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Reframing the Concept of Cultural Competence to Enhance Delivery of Behavioral Health Services to Culturally Diverse Populations

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Foundations of Behavioral Health

Abstract

This chapter presents a practical framework for making behavioral health services and supports accessible and appropriate for culturally diverse populations. It begins with an overview of important concepts, particularly behavioral health disparities and health equity, which have shaped research and practice efforts aimed at ensuring that all people receive the services and supports they need. It follows with an examination of “cultural competence” as a concept and how it has evolved. An implementation-based conceptual model is also presented, which operationalizes cultural competence from an organizational perspective and discusses issues with regard to its implementation in service delivery settings, as well as implications for future research and practice.

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References

  • Akutsu, P. D., Snowden, L. R., & Organista, K. C. (1996). Referral patterns in ethnic specific and mainstream programs for ethnic minorities and whites. Journal of Counseling Psychology, 43, 56–64.

    Article  Google Scholar 

  • Alegría, M., Canino, G., Lai, S., Ramirez, R. R., Chavez, L., Rusch, D., & Shrout, P. E. (2004). Understanding caregivers’ help-seeking for Latino children’s mental health care use. Medical Care, 42, 447–455.

    Article  Google Scholar 

  • Alvidrez, J. (1999). Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Mental Health Journal, 35, 515–530.

    Article  Google Scholar 

  • Bailey, D. B., Jr., Skinner, D., Rodriguez, P., Gut, D., & Correa, V. (1999). Awareness, use, and satisfaction with services for Latino parents of young children with disabilities. Exceptional Children, 65, 367–381.

    Article  Google Scholar 

  • Aronson, J., Burgess, D., Phelan, S. M., & Juarez, L. (2013). Unhealthy interactions: The role of stereotype threat in health disparities. American Journal of Public Health, 103(1), 50–56. https://doi.org/10.2105/AJPH.2012.300828

  • Bates, D. G., & Plog, F. (1990). Cultural anthropology. New York, NY, US: McGraw-Hill.

    Google Scholar 

  • Barten, F., Mitlin, D., Mulholland, C., Hardoy, A., & Stern, R. (2007). Integrated approaches to address the social determinants of health for reducing health inequity. Journal of Urban Health, 84(3 Suppl), i164–173. http://doi.org/10.1007/s11524-007-9173-7

    Google Scholar 

  • Bernal, G., & Domenech-Rodriguez, M. M. (Eds.). (2012). Cultural adaptations: Tools for evidence-based practice with diverse populations. Washington, DC: American Psychological Association.

    Google Scholar 

  • Bernal, G., & Sáez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34, 121–132.

    Article  Google Scholar 

  • Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24, 499–505.

    Article  Google Scholar 

  • Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7, 1–10.

    Article  Google Scholar 

  • Bonham, V. L., Warshauer-Baker, E., & Collins, F. S. (2005). Race and ethnicity in the genome era. American Psychologist, 60, 9–15.

    Article  Google Scholar 

  • Braveman, P. (2014). What are health disparities and health equity? We need to be clear. Nursing in 3D: Diversity, disparities, and social determinants. Public Health Reports, 129(Suppl. 2), 5–8.

    Article  Google Scholar 

  • Brooks, C., & Bolzendahl, C. (2004). The transformation of US gender role attitudes: Cohort replacement, social-structural change, and ideological learning. Social Science Research, 33, 106–133.

    Article  Google Scholar 

  • Busch, A. B., Yoon, F., Barry, C. L., Azzone, V., Normand, S. L., Goldman, H. H., & Huskamp, H. A. (2012). The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders. American Journal of Psychiatry, 170, 180–187.

    Article  Google Scholar 

  • Callejas, L. M., Hernandez, M., Nesman, T., & Mowery, D. (2010). Creating a front porch: Improving access to behavioral health services for diverse children and families. Evaluation and Program Planning, 33, 32–35.

    Article  Google Scholar 

  • Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Counsulting and Clinical Psychology, 70, 44–55.

    Article  Google Scholar 

  • Coard, S. I., & Holden, E. W. (1998). The effect of racial and ethnic diversity on the delivery of mental health services in pediatric primary care. Journal of Clinical Psychology in Medical Settings, 5, 275–294.

    Article  Google Scholar 

  • Chow, J. C. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93, 792–797.

    Article  Google Scholar 

  • Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: Vol. I. A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.

    Google Scholar 

  • Diamond, L. M., & Butterworth, M. (2008). Questioning gender and sexual identity: Dynamic links over time. Sex Roles, 59, 365–376.

    Article  Google Scholar 

  • Drescher, J. (2009). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual. Archives of Sexual Behavior, 39, 427–460.

    Article  Google Scholar 

  • Dressler, W. W. (1993). Health in the African American community: Accounting for health inequalities. Medical Anthropology Quarterly, 7, 325–345.

    Article  Google Scholar 

  • Fine, M. J., Ibrahim, S. A., & Thomas, S. B. (2005). The role of race and genetics in health disparities research. American Journal of Public Health, 95, 2125–2128.

    Article  Google Scholar 

  • Gamst, G., Dana, R. H., Der-Karabetian, A., Aragon, M., Arellano, L., & Kramer, T. (2002). Effects of Latino acculturation and ethnic identity on mental health outcomes. Hispanic Journal of Behavioral Sciences, 24, 479–505.

    Article  Google Scholar 

  • Guarnaccia, P., & Rodriguez, O. (1996). Concepts of culture and their role in the development of culturally competent mental health services. Hispanic Journal of Behavioral Sciences, 18, 418–443.

    Article  Google Scholar 

  • Guerra, N. G., & Jagers, R. (1998). The importance of culture in the assessment of children and youth. In V. C. McLoyd & L. Steinberg (Eds.), Studying minority adolescents: Conceptual, methodological, and theoretical issues (pp. 167–181). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Harris, M. (1968). The rise of anthropological theory. New York, NY: Crowell.

    Google Scholar 

  • Hernandez, M., Nesman, T., Mowery, D., Acevedo-Polakovich, I. D., & Callejas, L. M. (2009). Cultural competence: A literature review and conceptual model for mental health services. Psychiatric Services, 60, 1046–1050.

    Article  Google Scholar 

  • Hernandez, M., Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children’s mental health services. (Making children’s mental health services successful series, FMHI pub. no. 240-1). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children’s Mental Health.

    Google Scholar 

  • Hough, R. L., Hazen, A. L., Soriano, F. I., Wood, P., McCabe, K., & Yeh, M. (2002). Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services, 53, 1556–1562.

    Article  Google Scholar 

  • Huey, S. J., Jr., & Polo, A. J. (2010). Assessing the effects of evidence-based psychotherapies with ethnic minority youths. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 451–455). New York, NY: Guilford Press.

    Google Scholar 

  • Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press.

    Google Scholar 

  • Isaacs, M. R., Huang, L. N., Hernandez, M., Echo-Hawk, H., Acevedo-Polakovich, I. D., & Martinez, K. (2008). Services for youth and their families in diverse communities. In B. A. Stroul & G. M. Blau (Eds.), The system of care handbook: Transforming mental health services for children, youth, and families (pp. 619–639). Baltimore, MD: Paul H. Brookes Publishing Co.

    Google Scholar 

  • Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.

    Article  Google Scholar 

  • Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Medicine, 3, 1673–1676.

    Article  Google Scholar 

  • LaVeist, T. A. (2005). Disentangling race and socioeconomic status: A key to understanding health inequalities. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 82, iii26–iii34.

    Article  Google Scholar 

  • Malat, J. (2013). The appeal and problems of a cultural competence approach to reducing racial disparities. Journal of General Internal Medicine, 28, 605–607.

    Article  Google Scholar 

  • Martinez, K., Callejas, L. M., & Hernandez, M. (2010). Community-defined evidence: A “bottom up” behavioral health approach to measure “what works” in Latino communities. Report on Emotional and Behavioral Disorders in Youth, 10, 11–16.

    Google Scholar 

  • President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America (Final report. DHHS Pub. No. SMA-03-3832). Rockville, MD: Author.

    Google Scholar 

  • Rollins, R. (2011). Building partnerships through the “National Stakeholder Strategy for achieving health equity”. Paper presented at the annual meeting of the Health Outcomes among Children and Families Living in Rural Communities Conference, Bethesda, MD.

    Google Scholar 

  • Saha, S., Korthuis, P. T., Cohn, J. A., Sharp, V. L., Moore, R. D., & Beach, M. C. (2013). Primary care provider cultural competence and racial disparities in HIV care and outcomes. Journal of General Internal Medicine, 28, 622–629.

    Article  Google Scholar 

  • SenGupta, S., Hopson, R., & Thompson-Robinson, M. (2004). Cultural competence in evaluation: An overview. New Directions for Evaluation, 102, 5–19.

    Article  Google Scholar 

  • Shavers, V. L., & Shavers, B. S. (2006). Racism and health inequity among Americans. Journal of National Medical Association, 98, 386–396.

    Google Scholar 

  • Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. American Psychologist, 60, 16–26.

    Article  Google Scholar 

  • Staudt, M. M. (2003). Helping children access and use services: A review. Journal of Child and Family Studies, 12, 49–60.

    Article  Google Scholar 

  • Tyler, E. B. (1923). Primitive culture: Researches into the development of mythology, philosophy, religion, language, art, and custom (Vol. 1, 7th ed.). New York, NY: Brentano.

    Google Scholar 

  • U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity – A supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

    Book  Google Scholar 

  • Vega, W. A., & Lopez, S. R. (2001). Priority issues in Latino mental health services research. Mental Health Services Research, 3, 189–200.

    Article  Google Scholar 

  • Whitehead, M. (1990). The concepts and principles of equity and health (EUR/ICP/RPD 414). Copenhagen, Denmark: WHO Regional Office for Europe. Retrieved from http://whqlibdoc.who.int/euro/-1993/EUR_ICP_RPD_414.pdf

    Google Scholar 

  • Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5, 65–77.

    Article  Google Scholar 

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Correspondence to Linda M. Callejas .

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Callejas, L.M., Hernandez, M. (2020). Reframing the Concept of Cultural Competence to Enhance Delivery of Behavioral Health Services to Culturally Diverse Populations. In: Levin, B.L., Hanson, A. (eds) Foundations of Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-030-18435-3_15

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