A PRACTICAL GUIDE FOR M E N TA L H E A LT H S E RV I C E P R O V I D E R S
By Delia Saldaña, Ph.D.
Hogg Foundation for Mental Health
A PRACTICAL GUIDE FOR M E N TA L H E A LT H S E RV I C E PROVIDERS
Hogg Foundation for Mental Health The University of Texas at Austin
About the Author
Delia Saldaña, Ph.D., is a clinical associate professor at The University of Texas Health Science Center at San Antonio and past director of Health Services Research at the San Antonio State Hospital. Saldaña received her Ph.D. in clinical psychology at the University of California, Los Angeles in 1988, and her M.S. in clinical psychology at Trinity University in San Antonio in 1980.
The author would like to offer a special acknowledgement to Rick Ybarra, director of the Office of Multicultural Services at the Texas Department of Mental Health and Mental Retardation, for his contribution of materials and resources, as well as for his review of and comments on this publication.
Table of Contents
What is Cultural Competency? Definitions of competency Need for cultural competency Essential Knowledge, Skills and Attributes to Developing Cultural Competence Communication is Key Building Counselor/Client Rapport Failures in Cross-Cultural Therapeutic Process Engagement Therapeutic Alliance Outcome Is Your Message Getting Through? Conducting Culturally Sensitive Assessments Suggested Tests for Culturally Diverse Groups Evaluation of Culturally Related Syndromes Translator and Interpreter Challenges in Cross-Cultural Treatment Addressing Cultural Variability Building Bridges with Families What About Confidentiality? Conducting Effective Outreach References 3
4 5 6 7
8 9 10 11 12 13 14 16 16 18
What is Cultural Competency?
Cultural Competency can be defined as:
• A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations. Cultural competency is the acceptance and respect for difference, a continuous self-assessment regarding culture, an attention to the dynamics of difference, the ongoing development of cultural knowledge, and the resources and flexibility within service models to meet the needs of minority populations (Cross et al., 1989). • Davis (1997) operationally defines cultural competency as the integration and transformation of knowledge, information, and data about individuals and groups of people into specific clinical standards, skills, service approaches, techniques, and marketing programs that match the individual’s culture and increase the quality and appropriateness of health care and outcomes. • Cultural competency does not refer to the establishment or maintenance of diversity per se. The concept of competency is not related to numbers of representation, either in clients or in service providers. • Competency refers more explicitly to folkways, mores, traditions, customs, formal and informal helping networks, rituals, dialects, and so forth. In these areas, knowledge about various cultures and the development of specific skills and attitudes in providing services in a manner consistent with the client’s needs are essential.
Why is Cultural Competency Important?
• The cultural appropriateness of mental health services may be the most important factor in the accessibility of services by people of color. Developing culturally sensitive practices can help reduce barriers to effective treatment utilization. • Rapport building is a critical component of competency development. Knowing whom the client perceives as a “natural helper” and whom he/she views as traditional helpers (such as elders, the church) can facilitate the development of trust and enhance the individual’s investment and continued participation in treatment. • America’s population is not only growing, it is changing dramatically. Texas is no...
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