Developing Cultural Competence in Disaster Mental Health Programs:
Guiding Principles and Recommendations

Appendix F:

Cultural Competence Checklist for Disaster Crisis Counseling Programs

Cultural competence should be integrated into a community emergency mental health management plan before a disaster actually occurs. When disaster strikes, certain principles must be followed to ensure a culturally competent disaster crisis counseling program. The following checklist can assist in developing cultural competence in disaster crisis counseling programs. You also can use this checklist as an informal program assessment tool. For this purpose, use the check boxes to insert a numerical ranking from 1 to 3, with 1 reflecting the cultural pre-competence stage of development (good intentions, no actions yet); 2 representing the cultural competence stage (importance recognized, some actions underway); and 3 denoting the cultural proficiency stage (effective program in place). The terminology used to describe these phases was drawn from the Cultural Competence Continuum developed by Cross and colleagues (1989).

Recognize the importance of culture and respect diversity.
	Complete a self-assessment to determine your own beliefs about culture.
	Encourage staff to complete self-assessments in order to understand their own cultures and worldviews; examine their own attitudes, values, and beliefs about culture; and acknowledge cultural differences.
	Assess capabilities of the counselors to understand and respect the values, customs, beliefs, language, and interpersonal style of the disaster survivor.
	Seek evidence that you/staff respect the importance of verbal and nonverbal communication, space, social organization, time, and environment control within various cultures.
Maintain a current profile of the cultural composition of the community.
	Develop and periodically update a community profile that describes the community’s composition in terms of race and ethnicity, age, gender, religion, refugee and immigrant status, housing status, income and poverty levels, percentage of residents living in rural versus urban areas, unemployment rate, language and dialects, literacy level, and number of schools and businesses.
	Include in the profile information about the values, beliefs, social and family norms, traditions, practices, and politics of local cultural groups, and historical racial relations or ethnic issues.
	Gather information in consultation with community cultural leaders who represent and understand local cultural groups.
Recruit disaster workers who are representative of the community or service area.
	Review the community profile when recruiting disaster crisis counseling workers and attempt to recruit workers from the ethnic and cultural groups included among the survivors.
	If workers from the community or service area are not available, recruit others with backgrounds and language skills similar to those of local residents.
	Assess disaster workers’ personal attributes, knowledge, and skills as they relate to cultural competence.
Provide ongoing cultural competence training to disaster mental health staff.
	Offer ongoing cultural competence training (e.g., in-service training and regularly scheduled meetings) to service providers, administrators and managers, language and sign interpreters, and temporary staff.
	Involve community-based groups with expertise in cultural competence or in the needs of specific cultures.
	Allot time for training participants to examine and assess their values, attitudes, and beliefs about their own and other cultures.
Ensure that services are accessible, appropriate, and equitable.
	Identify and take steps to overcome reluctance of ethnic groups to use services because of mistrust of the system or previous inequitable treatment.
	Identify and take steps to eliminate service barriers that occur as a result of racial and ethnic discrimination, language barriers, transportation issues, and the stigma associated with counseling services.
	Involve representatives of diverse cultural groups in program committees, planning boards, and policy-setting bodies and in decision making.
	Identify and use strategies to address specific concerns of refugees who had negative experiences that make them suspicious of government intervention.
Recognize the role of help-seeking behaviors, customs and traditions, and natural support networks. Identify and use strategies to:
	Identify cultural patterns that may influence help-seeking behaviors.
	Build trusting relationships and rapport with disaster survivors.
	Recognize that survivors may find traditional relief procedures confusing or difficult.
	Recognize individual cultures’ customs and traditions related to healing, trauma, and loss, and identify how these customs and traditions influence an individual’s receptivity to and need for assistance.
	Acknowledge cultural beliefs about healing and recognize their importance to some disaster survivors.
	Help survivors reestablish rituals; organize culturally appropriate anniversary activities and commemorations.
	Recognize that outreach efforts focused only on the individual may not be effective for people whose cultures are centered around family and community.
	Determine who is significant in survivors’ families and social spheres by listening to their descriptions of the home, family, and community.
Involve community leaders and organizations representing diverse cultural groups as cultural brokers.
	Collaborate with trusted leaders (e.g., spiritual leaders, clergy members, and teachers) who know the community.
	Invite organizations representing cultural groups and other special interest groups in the community to participate in disaster mental health program planning and service delivery.
	Collaborate with community-based organizations to communicate with the cultural groups they represent.
	Identify effective ways to work with informal culture-specific groups.
	Coordinate with other public and private agencies in responding to the disaster.
Ensure that services and information are culturally and linguistically competent.
	Identify indigenous workers who speak the language of the survivors; use interpreters only when necessary.
	Identify trained interpreters who share the disaster survivors’ cultural backgrounds.
	Determine the dialect of the disaster survivor before asking for an interpreter.
	Assess the level of acculturation of the interpreter in relation to that of the disaster survivors.
	Establish a plan for providing written materials in languages other than English and at the literacy level of the target population.
	Provide means to reach people who are deaf or hard of hearing.
	Consult with cultural groups in the community to determine the most effective outreach activities.
	Use existing community resources (e.g., multicultural television and radio stations) to enhance outreach efforts.
Assess and evaluate the program’s level of cultural competence.
	Continuously assess the program to identify and correct problems that may impede the delivery of culturally competent services.
	Incorporate process evaluation into the crisis counseling program.
	Involve representatives of various cultural groups in process evaluation.
	Communicate process evaluation findings to key informants and cultural groups engaged in the program.

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