Abstract
As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children’s Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.
Similar content being viewed by others
References
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293–302.
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. doi:10.1377/hlthaff.24.2.499.
Brach, C., & Fraserirector, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57(Supplement 1), 181–217. doi:10.1177/107755800773743655.
Brunk, M., Koch, J. R., & McCall, B. (2000). Report on parent satisfaction with services at community services boards. Charlottesville, VA: Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services.
Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnick, D., et al. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70, 44–55.
Center for Mental Health Services. (2006). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program. Atlanta, GA: ORC Macro.
Constantine, M. G. (2002). Predictors of satisfaction with counseling: Racial and ethnic minority clients’ attitudes toward counseling and ratings of their counselors’ general and multicultural counseling competence. Journal of Counseling Psychology, 49, 255–263.
Cook, J.R., & Kilmer, R.P. (2010). Systems of care: New partnerships for community psychology. American Journal of Community Psychology.
Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.
Darnell, A. J., & Kuperminc, G. P. (2006). Organizational cultural competence in mental health service delivery: A multilevel analysis. Journal of Multicultural Counseling and Development, 34, 194–207.
Foster-Fishman, P., Nowell, B., & Yang, H. (2007). Putting the system back into systems change: A framework for understanding and changing organizational and community systems. American Journal of Community Psychology, 39, 197–216. doi:10.1007/s10464-007-9109-0.
Hernandez, M., & Hodges, S. (2003). Building upon the theory of change for systems of care. Journal of Emotional and Behavioral Disorders, 11, 19–26.
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 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.
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.
Holden, E. W., Friedman, R. M., & Santiago, R. L. (2001). Overview of the national evaluation of the comprehensive community mental health services for children and their families program. Journal of Emotional and Behavioral Disorders, 9, 4–12.
Isaacs, M. (1998). The state of the states: Responses to cultural competence and diversity in child mental health. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.
Kelly, J. G. (1968). Toward an ecological conception of preventive interventions. In J. Carter Jr (Ed.), Research contributions from psychology to community mental health (pp. 77–99). New York: Behavior Publications.
Lourie, I. S. (1994). Principles of local system development for children, adolescents, and their families. Chicago: Kaleidoscope.
Manteuffel, B., Stephens, R. L., & Santiago, R. (2002). Overview of the national evaluation of the comprehensive community mental health services for children and their families program and summary of current findings. Children’s Services: Social Policy, Research, and Practice, 5, 3–20.
President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: US Department of Health and Human Services.
Prilleltensky, I., & Prilleltensky, O. (2006). Promoting well-being: Linking personal, organizational, and community change. New York: Wiley.
Pullman, M. D. (2009). Participatory research in systems of care for children’s mental health. American Journal of Community Psychology, 44, 43–53.
Pumariega, A. J., Rogers, K., & Rothe, E. (2005). Culturally competent systems of care for children’s mental health: Advances and challenges. Community Mental Health Journal, 41, 539–556.
Pumariega, A. J., Rothe, E., & Rogers, K. (2009). Cultural competence in child psychiatric practice. Journal of American Academy of Child and Adolescent Psychiatry, 48, 362–366. doi:10.1097/CHI.0b013e31819aaca8.
Rabe-Hesketh, S., Skrondal, A., & Pickles, A. (2004). “GLLAMM Manual” (October 2004). U.C. Berkeley Division of Biostatistics Working Paper Series. Working Paper 160. Available at http://www.bepress.com/ucbbiostat/paper160.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, Calif: Sage Publications.
Siegel, C., Davis-Chambers, E., Haugland, G., Bank, R., Aponte, C., & McCombs, H. (2000). Performance measures of cultural competency in mental health organizations. Administration and Policy in Mental Health, 28, 91–106.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press.
StataCorp, L. P. (2007). Stata statistical software: Release 10. College Station, TX: StataCorp LP.
Stroul, B. A., & Blau, G. M. (2010). Defining the system of care concept and philosophy: To update or not to update. Evaluation and Program Planning, 33, 59–62. doi:10.1016/j.evalprogplan.2009.06.003.
Stroul, B. A., & Friedman, R. M. (1986). A system of care for children and youth with severe emotional disturbances. Washington, D.C.: CASSP Technical Assistance Center for Child Health and Mental Policy, Georgetown University Child Development Center.
Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53, 440–448.
Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice (3rd ed.). New York: John Wiley.
Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60, 525–548. doi:10.1146/annurev.psych.60.110707.163651.
Telfair, J., Bronheim, S. M., & Harrison, S. (2009). Implementation of culturally and linguistically competent policies by State Title V children with special health care needs (CSHCN) programs. Maternal and Child Health Journal, 13, 677–686. doi:10.1007/s10995-008-0407-4.
Trickett, E. J. (2009). Community psychology: Individuals and interventions in community context. Annual Review of Psychology, 60, 395–419. doi:10.1146/annurev.psych.60.110707.163587.
US Dept of Health Human Services. (2001). Mental health: Culture, race, and ethnicity–A supplement to mental health: A report of the surgeon general. Rockville, MD: Author.
Whaley, A. L., & Longoria, R. A. (2008). Assessing cultural competence readiness in community mental health centers: A multidimensional scaling analysis. Psychological Services, 5, 169–183. doi:10.1037/1541-1559.5.2.169.
Acknowledgments
This work was supported in part by contracts #280-97-8914, #280-00-8040, and #280-99-8023 to ICF Macro from Center for Mental Health Services within SAMHSA, and NIMH 1R01MH075828-01A1 (PI: Philip J. Leaf).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barksdale, C.L., Ottley, P.G., Stephens, R. et al. System-Level Change in Cultural and Linguistic Competence (CLC): How Changes in CLC are Related to Service Experience Outcomes in Systems of Care. Am J Community Psychol 49, 483–493 (2012). https://doi.org/10.1007/s10464-011-9442-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10464-011-9442-1