capture self-definition with a particular group.
Examine the Face Validity of Subscales and Individual Items:
Items measured include sense of belonging; positive and negative attitudes toward one's ethnic group; social participation and cultural practices; language use and preference; importance and percentage of in-group friends and dating partners; religious affiliation and practice; structured ethnic social groups; political ideology and activity, e.g. commitment to in-group politics and political runners; area of residence, e.g. proportion of in-group members within neighborhood; miscellaneous ethnic/cultural activities and attitudes, e.g. music and food preferences.
Phinney, J. S. (1990). Ethnic identity in adolescent and adults: Review of research. Psychological Bulletin, 108(3), 499-514.
8. Multidimensional Racial Identity Scale (MRIS)-Revised
(Thompson, V.L., 1995)
What theory (if any) does the scale test? What is the purpose?
The scale attempts to provide an assessment of African American ethnic identity along several dimensions.
Examine the Face Validity of Subscales and Individual Items:
The MRIS-R consists of four subscales, or factors: a psychological factor, a physical factor, a cultural factor, and a sociopolitical factor. Items within the psychological factor address issues related to (1) commitment to, (2) attachment to and (3) concern for black people and the African American community. Items that make up the physical factor assess the acceptance of physical features typically associated with blacks and African Americans. Items from the cultural factor measure attitudes toward black and African literature, music, and art. Items within the sociopolitical factor measure the individual's awareness of and beliefs about the caste of blacks and African Americans.
Thompson, V. L. (1995). The multidimensional structure of racial identification. Journal of Research in Personality, 29, 208-222.
9. African self-consciousness Scale
(Baldwin & Bell, 1985)
What theory (if any) does the scale test? What is the purpose?
The scale attempts to provide an assessment of African American ethnic identity along several dimensions.
Examine the Face Validity of Subscales and Individual Items:
The 42 items in this scale are designed to measure awareness/ recognition of one's African identity and heritage; general ideological and priority of activities based on Black survival, liberation and proactive/ affirmative development; preference of Africentric values, customs and institutions; attitude of resistance toward "anti-black" forces, and threats to black survival.
Baldwin, J. A., & Bell, Y. (1985). The African self-consciousness scale: An Africentric personality questionnaire. The Western Journal of Black Studies, 9, 61-68.
10. Black Racial Identity Attitude Scale-Form B
(Helms, 1990)
What theory (if any) does the scale test? What is the purpose?
Within-group and intracultural variance exists in racial-ethnic minority groups (i.e., groups are not homogeneous). The BRIAS-Form B attempts to operationalize Cross' 5-stage model of "Nigrescence", or Negro-to-Black conversion. In his model, Cross explains different levels of racial identity among members of the black community according to stages: Preencounter, Encounter, Immersion-Emersion, and Internalization.
Examine the Face Validity of Subscales and Individual Items:
Items from each subscale relate to the defining features of each stage. Items in the Preencounter subscale measure the degree of adoption of Euro-American world views and behaviors and devaluation of black culture. Items from the Encounter subscale assess the extent to which (1) a critical personal experience has challenged an individual's current world view and (2) an individual has become receptive to new world views and has begun to search for a new identity. The Immersion-Emersion subscale estimates psychological withdrawal and immersion into black experiences and culture (i.e., how much the individual discredits "Whiteness" and idealizes "Blackness"). The Internalization subscale the individual's self-confidence and security with his or her Black identity.
Helms, J. E. (1990). Black and White Racial Identity: Theory, Research, and Practice. New York: Greenwood Press.
11. White Racial Identity Attitude Scale
(Helms & Carter, 1990)
What theory (if any) does the scale test? What is the purpose?
The WRIAS attempts to operationalize Helms' (1984) theory of White racial identity. According to her theory, as Whites become racially conscious, they progress through two phases of development: Phase I (Abandonment of Racism), which includes the Contact, Disintegration, and Reintegration stages and Phase II (Defining a Nonracist White Identity), which consists of the Pseudo-independence, Immersion/ Emersion, and Autonomy stages .
Examine the Face Validity of Subscales and Individual Items:
The WRIAS is a self-report measure consisting of 50 items, each rated on a five-point Likert scale. They measure the attitudes associated with 5 of the 6 stages in Helms' model of racial identity development. The Contact subscale consists of items related to naivete about Blacks and racial differences. The Disintegration subscale assesses the amount of anxiety, depression, and guilt resulting from conflict between internal moral standards about past injustices against Blacks and fear of exclusion by White peers. The Reintegration subscale measures hostility and anger toward Black culture and positive biases toward White culture. The Pseudo-independence subscale identifies the degree of genuine curiosity about cross-racial relations, intellectualized acceptance of Blacks, and positive identification with one's Whiteness. Finally, the Autonomy subscale indicates the amount of appreciation for racial differences and involvement in cross-racial interactions.
Helms, J. E. (1990). Black and White Racial Identity: Theory, Research, and Practice. New York: Greenwood Press.
12. Jewish Rating Scale
(Dor-Shav, 1990)
What theory (if any) does the scale test? What is the purpose?
This scale attempts to measure children's ethnic identification as Jewish.
Examine the Face Validity of Subscales and Individual Items:
This scale is administered as a structured questionnaire with criterion questions "Why are you a Jew? What makes you a Jew?" It discriminates between eight-levels of children's modes of self-identification as Jewish.
Dor-Shav, Z. (1990). Development of an ethnic self-definition: The ethnic self-concept "Jew" among Israeli children. International Journal of Behavior Development, 13(3), 317-332.
13. Multigroup Ethnic Identity Measure
(Phinney, 1992)
What theory (if any) does the scale test? What is the purpose?
Groups share common elements of ethnic identity. This measure assesses similarities and differences in ethnic identity so that researchers can study and compare ethnic identity and its correlates across all ethnic groups.
Phinney, J. (1992). The Multigroup Ethnic Identity Measure: A new scale for use with diverse groups. Journal of Adolescent Research. Journal of Adolescent Research, 7, 156-176.
Exposure to Discrimination
14. Scale for the Effects of Ethnicity and Discrimination (SEED)
(Cardo, 1994)
What theory (if any) does the scale test? What is the purpose?
The scale is designed to measure ethnicity and discrimination (35 items, unknown point scale).
Examine the Face Validity of Subscales and Individual Items:
Items measured include those tapping valence of ethnicity for self (VES), dealing with individual's own ethnic identity; valence of ethnicity for others (VEO), dealing with knowledge of and reaction toward other ethnic groups; and perception of discrimination (PD), dealing with perceived effects of selective, differential treatment based on one's ethnic group membership.
Cardo, L. M. (1994). Development of an instrument measuring valence of ethnicity and perception of discrimination. Journal of Multicultural Counseling and Development, 22, 49-59.
15. Cultural Mistrust Inventory
(Terrell & Terrell, 1981)
What theory (if any) does the scale test? What is the purpose?
The scale was developed to measure the degree of mistrust of Whites and White related institutions by individuals (assumed to be a result of exposure to discrimination).
Examine the Face Validity of Subscales and Individual Items:
CMI is scored on a 7-point Likert scale with 48 items with items tapping mistrust in education and training; mistrust in law and politics; mistrust in work and business; mistrust in interpersonal and social settings
Terrell, F., & Terrell, S. L. (1981). An inventory to measure cultural mistrust among Blacks. Western Journal of Black Studies, 5(3), 180-184.
Deprivation
16. Index of Multiple Deprivation
(Townsend, 1987)
What theory (if any) does the scale test? What is the purpose?
The questionnaire attempts to capture indicators of deprived conditions, experiences and behaviors.
Examine the Face Validity of Subscales and Individual Items:
Subscales measured include Material Deprivation (dietary, clothing, housing, home facilities, environment, location, work) and Social Deprivation (rights to employment, family activities, integration into community, formal participation in social institutions, recreation, education)
Townsend, P. (1987). Deprivation. Journal of Social Policy, 16(2), 125-146.
SES Measures
The following are not developed scales, but suggestions of a variety of areas that may be important to examine in assessing the socio-economic status of the population of clients one is working with.
A. Poverty
Items to consider measuring:
- neighborhood poverty, i.e. Tract & Block-group U.S. census (Bureau of Census, 1990)
- social class and employment status.
- composite of household income, education and occupational status (Knupfer & Room, 1970).
- work history, autonomy, and decision-making authority (suggested additions by Schneider, 1986)
Items to consider measuring:
- Earned school diplomas (high school, BS, graduate or professional, etc)
- Patterns of schooling (i.e. only during non-harvest time, or year round schooling)
B. Private or Public Insurance
C. Social environment (Suggested by Lillie-Blanton & LaViest, 1996)
Items to consider measuring:
- Socio-economic (e.g. employment, education)
- Physical surroundings (e.g. neighborhood and work conditions, resources available)
- Social relations (e.g. within a community or workplace, i.e. segregation)
- Power arrangements (e.g. political empowerment, individual and community control
and influence)
Lillie-Blanton, M., & LaVeist, T. (1996). Race/ethnicity, the social environment, and health. Social Science & Medicine, 43(1), 83-92.
Table of Contents | Previous | Next
|
