Cultural Competence in Serving Children and Adolescents With Mental Health Problems
All cultures practice traditions that support and value
their children and prepare them for living in their
society. This way, cultures are preserved for future
Culturally competent mental health service providers
and the agencies that employ them are specially trained
in specific behaviors, attitudes, and policies that
recognize, respect, and value the uniqueness of
individuals and groups whose cultures are different
from those associated with mainstream America. These
populations are frequently identified as being made up
of people of color--such as Americans of African,
Hispanic, Asian, and Native American descent.
Nevertheless, cultural competence as a service delivery
approach can be applied to systems that serve all
persons, because everyone in the society has a culture
and is part of several subcultures, including those
related to gender, age, income level, geographic
region, neighborhood, sexual orientation, religion, and
Culturally competent service providers are aware and
respectful of the importance of the values, beliefs,
traditions, customs, and parenting styles of the people
they serve. They are also aware of the impact of their
own culture on the therapeutic relationship and take
all of these factors into account when planning and
delivering services for children and adolescents with
mental health problems and their families.
In a "System of Care," local organizations work in
teams-with families as critical partners-to provide a
full range of services to children and adolescents with
serious emotional disturbances. The team strives to
meet the unique needs of each young person and his or
her family in or near their home. These services
should also address and respect the culture and
ethnicity of the people they serve.
Goals and Principles of Cultural Competence
Culturally competent "systems of care" provide
appropriate services to children and families of all
cultures. Designed to respect the uniqueness of
cultural influences, these systems work best within a
family's cultural framework. Nine principles govern
the development of culturally competent programs:
Ideally, culturally competent programs include
multilingual, multicultural staff and involve community
outreach. Types of services should be culturally
appropriate; for example, extended family members may
be involved in service approaches, when appropriate.
Programs may display culturally relevant artwork and
magazines to show respect and increase consumer comfort
with services. Office hours should not conflict with
holidays or work schedules of the consumers.
- The family, however defined, is the consumer and
usually the focus of treatment and services.
- Americans with diverse racial/ethnic backgrounds
are often bicultural or multicultural. As a result,
they may have a unique set of mental health issues that
must be recognized and addressed.
- Families make choices based on their cultural
backgrounds. Service providers must respect and build
upon their own cultural knowledge as well as the
- Cross-cultural relationships between providers and
consumers may include major differences in world views.
These differences must be acknowledged and addressed.
- Cultural knowledge and sensitivity must be
incorporated into program policymaking, administration,
- Natural helping networks such as neighborhood
organizations, community leaders, and natural healers
can be a vital source of support to consumers. These
support systems should be respected and, when
appropriate, included in the treatment plan.
- In culturally competent systems of care, the
community, as well as the family, determine direction
- Programs must do more than offer equal,
nondiscriminatory services; they must tailor services
to their consumer populations.
- When boards and programs include staff who share
the cultural background of their consumers, the
programs tend to be more effective.
Developing Cultural Competence
Although some service providers are making progress
toward cultural competence, much more needs to be done.
Increased opportunities must be provided for ongoing
staff development and for employing multicultural
staffs. Improved culturally valid assessment tools are
needed. More research will be useful in determining
the effectiveness of programs that serve children and
families from a variety of cultural backgrounds.
For many programs, cultural competence represents a new
way of thinking about the philosophy, content, and
delivery of mental health services. Becoming
culturally competent is a dynamic process that requires
cultural knowledge and skill development at all service
levels, including policymaking, administration, and
practice. Even the concept of a mental disorder may
reflect a western culture medical model.
At the Policymaking Level
Programs that are culturally competent:
At the Administrative Level
- appoint board members from the community so that voices from all groups of
people within the community participate in decisions;
- actively recruit multiethnic and multiracial staff;
- provide ongoing staff training and support developing cultural competence;
- develop, mandate, and promote standards for culturally competent services;
- insist on evidence of cultural competence when contracting for services;
- nurture and support new community-based multicultural programs and engage
in or support research on cultural competence;
- support the inclusion of cultural competence on provider licensure and
certification examinations; and
- support the development of culturally appropriate assessment instruments,
for psychological tests, and interview guides.
Culturally competent administrators:
At the Service Level
- include cultural competency requirements in staff job descriptions and
discuss the importance of cultural awareness and competency with potential
- ensure that all staff participate in regular, inservice cultural
- promote programs that respect and incorporate cultural differences; and
- consider whether the facility's location, hours, and staffing are
accessible and whether its physical appearance is respectful of different
Practitioners who are culturally competent:
Achieving Cultural Competence
- learn as much as they can about an individual's or family's culture,
while recognizing the influence of their own background on their responses
to cultural differences;
- include neighborhood and community outreach efforts and involve community
cultural leaders if possible;
- work within each person's family structure, which may include
grandparents, other relatives, and friends;
- recognize, accept, and, when appropriate, incorporate the role of
natural helpers (such as shamans or curanderos);
- understand the different expectations people may
have about the way services are offered (for
example, sharing a meal may be an essential feature
of home-based mental health services; a period of
social conversation may be necessary before each
contact with a person; or access to a family may be
gained only through an elder);
- know that, for many people, additional tangible
services--such as assistance in obtaining housing,
clothing, and transportation or resolving a problem
with a child's school--are expected, and work with
other community agencies to make sure these services
- adhere to traditions relating to gender and age that
may play a part in certain cultures (for example, in
many racial and ethnic groups, elders are highly
respected). With an awareness of how different
groups show respect, providers can properly
interpret the various ways people communicate.
To become culturally competent, programs may need to:
- assess their current level of cultural competence;
- develop support for change throughout the organization and community;
- identify the leadership and resources needed to change;
- devise a comprehensive cultural competence plan with specific action steps
and deadlines for achievement; and
- commit to an ongoing evaluation of progress and a willingness to respond
Important Messages About Children's and Adolescents' Mental Health:|
- Every child's mental health is important.
- Many children have mental health problems.
- These problems are real and painful and can be severe.
- Mental health problems can be recognized and treated.
- Caring families and communities working together can help.
- Information is available; call 1.800.789.2647.
This fact sheet is based on a monograph, Towards a
Culturally Competent System of Care, authored by Terry
L. Cross, Karl W. Dennis, Mareasa R. Isaacs, and
Barbara J. Bazron, under the auspices of the National
Technical Assistance Center for Children's Mental
Health at Georgetown University in Washington, D.C.,
and funded by the National Institute of Mental Health
For free information about children's and adolescents'
mental health--including publications, references, and
referrals to local and national resources and
organizations--call 1.800.789.2647; TTY 301.443.9006.
Source: Knowledge Exchange Network
Last Update: 3.14.96