Improving Cultural Competence – NCBI Bookshelf

Improving Cultural Competence – NCBI Bookshelf


The development of culturally-responsive clinical skills is vital to the effectiveness of behavioral health services. According to the U. S. Department of Health and Human Services (HHS), cultural competence “refers to the ability to honor and respect the beliefs, languages, interpersonal styles, and behaviors of individuals and families receiving services, as well as staff members who are providing such services. Cultural competence is a dynamic, ongoing developmental process that requires a long-term commitment and is achieved over time” (HHS 2003a, p. 12). It has also been called “a set of behaviors, attitudes, and policies that … enable a system, agency, or group of professionals to work effectively in cross-cultural situations” (Cross et al. 1989, p. 13).

This Treatment Improvement Protocol (TIP) uses Sue’s (2001) multidimensional model for developing cultural competence. Adapted to address cultural competence across behavioral health settings, this model serves as a framework for targeting three organizational levels of treatment: individual counselor and staff, clinical and programmatic, and organizational and administrative. The chapters target specific racial, ethnic, and cultural considerations along with the core elements of cultural competence highlighted in the model. These core elements include cultural awareness, general cultural knowledge, cultural knowledge of behavioral health, and cultural skill development. The primary objective of this TIP is to assist readers in understanding the role of culture in the delivery of behavioral health services (both generally and with reference to specific cultural groups). This TIP is organized into six chapters and begins with an introduction to cultural competence. The following subheadings provide a summary of each chapter and an overview of this publication.


Joseph P. Gone on Cultural Competence

“We are all embedded in cultural processes and practices… we have a lot of assumptions and orientations that are cultural themselves these are not always shared with the people we work with.”

Joseph P. Gone, PhD, Associate Professor of Psychology (Clinical Area) and American Culture (Native American Studies) at the University of Michigan in Ann Arbor talks about cultural competence: what is it, what is the relationship between evidence-based practice and cultural competence and how does cultural competence relate to mental health care and mental health care for Indigenous populations in particular?

For more information on Dr. Gone, please visit his website

New Cultural Competence Guidelines for Child and Adolescent Psychiatry

The American Academy of Child and Adolescent Psychiatry (AACAP) Diversity and Culture Committee has developed practice parameters for cultural competence in child and adolescent psychiatric practice. The guidelines are based on an extensive literature review and expert consensus and include the following principles:

  1. Clinicians should identify and address barriers (economic, geographic, insurance, cultural beliefs, stigma, etc.) that may prevent culturally diverse children and their families from obtaining mental health services.
  2. Clinicians should conduct the evaluation in the language in which the child and family are proficient.
  3. Clinicians should understand the impact of dual-language competence on the child’s adaptation and functioning.
  4. Clinicians should be cognizant that cultural biases might interfere with their clinical judgment and work toward addressing these biases.
  5. Clinicians should apply knowledge of cultural differences in developmental progression, idiomatic expressions of distress, and symptomatic presentation for different disorders to the clinical formulation and diagnosis.
  6. Clinicians should assess for a history of immigration-related loss or trauma and community trauma (violence, abuse) in the child and family and address these concerns in treatment.
  7. Clinicians should evaluate and address in treatment the acculturation level and presence of acculturation stress and intergenerational acculturation family conflict in diverse children and families.
  8. Clinicians should make special efforts to include family members and key members of traditional extended families, such as grandparents or other elders, in assessment, treatment planning, and treatment.
  9. Clinicians should evaluate and incorporate cultural strengths (including values, beliefs, and attitudes) in their treatment interventions to enhance the child’s and family’s participation in treatment and its effectiveness.
  10. Clinicians should treat culturally diverse children and their families in familiar settings within their communities whenever possible.
  11. Clinicians should support parents to develop appropriate behavioural management skills consonant with their cultural values and beliefs.
  12. Clinicians should preferentially use evidence-based psychological and pharmacologic interventions specific for the ethnic/racial population of the child and family they are serving.
  13. Clinicians should identify ethnopharmacologic factors (pharmacogenomic, dietary, use of herbal cures) that may influence the child’s response to medications or experience of side effects.

Source: Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Adolescent Psychiatry Committee on Quality, I. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. J Am Acad Child Adolesc Psychiatry, 52(10), 1101-1115. doi: 10.1016/j.jaac.2013.06.019

Dr. Jaswant Guzder: Culture and working with families


“The whole trajectory of development is shaped by cultural expectations”

Dr. Jaswant Guzder, head of Child Psychiatry at the Jewish General Hospital discusses the influence of culture in her work with families. In her practice, she often encounters children and parents negotiating between two cultures, a Western one which often emphasizes individualism and the patient’s culture of origin which may put emphasis on interdependence. Dr. Guzder suggests strategies for clinicians to create a culturally safe space to share differing cultural opinions without shame or judgement. In order to provide the best care for children and families, how can clinicians understand families’ interpretation of their cultural ideas ? What is the best way forward in instilling cultural competence amongst clinicians to identify their own cultural blind spots?