This article defines cultural competence and culturally competent practice and focuses on cultural awareness, knowledge acquisition, and skill development as key components. It traces the historical development of cultural competence in the disciplines of psychology and social work, pointing out how cultural competence has become a professional standard. Cultural competence has also been recognized on the federal and state health and human services levels. Cultural competence is viewed on the practitioner, agency, and community levels as well as the micro, mezzo, and macro dimensions. Among the implications for practice are the issues of cultural competence and cultural competencies, the ethics of cultural competence, social context, and biculturation and multiculturalization. Cultural competence research is briefly surveyed, as is the relationship between cultural competence and critical race theory.

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This paper attempts to build a cultural competency framework by reviewing the literature and laying a conceptual foundation for professional standards in clinical social work. It also explores the implications of cultural competency by relating some important factors to clinical decisions, alliance, and outcome in the mental health field. The pathways and directions of the relationships as well as the potential factors affecting cross-cultural clinical alliance are illuminated in a general model to guide hypothesis formulation in further research. Empirical data are presented on clinical social work practice with Asian American clients in light of a key factor in shaping cultural competency, i.e., clinicians' personal achieving styles. The findings suggest that such styles are culturally bound.

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The results of a national survey of health maintenance organization project directors' attitudes on HMO delivery issues are presented and discussed.