Cultural Competency
Prepared by the Substance Abuse and Mental Health Services Administration
(SAMHSA) Disaster Technical Assistance Center (DTAC), ESI, under contract
with the Emergency Mental Health and Traumatic Stress Services Branch, Center
for Mental Health Services, SAMHSA.
Peer-Reviewed Journal Articles
Aderibigbe, Y.A., Bloch, R.M. and Pandurangi, A. (2003). Emotional
and somatic distress in eastern North Carolina: Help-seeking behaviors. International
Journal of Social Psychiatry. 49(2):126-41.
A telephone survey within eastern North Carolina using random-digit
dialing was used to determine the socio-demographic characteristics and ethnic
differences in the types of support sought after a disaster within a rural
community. African-Americans were more likely to seek support from clergy
and use support groups than European-Americans.
Campo, A.E. (2001). Psychiatric consultation to schools on remote
islands. Child and Adolescent Psychiatric Clinics of North America. 10(1):161-8.
The authors describe collaboration between child psychologists, agencies,
and community organizations in providing psychiatric support to schools on
remote islands.
Dana, R.H. (2002). Mental health services for African Americans:
A cultural/racial perspective. Cultural Diversity in Ethnic Minority Psychology.
8(1):3-18.
The article discusses the cultural differences of treating African-Americans
in an effort to improve services, explore the “cultural self,” and provide
a cultural/racial perspective. An assessment-intervention model is used to
illustrate a culturally aware method of treatment.
Fothergil, A., Maestas, E.G., and Darlington, J.D. (1999). Race,
ethnicity and disasters in the United States: A review of the literature.
Disasters. 23(2): 156-73.
This literature review examined issues of race and ethnicity in emergency
response, recovery, and reconstruction. The authors discuss how different
ethnic groups react to natural hazards risks and respond to warnings, and
how groups are affected differently. The groups are presented in a matrix
to reveal patterns of racial and ethnic inequalities in disaster response.
Jones, R.T., Frary, R., Cunningham, P., Weddle, J.D., and Kaiser,
L. (2001). The psychological effects of Hurricane Andrew on ethnic minority
and Caucasian children and adolescents: A case study. Cultural Diversity and
Ethnic Minority Psychology. 7(1):103-8.
The study explores gender and racial differences regarding the impact
of Hurricane Andrew on African-American, Caucasian, and Hispanic elementary
and middle school children. Findings show higher levels of symptomatology
for girls, and no differences among the racial groups. The study seeks to
inspire future studies.
Kaniasty, K. and Norris, F.H. (2000). Help-seeking comfort and receiving
social support: The role of ethnicity and context of need. American Journal
of Community Psychology. 28(4):545-81.
The study assesses the correlation between comfort in seeking help
and the subsequent amount of social support among Latinos, African-Americans,
and European-Americans. Set within the context of Hurricane Andrew, an emergency
setting, and a non-emergency setting two years later, the results indicate
all groups had high levels of comfort and support in emergency situations,
but in non-emergency situations, Latinos received the least support.
Lo, H.T. and Fung, K.P. (2003). Culturally competent psychotherapy.
Canadian Journal of Psychiatry. 48(3):161-70.
The authors provide guidelines to therapists in generic and specific
cultural competence to treat patients more effectively. Clinically relevant
issues are discussed for each phase of psychotherapy, and the authors advocate
using cultural analysis DSM-IV cultural formulation model in treatment. Several
techniques and strategies to enhance clinician effectiveness are described.
Manoleas, P., Organista, K., Negron-Velasquez, G., and McCormick,
K. (2000). Characteristics of Latino health clinicians: A preliminary examination.
Community Mental Health Journal. 36(4):383-94.
This preliminary study explores the characteristics of experienced
Latino psychotherapists, who serve predominately Latino clients, to determine
elements of cultural competence in clinical interventions.
Marsella, A.J. (1993). Counseling and psychotherapy with Japanese
Americans: Cross-cultural considerations. American Journal of Orthopsychiatry.
63(2):200-8.
This is a literature review of mental health services and issues
for Japanese-Americans, with an emphasis on the effects of verbal and nonverbal
factors in therapy. Traditional Japanese cultural values and behaviors are
addressed.
Norris, F.H., Perilla, J.L., and Murphy, A.D. (2001). Postdisaster
stress in the United States and Mexico: A cross-cultural test of the multicriterion
conceptual model of posttraumatic stress disorder. Journal of Abnormal Psychology.
110(4):553-63.
This study measures and assesses posttraumatic stress disorder (PTSD) using
the Revised Civilian Mississippi Scale on samples drawn from the United States
after Hurricane Andrew and from Mexico after Hurricane Paulina. Although the
study does not address the severity of symptoms, results indicate that PTSD
should be examined further in Latin American societies.
Pedersen, P.B., Carter, R.T., and Ponterotto, J.G. (1996). The cultural
context of psychology: Questions for accurate research and appropriate practice.
Cultural Diversity in Mental Health. 2(3):205-16.
This article summarizes the August 1995 conference titled “The Cultural
Context of Psychology.” Subdivided into three areas: knowledge, skills, and
awareness, the article provides topics for future research and discussion.
Pfefferbaum, B. (1997). Posttraumatic stress disorder in children:
A review of the past 10 years. Journal of the American Academy of Child and
Adolescent Psychiatry. 36(11):1503-11.
This is a literature review of posttraumatic stress disorder (PTSD)
in children, specifically addressing factors such as comorbidity, gender,
age, developmental level, cultural competence, and children’s response to
disaster. The author further summarizes the assessment, treatment, and clinical
presentation of PTSD over the past decade, and addresses the lack of longitudinal
research.
Salvendy, J.T. (1999). Ethnocultural considerations in group psychotherapy.
International Journal of Psychotherapy. 49(4):429-64.
This is a literature review of cultural competency in group psychotherapy,
specifying the socio-cultural elements specific to group therapy. The author
recommends modifying the group therapy curriculum and providing cultural training
for group therapists to create a culturally sensitive treatment program.
Schwab-Stone, M., Ruchkin, V., Vermeiren, R., and Leckman, P. (2001).
Cultural considerations in the treatment of children and adolescents. Operationalizing
the importance of culture in treatment. Child and Adolescent Psychiatry Clinics
of North America. 10(4):729-43.
To effectively treat clients, therapists must constantly evaluate
cultural constructs and differences within every context. The authors also
warn that therapists should be careful of stereotypes.
Shalev, A.Y. (2000). Biological responses to disasters. Psychiatric
Quarterly. 71(3):277-88.
This paper discusses the biological mechanisms that are triggered
by stress, and how responses are shaped by biological, personal, and cultural
factors. The author also describes how irreversible neuronal damage can result
in those with traumatic stress disorders.
Sue, S. (1998). In search of cultural competence in psychotherapy
and counseling. American Psychology. 53(4):440-8.
This article discusses whether a therapist of the same ethnicity
as the client can provide more effective treatment; if clients who seek ethnic-targeted
services have better outcomes in treatment; and how a cognitive match of client
and therapist may correlate with the outcome.
Wallace, B.C. (1993). Cross-cultural counseling with the chemically
dependent: Preparing for service delivery within a culture of violence. Journal
of Psychoactive Drugs. 25(1):9-20.
This article discusses culturally competent treatment programs for
group therapy. The author places society in a “culture of violence,” and evaluates
how chemically dependent minorities have been affected by personal and cultural
traumas. Future research topics are suggested.
Warheit, G.J., Zimmerman, R.S., Khoury, E.L., Vega, W.A., and Gil,
A.G. (1996). Disaster related stresses, depressive signs and symptoms, and
suicidal ideation among a multi-racial/ethnic sample of adolescents: A longitudinal
analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines.
37(4):435-44.
This article presents the findings of a longitudinal study evaluating the
relationship between disaster-related stress, suicide, and depression among
a multi-ethnic sample of adolescents who experienced Hurricane Andrew. Results
indicate that being female or of low socioeconomic status, having pre-existing
depression, high stress, or poor family support all directly affect post-hurricane
suicidal ideation.
SAMHSA and Other Publications
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
The Role of Culture in Helping Children Recover from a Disaster
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Age-Specific Interventions at Home for Children in Trauma: From Preschool
to Adolescence
SAMHSA’s National Mental Health Information Center
Center for Mental Health Services
Cultural Competence in Serving Children and Adolescents With Mental Health
Problems
SAMHSA’s National Mental Health Information Center
Center for Mental Health Services
Cultural Competence Standards in Managed Care Mental Health Services: Four
Underserved/Underrepresented Racial/Ethnic Groups
National Technical Assistance Center for State Mental Health Planning
Cultural Diversity Series: Meeting the Mental Health Needs of Persons Who
Are Deaf
National Technical Assistance Center for State Mental Health Planning
Cultural Diversity Series: Meeting the Mental Health Needs of Asian and Pacific
Islander Americans
National Technical Assistance Center for State Mental Health Planning
Cultural Diversity Series: Creating Culturally Competent Mental Health Systems
for Latinos: Perspectives from an Expert Panel
National Technical Assistance Center for State Mental Health Planning
Examples from the Field: Programmatic Efforts To Improve Cultural Competence
in Mental Health Services
National Technical Assistance Center for State Mental Health Planning
Cultural Diversity Series: Meeting the Mental Health Needs of Gay, Lesbian,
Bisexual and Transgender Persons
National Technical Assistance Center for State Mental Health Planning
Cultural Diversity Series: Meeting the Mental Health Needs of African Americans
State Program Materials
Texas Department of Mental Health and Mental Retardation
Disaster Assistance Training Program: Cultural Competency Powerpoint Training
Materials
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Assistance and Training 
