Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Abstract

This article presents a conceptual model of organizational cultural competence for use in mental health services that resulted from a comprehensive review of the research literature. The model identifies four factors associated with cultural competence in mental health services (community context, cultural characteristics of local populations, organizational infrastructure, and direct service support) and redefines cultural competence as the degree of compatibility among these factors. A strength of this model of organizational cultural competence is that it facilitates future research and practice in psychiatric services settings and links culturally competent practices to service parity.

Rethinking cultural competence

“…A variety of measures for these and related domains have been developed (Gozu et al, 2007;Hernandez, Nesman, Mowery, Acevedo-Polakovich, & Callejas, 2009;Siegel et al, 2000).…”

Working together to solve disparities: Latina/o parents’ contributions to the adaptation of a preventive intervention for childhood conduct problems.

“…Important benefits such as increased service availability, accessibility, utilization and effectiveness have been demonstrated from cultural adaptation (Hernandez, Nesman, Mowery, Acevedo-Polakovich, & Callejas, 2009). Meta-analytic results suggest that practices that are responsive to specific cultural groups have effect sizes that are on average four times larger than those of broadly targeted practices (Griner & Smith, 2006; Smith, Domenech Rodriguez, & Bernal, 2011).…”

“…For instance, services might be expanded to incorporate a broader range of settings and providers such that they are responsive to US Latinas/os cultural preferences for help seeking (Acevedo-Polakovich et al, 2011; Hernandez, et al, 2009). Typically, the expansion of services into settings that are not traditionally associated with mental health, such as schools and primary care settings, has rendered positive results in terms of engaging historically underserved groups, including US Latina/o families, into services (Atkins et al, 2006; Manoleas, 2008).…”

Exploring the role of natural helpers in efforts to address disparities for children with conduct problems

“…Underutilization among ethnic minority children and families has been linked to contextual and cultural factors (Hernandez, Nesman, Mowery, Acevedo-Polakovich, & Callejas, 2009). Contextually, historical patterns of discrimination lead to greater prevalence of utilization barriers—such as being uninsured (Alegria et al, 2012) or living in communities where mental health services are unavailable (Alegria et al, 2004)—among ethnic minority families.…”

“…Contextually, historical patterns of discrimination lead to greater prevalence of utilization barriers—such as being uninsured (Alegria et al, 2012) or living in communities where mental health services are unavailable (Alegria et al, 2004)—among ethnic minority families. Cultural values and beliefs can also prevent service utilization (Hernandez et al, 2009; Lopez & Guarnaccia, 2000). For instance, many Latinas/os ascribe significant stigma to formal mental health care (e.g., Guarnaccia, Lewis-Fernandez & Rivera-Marano, 2003; Vega & Lopez, 2001) and are more likely to seek assistance for mental health problems from individuals without mental health care training in their personal (e.g., friends, family, community members) and formal (e.g., physicians, teachers, church ministers) networks (Callejas, Hernandez, Nesman & Mowery, 2010).…”