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F2. Annotated bibliography on training in culture and mental health

Margaret O'Byrne

This bibliography provides an overview of cross-national practices and programs in the area of cross-cultural training and cultural competence in the domain of Mental Health. The references are divided into six sections, which represent the salient themes in cross-cultural theory and training practices:

Section I covers general issues in theory and clinical practice. Included in this area are selections of book chapters, books, and articles that address historical, philosophical, and conceptual underpinnings of clinical practice in cross-cultural psychiatry, psychology and related mental health disciplines.

Section II summarizes training programs, and manuals that are currently being implemented in a variety of North American, European, and Australian contexts.

Section III provides similar information in the context of interpreter training.

Section IV catalogues university curricula within the domains of psychiatry, psychology, counseling, nursing, and social work.

Section V provides standards, practices and programs that embrace models of cultural competence. This concept, although related to the theory and practice of cross-cultural training, goes well beyond didactic or practical instruction in order to address institutionalized forms of racism, and incompetent cultural interactions in the health domains.

Section VI provides sources for research and evaluation methods for testing the efficacy and relevance of cross-cultural practices and training models in mental health.

Section I. General and Theoretical Materials on Culture in Mental Health

Acharyya, S., Moorhouse, S. et al. (1989). Nafsiyat: a Psychotherapy Centre for Ethnic Minorities. Psychiatric Bulletin 13(7): 358-360.

Alarcon, R., Ed. (1995). Psychiatric Clinics of North America. Cultural Psychiatry. Philadelphia, London, Toronto, W.B. Saunders.

Alarcon, R., Foulks, E. et al. (1998). Personality Disorders and Culture. New York, John Wiley and Sons.

This book touches on the importance of introducing the notion of the cultural relativeness of personality disorders in cross-cultural training programs.

Berg-Cross, L. and Takushi, C. (1995). Multicultural Training Models and the person-in-culture interview. Handbook of Multicultural Counseling. Thousand Oaks, Sage.

Berry, J., (Ed.) (1997). Handbook of Cross-Cultural Psychology. Needham, Allyn and Bacon.

Considered an authoritative work in the area of cross-cultural psychology. First published in 1980 under the general editorship of Harry C. Triandis.

Bhui, K. and Bhugra, D. (1998). Training and supervision in effective cross-cultural mental health services. Hospital Medicine 59(11): 861-865.

The authors advocate local multidisciplinary training as the most suitable method of integrating training and supervision in developing culturally appropriate services. The authors note the lack of universal training packages but the abundance of information packs that exist. They recommend that the core features of a program include the following: sociodemographics of minority groups; studies of definition and impact of racism and anti-racism; differences and similarities in cultures at the micro and macro levels; culturally determined beliefs on health and help-seeking; use and practice of alternative healing; idioms of distress used by cultural groups. The authors further discuss five models of training, which include: Model A: team approach of liaison with specific cultural groups. Model B: uses cultural -specific voluntary and independent providers to provide in-service training. Model C: employ members of targeted ethnic and cultural groups. Model D: expert panels including members of specific ethnic or minority populations. This model differs from culture broker in that not one individual but a community committee is the liaison point.

Brislin, R. (1999). Communicating information about culture and personality in formal cross-cultural training programs. Personality and Person Perception across Cultures. Y.-T. Lee, C. McCauley and J. Draguns. Mahwah, New Jersey, Lawrence Erlbaum: 255-277.

The authors explore several questions relating to various conceptual models, designs. Research and evaluation practices of cross-cultural training programs. In particular, they point out the lack of, and the need for, empirical research in the area of cross-cultural training. Research in this area would provide a coherent basis for all decisions regarding content, structure and goals of training programs. The authors present a description of various conceptual models that influence training programs in their understanding of cultural difference. The first model described is that of Geert Hofstede (1980) which views cultural difference from a number of spectrums including individualism-collectivism, power-distance, uncertainty-avoidance, masculinity-femininity and emphasis on long range planning. Individualism-collectivism in particular has been highly researched and used in training programs. Other training conceptual frameworks includes concepts based on notions such as "the evolution view", "the big five", "the indigenous approach" and "the competencies approach" etc.

Brown, M. and Landrum-Brown J. (1995). Counselor supervision: Cross-cultural perspectives. Handbook of Multicultural Counseling. C. Panterotto, Sage.

This chapter provides an interesting discussion on the influence of cross-cultural factors that influence clinical supervision. The authors point out that in any triadic relationship between client, therapist and supervisor there exists "dimensions of difference" between them which bring complexity to understanding another's world view and which raises potential problems of misperceptions and assumptions. The "worldview congruence model" is offered as a way to illustrate and understand how worldview conflicts can enter into the supervision process. Five basic worldview congruence possibilities between the triadic relationship are illustrated across eight dimensions. These illustrate the complexity of the possibilities of difference on core values and world view beliefs.

Caisse, P. (1981). Training for the Cross-Cultural Mind. Washington, DC, The Society for Intercultural Training and Research.

The book incorporates an organizational development perspective and draws from theorists such as Jung, Lewin, and Maslow. The author outlines five types of cross-cultural training; cognitive, self-awareness, attribution theory, behavior modification and experiential learning and proposes using a combination of these five approaches.

Carter, R. and Qureshi, A. (1995). A Typology of Philosophical Assumptions in Multicultural Counseling and Training. Handbook of Multicultural Counseling. J. G. Panterotto and M. Casas.

The authors maintain that an examination of the recent literature in the United States reveals five trends of philosophical assumptions in current multicultural training practices. These include: the universal or etic approach, the ubiquitous or liberal position, the traditional anthropological approach which defines culture as country, the race-based approach which assumes that people are classified into races by skin colour, language and physical features and that racism should be the focus of intercultural training and finally, the Afrocentric or Pan-National approach which gives focus to a broad understanding of race as it relates to oppression throughout the world. This article highlights the need to develop and maintain an ongoing discussion on the philosophical underpinnings of current training practices.

Castillo, R. (1997). Culture and Mental Illness: A Client-Centered Approach. Albany, Brooks/Cole Publishing Co.

This book covers a range of topics related to assessment and diagnosis of mental illness in a culturally sensitive context. The author embraces a "holistic" paradigm and focuses on theoretical issues relating to underlying psychological, social, and cultural factors in the etiology, structure, and treatment of mental illness. The second portion of the book review the major DSM-IV categories from a "client-centered approach." Finally, the book considers specific diagnoses.

Cohen-Emerique, M. (1993). L'approche interculturelle dans le processus d'aide. Santé mentale au Québec 1: 71-92.

The author describes the "intercultural approach" as conceived by the author and French theorists before her. Situated in the tradition of French theorist G. Devreaux (1985) and building from the work of perspectives such as those of Goffman (1975), the author describes an intercultural process as an interaction between two people in the context of their own specific cultural\social identities.

Cushner, K. and Brislin, R. Eds. (1997). Improving Intercultural Relations. Thousand Oaks, Sage Publications.

This text is intended as a pragmatic tool for designing and implementing training modules in intercultutal training. Although it is not directed specifically towards a mental health practioner audience, it offers a useful collection of case studies, practical exercises and didactic lesson plans. Chapter one provides an excellent overview of some key concepts in the field of cross-cultural training.

Cushner, K. and Landis, D. (1996). The intercultural sensitizer. Handbook of Intercultural Training. D. Landis and S. Bhagat. Thousand Oaks, CA, Sage.

This chapter describes the intercultural sensitizer (ICS), also known as the cultural assimilator. The ICS is a cross-cultural strategy that makes use of critical incidents or short vignettes to portray the subjective perspectives of individuals within their specific cultural context. A distinction is made between culture-specific assimilators and culture-general assimilators. The former approach was developed in order to teach individuals about a particular host culture while the latter attempts to address the similarities in cross-cultural experiences. The authors describe in table format eighteen themes of the Culture-General Assimilator.

D'Andrea, M. and Daniels, J. (1991). Exploring the different levels of multicultural counseling training in counselor education. Journal of Counseling and Development 70(September/October).

The authors pose the question "Does the counseling profession perpetuate racism"? In addressing this question they propose that the presence or absence of multicultural counselor training take place at two levels across four stages. The first level they deem to be "cultural encapsulation" where multicultural training is nonexistent and where programs reflect White, middle-class, male professors who have little knowledge of multicultural issues. A progression from stage one to stage two at this level, involves movement from a culturally entrenched position to that of a cultural awakening stage. At level two, a training program moves to a stage of cultural integrity. At this stage, the program is characterized by having a multicultural education course that is provided by a culturally competent instructor. Finally, a fourth stage involves moving towards infusion. At this stage, the program embraces an inter-disciplinary, or integrated curriculum and encourages the student to take courses outside of their specific field which are pertinent to increasing cultural knowledge. The aim at the infusion level is to aid in the development of cultural intentionally which is characterized as the ability to integrate an understanding of multiculturalism at a variety of counseling levels.

Dana, R. (1998). Understanding Cultural Identity in Intervention and Assessment. London, Sage.

This book has a dual focus on the needs of specific cultural groups as well as a more general discussion of multiculturalism in mental health. Of specific interest in the current context of study, is a critique of the current APA ethical guidelines and an illustration of how they do not explicitly or implicitly address the multicultural reality of present day North American Society. The author points out that cultural competence is not distinguished from professional competence in general and argues that that a new code must be developed in order to embrace a paradigmatic shift from Eurocentric cultural belief systems and categories to more relativistic positions.

deAnda, D., Ed. (1997). Controversial Issues in Multiculturalism.

This book provides a series of debates on the impact of multiculturalism in research and practice. Each chapter presents a topic with two opposing viewpoints. Questions regarding such things as ethnic-matching, acculturation, ethno-specific services are addressed.

Dennis, P. (1994). "The life of a culture broker." Human Organization 53(3): 303-308.

Describes a culture broker as someone competent in two languages, who can relate two different groups to each other.

Dorothy, C. H. (1993). Teaching and Learning for Cultural Diversity. Toronto, Canadian Scholars Press.

Faubert, M., Locke, D. et al. Applying a cognitive-behavioral approach to the training of culturally competent mental health counselors. Journal of Mental Health Counseling: 200-215.

The authors argue that cognitive behavioral approaches can be used as a framework in cultural competence training for mental health professionals by helping them to understand distorted viewpoints and enabling them to develop a genuine sensitivity to other cultural perspectives.

Ferns, P. and Madden, M. (1995). Training to promote race equality. Mental Health in a Multiethnic Society: A Multi-disciplinary Handbook. S. Fernando.

Race equality training is seen as central to intercultural training. It is concerned with promoting race equality and unearthing racism at the structural, institutional, and personal levels. The authors disavow a cultural approach or having "race experts" in training practices in favor of an explicit anti-racist approach. This view is distinctly held by cultural theorists in the U. K.

Flannery, D. and Ward, K. (1999). Service Learning: A vehicle for developing cultural competence in health education. American Journal of Health Behavior 23(5): 323-331.

The article explores the connections between multicultural education, service learning, and the development of professional competencies within the context of a California classroom based study. Service learning is described as an experiential learning process where reflection and reciprocity are considered key concepts. In the present case this entailed that each student design a health phamplet for a particular ethnic group. Results of this qualitative study lend support to the model of community based service learning as a vehicle to enhance cultural awareness and promote cultural competence.

Foulks, E., Westermeyer, J. et al. (1998). Developing curricula for transcultural mental health for trainees and trainers. Clinical Methods in Transcultural Psychiatry. S. O. Okpaku. (ed.)

This chapter considers the implications of the recent changes to the DSM IV, which now contains guidelines for a cultural formulation in clinical psychiatric assessments and further details the types of training in cultural psychiatry that should be developed. Three levels of training are identified aimed towards the medical student, the psychiatry resident, and a fellow or psychiatrist who wishes to develop further expertise as a cultural psychiatrist.

Fowler, S., Ed. (1995). Intercultural Sourcebook: Cross-Cultural Training Methods. Yarmouth Maine, Intercultural Press.

Describes experiential methods for intercultural training. Describes the use of role-plays, simulation games, critical incidents, as training tools.

Freeman, P. (1997). "Ethnopsychiatry in France." Transcultural Psychiatry 34: 313-319.

This article describes the pioneering work George Devereux and his student Tobie Nathan in the field of ethnopsychiatry in France. Their work has led to the establishment of the Centre George Devereux in France, which actively practices an ethno-psychiatry, which places emphasis on communal intervention and attentive respect for the individual and collective cultural narrative. Several other centres in France have been generated from their model.

Gee, K., Du, N. et al. (1999). The Asian focus unit at UCSF: An 18-year perspective. In: Cross Cultural Psychiatry. J. Henera, W. Lawson and J. Sramek (eds.), John Wiley &Sons.

Gopaul-McNicol, S. (1997). A theoretical framework for training monolingual school psychologists to work with multilingual/multicultural children: An exploration of the major competencies. Psychology in the Schools 34(1): 17-29.

The main purpose of the article is to propose cultural competency skills that are needed by school psychologists. The author outlines fifteen major competency skills and discusses them in detail. All of these are summarized in a table. The list contains the usual ingredients found in most cultural competence standards but has added dimensions as well. For example, the author discusses "cross-cultural ethical competence" as a fundamental ethical imperative for all professionals working in a multicultural context. In addition to competencies, the author addresses university level training within the field of psychology. She points out the need for supervision competencies and describes ethical guidelines proposed for cross-cultural research. Finally, the author proposes a multicultural training program and lists precise guidelines for the implementation of such a program.

Gopaul-McNicol, S. and Brice-Baker, J. (1998). Cross-Cultural Practice. New York, John Wiley.

The book is divided into three parts including the following: the historical assumptions about culture in training of mental health workers, assessment and culture, and cross-cultural training. The areas are broken down into chapters that cover issues relating to assessment of children, families and couples, treatment of culturally diverse clients, and creating multicultural teaching-training programs. A very useful chapter on "training in cross-cultural supervision" examines models of supervision practices and considers the supervisory relationship within a cultural framework.

Grant, C. and Yehudi, W. (1997). Does multicultural education have an adequate conceptual and theoretical foundation? Controversial Issues in Multiculturalism. d. Diane. Needham Heights, MA, Allyn & Bacon.

Carl Grant represents the yes side in a debate that centres on the question posed in the title of this chapter, namely; does multiculturalism education have an adequate conceptual and theoretical foundation? In presenting his arguments he highlights five approaches to multicultural education that include perspectives such as teaching the exceptional and culturally different to the human relations approach. Yehudi Webster's rejoinder argues that there is not a coherent conceptual multicultural framework in the United States. He presents a view that current multicultural education actually promotes eurocentric classification systems of ethnicity and culture by placing emphasis on cultural differences rather than essential similarities between human beings.

Green, J. W. (1995). Cultural Awareness in the Human Services: A Multi-Ethnic Approach. Needham Heights, MA, Simon and Shuster.

The book is addressed to social work issues and practices within a multi-cultural context. The first chapter of this book offers an interesting discussion on the various notions of race, culture, and ethnicity as they are applied to social work practice. "Categorical" definitions of ethnicity are compared to "transactional" approaches. The categorical definition emphasizes cultural "content" within groups and seeks for uniformity, assimilation, simplification, and is associated with melting pot and pluralistic ideologies. The transactional approach emphasizes boundaries between groups, expects differences and conceptual complexity, seeks resolution within indigenous frameworks and anticipates resistance to political and cultural domination. Various social interventions styles are also considered, including approaches such as: group advocate, counselor, regulator, broker, "diplomat", and "missionary", and "teacher". Also presented in this book is an "ethnic competence model" which emphasizes a comparative/ethnographic approach to cross-cultural education. This involves a comparative study of cultural variation within and between different cultures that conceptualizes a three strong emphasis on learning. This includes developing a knowledge base, addressing the personal meanings of cultural difference and self-assessment and finally, conducting a comparative analysis of cultural difference. The author advocates the "ethnic competence model" as one that promotes a system of learning.

Gropper, R. (1996). Culture and the Clinical Encounter: An Intercultural Sensitized for the health Professions. Yarmouth, Maine, Intercultural Press.

The technique known as the intercultural sensitizer is based on attribution theory, which according to the author states four propositions.

Gutierrez-Mayka, M. and Contreras-Neira, R. (1998). A Culturally Receptive Approach to Community Participation in System Reform. Promoting Cultural Competence in Children's mental Health Services. M. Hernandez and M. Isaacs, Paul H Brooks Publishing Co.

This chapter addresses cultural competence as it pertains to community participation. The authors stress that cultural receptivity and sensitivity should be addressed at the level of community participation. In this context, the mental health worker does not enter a community as a teacher/expert but that of learner/facilitator.

Harriet, L. (1986). Why cross-cultural training? Applied issues in culture and mental health service delivery. Cross-Cultural Training for Mental Health Professionals. H. Lefley and P. Lefley, Thomas Books: 11-42.

Hernandez, M., Isaacs, M. et al. (1998). Perspectives on Culturally Competent Systems of Care. Promoting Cultural Competence in Children's Mental Health Services. M. Hernandez and M. Isaacs (eds.) Baltimore, Paul Brooks Publishing Co.

This first chapter in the book provides an overview of the call for cultural competence and describes both the history and development of this paradigm for change. Cultural competence is described as a continuum, which ranges from cultural destructiveness to advanced cultural competence. This concept is contrasted with the notions of diversity, cultural sensitivity and cultural awareness. The author regard the essential difference between these values and those ascribed by cultural competence is that the latter concept reaches a practical level of policies and practices.

Hong, G., Garcia, M. et al. (2000). Responding to the Challenge: Preparing Mental Health Professionals for the New Millennium. Handbook of Multicultural Mental Health. I. Cuellar and F. Paniagua. San Diego, Academic Press.

The chapter opens a discussion on the etic vs emic approaches to multicultural therapy and training. On the one hand an etic approach focuses on common themes between cultural groups and emphasizes commonalties between cultures while the emic view asserts that psychotherapy should be initiated within a specific cultural context. The authors support a blended approach and point out that a purely emic standpoint is not practical given the multiplicity of cultural and linguistic backgrounds of people living in the United States. As well, the chapter offers a useful discussion and comparison of two paradigms of cultural competence . The first approach and tool was outlined by Terry Cross (1989) which views cultural competence on a continuum, ranging from cultural destructiveness at one end of the scale to advanced cultural competence at the other. This approach is particularly useful at the institutional level. A second approach is described as "Pedersen's Model of Training" and identifies three levels of cultural competence; awareness, knowledge, and skills. The authors recommend using these two approaches to cultural competence as tools in planning university course work and curriculum.

Ivey, A., Bradford Ivey, M. et al. (1997). Counselling and Psychotherapy: A Multicultural Perspective. Boston, Allyn and Bacon.

James, C. E. (1999). Seeing Ourselves: Exploring Race and Culture. Toronto, Thompson Educational Publishing.

This book provides a collection of essays and narratives that have been collected from university students over a twelve-year period. The students reflect on their experiences, feelings and beliefs pertaining to their own ethnic cultural backgrounds as well as those of others.

Kareem, J. (1992). The Nafsiyat Intercultural Therapy Centre: Ideas and Experience in Intercultural Therapy. Intercultural Therapy. J. K. A. R. Littlewood. Oxford, Blackwell Science Ltd: pg14-38.

This chapter describes the work conducted at the Nafsiyat centre in London. The term Nafsiyat is derived from three languages to mean mind, body, and soul and represents a core value of the centre to address the needs of the whole person through what they term intercultural therapy. The author likens much of his formal psychiatric training to a kind of colonization of the mind and cautions against a similar "ten-point program of skills in the field of intercultural therapy".

Kirmayer, L. J. & Minas, H. (2000). The Future of Cultural Psychiatry: an International Perspective. Canadian Journal of Psychiatry 45: 438-446.

Describes the evolution of cultural psychiatry along three lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) mental health needs of culturally diverse populations; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. The authors provide a historical analysis of the evolution of cultural psychiatry noting its shift through three phases characterized as; the colonialist beginnings, the search for universality in psychiatry, and finally the movement towards a dialogue between psychiatry and anthropology. The authors further consider the place of culture in psychiatric nosology and practice and present various models of health care from a cross-national perspective.

Kohls, L. R. (1988). Models for Comparing and Contrasting Cultures. Building the Professional Dimension of Educational Exchange. J. M. Reid. Yarmouth, Maine, Intercultural Press.

This short article proposes that the use of models to compare and contrast cultures is a useful way to gain intercultural awareness. The author urges trainers and teachers in this field to use more instead of fewer models to examine cultural difference.

LaFromboise, T. and Foster, S. (1992). Cross-cultural Training: Scientist-practitioner Model and Methods. The Counseling Psychologist 20(3): 472-489.

This article presents a model for organizing and evaluating cross-cultural content in clinical and research training during doctoral study in scientist-practitioner programs. The authors argue that cross-cultural competence requires both scientific and clinical understanding and is best learned through interactions with skillful mentors. Curriculum models are also presented with an emphasis placed on an integration approach to cross-cultural issues in each course area. The authors also note two trends that have emerged in the publication of cross-cultural curriculum material. The first trend gives more emphasis to ethno-specific characteristics and needs. The second approach gives emphasis to compiling cross-cultural competencies and standards.

Landis, D. and Bhagat, S. Eds. (1996). Handbook of Intercultural Training 2nd ed. Thousand Oaks, Sage.

The book is divided into three parts that is prefaced by an introduction and overview of intercultural training. Part one deals with theory and method in intercultural training, part two give focus to various contexts of intercultural work and part three focuses on "area studies" which looks at specific cultural groupings in international perspectives.

Lee, Y.-T. (1999). Personality and Person Perception across Cultures. Mahwah, New Jersey.

The aim of this volume is to provide readers with a view of how cultures differ from each other and what they find in common both within a given culture and across cultures. Research on personality and culture is presented not as a scientific work but a practical guide for preparing people to interact with cultural groups different from their own.

Lefley, H. and Pedersen, P. Eds. (1986). Cross-Cultural Training For Mental Health Professionals. Syracuse, Thomas Books.

The purpose of the book is described as an attempt to address some of the issues in the training of mental health professionals to deliver culturally sensitive services. Included are training models, evaluation strategies, and empirical findings of the impact of cross-cultural training. Written in 1986, this book nevertheless provides up to date perspectives and relevant issues to consider in the area of cross-cultural training for mental health professionals. Three training models are presented and compared.

Lu, F. ( 2000). Annotated Bibliography on Cultural Psychiatry and Related Topics, Department of Psychiatry, San Francisco.

Lu, F., Lim, R. et al. (1995). Issues in the assessment and diagnosis of culturally diverse individuals. Review of Psychiatry. Oldham, J. and Riba, M., (eds.) Washington: American Psychiatric Press. pp. 477-510.

This chapter provides an excellent overview of the cultural competence model and offers concise descriptions and definitions of some key concepts and practical elements of cross cultural mental health assessments. Included in this chapter is a discussion of the cultural formulation and how it may be applied to mental health practices.

Lukoff D and Lu, F. (1999). "Cultural competence includes religious and spiritual issues in clinical practice." Psychiatric Annals V.29(8): 469-472.

The authors note that religious experience has historically been pathologized or ignored in mental health. This brief article highlights types of religious and spiritual problems that are concurrent with mental disorders. The authors note that a distinction should be made between what may be considered psychopathology and what may be religious-spiritual problems.

Minas, H. (2000). Cross-Cultural training for health professionals. Chiron, (University of Melbourne), 1997, 4:8-10 (also available at http://www.cimh.unimelb.edu.au)

The author outlines a teaching program that based at the Centre for Cultural Studies in Health, University of Melbourne, Australia aimed at health care professionals. He also provides a thoughtful discussion on the notion of culture, the cultural construction of the self and how these interplay with notions of illness. Minas manages to avoid the repetitive and clichéd jargon that pervades much of the literature on cultural competence and offers a refreshing account of the meanings of culture.

Minas, H. (2000). "Culture and Psychiatric Education." Australian Psychiatry 8: 204-206.

This brief paper highlights a conceptual shift-taking place from a notion of postgraduate training to one of postgraduate education in cultural and mental health. Minas lists the ingredients of such an education to include an understanding of the experiences and history of those who have migrated to Australia, and the consequences of European settlement for the aboriginal communities. As well, the concepts of race, ethnicity, culture and nationality should be well understood in connection with psychiatric practices. Epidemiology of mental illness across cultures, cross-cultural psychiatric assessment and policy design are also included as important areas of curricula.

Minas H, Lambert, T. J. R. et al. (1996). Mental Health Services for NESB Immigrants. Canberra, Australian Government Publishing Service.

Moffic H, Kendrick, E. et al. (1987). Education in cultural psychiatry in the United States. Transcultural Psychiatric Research Review 24: 167-187.

Discusses definitions and educational models in cultural psychiatry from a historical perspective and proposes guidelines for future educational practices in this area. This article provides an interesting historical backdrop to education and training in cultural psychiatry for the present day. Written in 1987, the article presents evidence of what was seen as the then decline of formal training programs in cultural psychiatry. This trend stood in contrast to other research indicating a growing interest in this area. This article provides a useful comparison to present day practices and trends.

Myers, H., Wohlford, P. et al., Eds. (1991). Ethnic Minority Perspectives on Clinical Training and Services in Psychology. Washington, American Psychological Association.

This monograph was developed from an initiative set in motion by the National Institute of Mental Health (NIMH) and is devoted to the subject of cross-cultural clinical training in the field of Psychology. The monograph is divided into four parts and includes an appendix on policy recommendations for training in the field. Part one deal with issues relating to needs and trends for training ethnic minorities in the field of Mental Health and service needs for specific undeserved populations. Part two highlights some existing training programs and part four contains recommendations from NIMH Working Groups in various training areas. This is a highly valuable work that covers extensive research into the state of training in Cross-Cultural Psychology.

Okpaku, S., Ed. (1998). Clinical Methods in Transcultural Psychiatry. Washington, DC, American Psychiatric Press Inc.

Includes a chapter on training.

Ponterotto, J., Casas, J. et al. Eds. (1995). Handbook of Multicultural Counseling. Thousand Oaks, London, Sage.

The edited handbook provides an overview and practical guide of some of the most pertinent issues in multi cultural counseling. The book is divided into seven sections. Section I consists of three chapters that focus on historical perspectives and professional issues. The first chapter traces the development and history of multiculturalism and the genesis of the multicultural counseling movement within the United States. The second chapter looks at promoting multiculturalism through organizational change. The third chapter provides guidelines for ethical practice within a multicultural framework. Section II of the book consists of eight chapters, which focus on theory and research in racial/identity development. Section III covers Supervision and Training. In this section areas including philosophical assumptions, supervision, teaching strategies are presented. Part IV consists of three chapters that focus on multicultural practice within counseling. Part V presents two research reviews the first entitled "The role of ethnicity, cultural knowledge and conventional techniques in counseling and psychotherapy" and the second, which examines racial and ethnic considerations in help seeking attitudes. Part VI presents critical and emerging topics in the field. These include topics such as models of intervention for indigenous people and young African males, group work and work with families. An appendix to the book contain advisory principles for ethical, and standards for cultural competence.

Rack, P. (1982). Race, Culture and Mental Disorder. London, Tavistock Publications.

Despite its age, this book provides a useful introductory section that outlines definitions of race, culture, ethnicity, and nationality.

Segall, M., Lonner, W. et al. (1998). Cross-cultural Psychology as a Scholarly Discipline: On the flowering of culture in behavioral research. American Psychologist 53(10): 1101-1110.

The authors provide a broad overview of the history and development of cross-cultural psychology. The evolution of notions such as cultural relativism and absolutism, are highlighted as are issues such as the etic and emic perspectives. A rich bibliography provides a quick overview of the latest research in the field.

Shiang, J., Kjellander, C. et al. (1998). Developing cultural competency in clinical practice: treatment considerations for Chinese cultural groups in the United States. American Psychological Association: 182-209.

Singelis, T., Ed. (1998). Teaching About Culture, Ethnicity, & Diversity: Exercises and Planned Activities.

Spiegel, J. and Papajohn, J. (1986). Training Program in Ethnicity and Mental Health. Cross-Cultural Training for Mental Health Professionals. Lefley, H. and Pedersen, P. (eds.) : 49-71.

Transactional systems theory and cultural value orientation theory form the theoretical basis of this early training approach. Transactional systems theory is based on the belief that events constitute a field of transaction and that an individual's neurosis can be seen as a transactional interplay between psychological, cultural, social, amd biological events. The prescribed treatment approach is to address the disequilibrium between a variety of social, biological, and other events. Value orientation theory, defined by Florence Kluckhohn, is a generalized and organized conception that influences behavior of time, of nature, and human's place in it, as well as their relationship to other humans. Based on these principles the authors formulated and implemented a training plan in the Boston area.

Swartz, L. (1998). Culture and Mental Health: A South African View. Capetown: Oxford University Press.

A good overview of clinical and conceptual implications contemporary of medical anthropology and cross-cultural psychiatry.

Tervalon, M. (1998). "Cultural Humility versus Cultural Competence : A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education." Journal of Health Care 9: 117-125.

Tolan, J. and Lendrum, S. (1996). Case Material and Role Play in Counselling Training. London, Routledge.

Torralba-Romero, J. (1998). Recruitment, Retention, Training, and Supervision of Mental Health Services Staff. Promoting Cultural Competence in Children's Mental Health Services. M. Hernandez and M. Isaacs. Baltimore, Paul Brooks Publishing Co.

Triandis, H., Brislin, R. et al. (1988). Cross cultural training across the individualism-collectivism divide. International Journal of Intercultural Relations 12: 269-289.

The concepts of individualism and collectivism, which Triandis has developed in cross-cultural psychology are suggested as important topics for coverage in cross-cultural training programs. "Individualism is characterized by the subordination of a group's goals to a person's own goals," collectivism is the reverse.

Valle, R. (1986). Cross-Cultural Competence in Minority Communities: A Curriculum Implementation Strategy. Mental Health Health Research and Practice in Minority Communities: Development of Culturally Sensitive Training Programs. M. Manuel and H. Kitano. Rockville, Maryland, National Institute of Mental Health: 29-49.

Discusses the definition and meaning of cross-cultural competence as the ability to understand another at three levels; the symbolic/linguistic, the naturalistic-interactional, and values and beliefs. Notes the pragmatic need for agreement on a cross-cultural paradigm in the area of mental health, and outlines the obstacles of establishing cross-cultural expertise in the mental health field. Included in these are: the "politics of knowledge", the lack of knowledge about ethnic minority populations and finally, resistance to change. The author also presents a change model based on four stages of "targeting innovations". This chapter, having been written in 1986 offers an interesting point of comparison with current practices and knowledge in the field. It is worth noting as a point of current comparison that the author believed the field was at the time, in the first stage of innovation; one where cross-ethnic and cross-cultural innovations were being tested and presented in the field. This could arguably still be the case in present day.

Weaver, H. (1999). Indigenous People and the Social Work Profession: Defining Culturally Competent Services. Social Work 44(3): 217-225.

The recent discussion in social work literature has moved from a perspective of cultural sensitivity to that of cultural competence. This shift reflects a move towards gaining the ability to integrate cultural knowledge and sensitivity with skills that may lead to a more effective and culturally appropriate healing process. This article reports the results of a study, which solicited views on culturally competent helping practices amongst Native Americans. The study canvassed social work student bodies with high Native American enrollment on three questions pertaining to skills, attitudes, and values they believed were important for culturally competent services. The results of this survey were gathered to make a profile of what might be considered a curriculum for training programs aimed at enhancing cultural competence for social work practice with Native populations in North America.

Wederspahn, G. (2000). Intercultural Services: A Worldwide Buyer's Guide and Sourcebook. Houston, Texas, Gulf Publishing Company.

Westermyer, J. (1990). Working with an interpreter in psychiatric assessment and treatment. Journal of Nervous and Mental Disorders 178(12): 745-749.

Discusses the roles and skills required of an interpreter which include the ability to interpret connotative as well as denotative meanings.

Yager, J., Chang, C. et al. (1989). Teaching Transcultural Psychiatry. Academic Psychiatry 13(Fall).

Describes programs in transcultural psychiatry for medical students, residents, and fellows that have been implemented at UCLA over the past six years. A year-round transcultural psychiatry clerkship was established for medical students as well as an ongoing weekly transcultural psychiatry seminar.

Zweifler, J. and Gonzalez, A.-M. (1998). "Teaching Residents to Care for Culturally Diverse Populations." Academic Medicine 73(10): 1056-1061.

The authors present a rationale for resident training in primary care that extends to three areas outside of their specific specialty. This includes cultural competency, community -oriented primary care (COPC) and public health. In the area of cultural competence, they suggest using the guidelines provided by the Society of Teachers of Family Medicine (STFM, see R. Like, 1996 et. al). Community-oriented primary care is described as a concept of care that originated in Europe and that involves a process of defining community and assessing community health systems. Finally the area of public health is considered. This area covers epidemiological of health trends as they effect specific cultural communities.

(2000). Cross Cultural Mental Health. Visions(9).

A special issue of a quarterly journal produced by the Canadian Mental Health Association that addresses cross-cultural health and includes sections covering cultural perspectives on mental health, cultural competence, and program approaches.

Section II. Training Programs & Manuals

Altamirano, C. Youth Intervention and Ethnic Diversity: Adapting Professional Skills. Centre de Psycho-éducation du Québec.

Carrillo, E., Green, A. et al. (1999). "Cross-Cultural Primary Care: A Patient-Based Approach." Annals of Internal Medicine 130(10): 829-834.

The authors' discuss what is described as a patient-based cross-cultural curriculum for residents and medical students. This model is intended to counteract the tendency in curricula to take a categorical and potentially stereotypic approach to "cultural competence" and proposes a framework that focuses on the patient's particular social and cultural context and health beliefs. The strength of this approach is that it provides a generic model to understand cross-cultural interactions in a medical setting. The potential weakness is that while professing to avoid a stereotypic and categorical approach may actually be subject to the same pitfalls that it protests against.

Casimir, G. and Morrison, B. (1993). "Rethinking Work with Multicultural Populations." Community Mental Health 29(6): 547-559.

This article discusses the importance of ethnic and cultural factors in mental health services and advocates for change at the policy level. One interesting part of this article is the information provided on the Multicultural Advisory Committee (MERTI). Based out of the Department of Psychiatry of the Metropolitan Hospital Center in New York City, this group has developed curricula in multicultural competence for four major multicultural populations. Using a train-the-trainer model this program has been implemented in a number of regions New York State.

Caroll, J. (1999). A Schizophrenia and Depression Training Workshop for Psychiatrists from Asian Countries, Centre for Cultural Studies in Health and University of Melbourne Department of Psychiatry.


Chrisman, N. and Schultz, P. (1997). Transforming Health Care through Cultural Competence Training. Cultural Diversity in Nursing : Issues Strategies, and Outcomes. J. Dinemann, American Academy of Nursing.

This chapter is of interest because it provides an overview of competency training in the area of general health and outlines examples of types of training available. It points out the current state of piecemeal training leading to a surface understanding of culture. It outlines a concise summary of the relevant issues at hand and offers a list of practical strategies to implement training programs

Cultural Consultation Service (CCS) Jewish General Hospital and Montreal Children's Hospital, Departments of Psychiatry. www.medicine.mcgill.ca/psychiatry/transcultural/ccs

The Cultural Consultation Service (CCS) is based out of two hospitals in Montreal. In addition to offering clinical consultations to mental health providers, the service offers in-service training and workshops to health care professionals as well as internships, and rotations for trainees in psychiatry, psychology and related disciplines.

Dienemann, J. Ed. (1997). Cultural Diversity in Nursing: Issues, strategies, and outcomes. American Academy of Nursing.

This edited book on nursing issues in cross-cultural contexts includes a useful table summarizing cross-cultural training settings in the Nursing field.

Disman, M. and Masi, R. (1991). Teaching Medical Care for a Racially and Culturally Diverse Population.

Dutt, R. and Ferns, P. (1995). Letting Through Light. REU (formerly the Race Equality Unit) Department of Health. London, England.

Training Program: Area: A training pack which focuses on adult mental health. Target Group: primarily social workers, case managers, community based health workers. Aim: To raise awareness of race and culture in working with black people


Population Focus: African, Caribbean, Asian Methodology: manual was based on two main principles; 1) inclusion of mental health users in design of a program; 2) careers should be included in panning and design of policy and practice. Content: The pack is divided into six modules: 1. Values and Principles, 2. Legislative issues, 3. Care approaches, 4. Crisis Intervention and Risk Assessment, 5. Prevention, 6. Monitoring. Teaching Modality: Comments:

Garza-Trevino, E., Ruiz, P. et al. (1997). A Psychiatric Curriculum Directed to the Care of the Hispanic Patient. Academic Psychiatry 21(1): 1-10.

The article describes a model curriculum for psychiatry residency training programs directed towards the needs of Hispanic patients based in the United States. It is one of six residency curricula written for the APA that addresses the needs of minority and under-represented groups. The curriculum is divided into knowledge, skills, attitudes, clinical experience and didactic experience. A seminar series is recommended to cover topics such cultural characteristics, Hispanic belief systems, psychotherapy issues, etc.

Larson, D., Lu, F. et al., Eds. (1996). Model Curriculum for Psychiatry Residency Training Programs: Religion and Spirituality in Clinical Practice. Rockville, Maryland, The National Institute for Healthcare Research.

Lashley, M. (1995). The Patient's Preference. Montreal, Montreal Children's Hospital.

This training manual is aimed towards middle managers in health care settings. The goals of the manual include: to sensitize managers to develop awareness; increase sensitivity to the effects of culture; increase comfort in multicultural frameworks; and acquire skills in becoming a cross-cultural manager. A video "Valuing Diversity" accompanies the manual.

Like, R., Steiner, P. et al. (1996). "Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care." Family Medicine 28(4): 291-297. http://stfm.org/corep.html

The article describes guidelines and recommendations developed by the Society of Teachers of Family Medicine (STFM) that aim to help residency programs to provide culturally competent health care. The curriculum guidelines cover topics related to culture, health and illness under the areas of attitudes, knowledge, and skills. Also included in this article is a list of some eighty-nine resources that address cultural various issues and training. Experiential exercises are also listed. One value of this article is the fact that it offers concise information and is well presented. Guidelines can be found on internet at the web cite indicated.

London Inter-cultural Mental Health Centre (1993). Culture Health and You.

Goals: Based on a model of promoting contextual learning, the program aims to bring the trainee to an understanding of how the professional and the service recipient participate in a "human equation of interaction". A series of discussion exercises and video presentations are used to encourage participants to think about and work through cultural various dilemmas. Content: The program is divided into three components: Culture and Health; Health Promotion; and Communication

Lonner, W. (2000). Graduate Education in Cross-Cultural Psychology or Cultural Psychology and What To Do With It with It When Completed.


The author doubts that Ph.D. programs in cross-cultural Psychology exist within the U.S. or Canada and offers advice in searching for Graduate level programs that do offer a cross-cultural emphasis. He also invites web readers to add updated or additional information to his report.


Lonner, W. (2000). The Center for Cross-Cultural Research. http://www.acwwu.edu/edu-lonner/cross_culture.html

Maternal and Child Health National Center for Cultural Competence (NCCC) (1998). Culturally competent Services and Systems: Implications for Children with Special Health Needs: Training and Technical Assistance Resource Manual, Georgetown University Child Development Center.

Minas, H. & Bruce, S. (1999). A Schizophrenia and Depression Training Workshop for Psychiatrists from Asian Countries, Centre for Cultural Studies in Health and University of Melbourne Department of Psychiatry.


Describes a training workshop that was run in Melbourne, July, 1999 and was attended by 51 psychiatrists from 10 countries.

Mount Saint Joseph Hospital (1996). Exploring Multiculturalism and Diversity in Health Care. Vancouver, BC.

This program was developed out of Mount Saint Joseph in Vancouver, B.C. and was funded by Multiculturalism BC. It was developed in response to the belief that Diversity is an ongoing issue in the health care sector. The manual is divided into two broad sections: self-awareness and skill building. The following themes are addressed: Diversity, Values, Cultural Awareness, Oppression, Systemic Issues, Poverty, Social Identity, Class, Communication, Counseling, Critical Incidents and culturally Sensitive Health Care.

Naidoo, U., Christie, S. et al. (2000). "Exploring a Model to Improve Diversity among Trainees in Psychiatry." Harvard Review Psychiatry 8(July/August): 91-93.

Describes a pro-active approach taken at the Harvard Longwood Psychiatry Residency Training Program in order to increase minority recruitment. A Diversity Committee was established and has begun to focus on clinical and didactic training on cross-cultural and diversity issues.

Pedersen, P. & Hernandez, D. (1997). Decisional Dialogues in a Cultural Context: Structured Exercises. Sage.

Proulx, J. & Chiasson, N. (1996). L'Approche clientèle dans un contexte interculturel, Université de Sherbrooke.

A trainer program manual sponsored by the MSSS in Montréal Québec. The program uses an interactive teaching modality based on learning model of Pfeiffer and Jones (1983). Five phases of learning are charted: (1) experience; (2) information sharing; (3) interpretation; (4) generalization; (5) transfer of knowledge into practical activity. Three training modules cover; notions of culture across a variety of spectrums; the relationship between health worker and service user; social and political contexts. This program does not deal with specifically with mental health issues and does not address ongoing issues that health workers are concerned with on a daily basis.

Queensland Centre for Cross-Cultural Development (1988). Managing Cultural Diversity in Mental Health. Brisbane, Bureau of Ethnic Affairs.

This program emerges from the Queensland 10 year Mental Health Strategy to ensure accessibility of service to special needs groups. This program in particular aims to address the mental health concerns of people from linguistically and culturally diverse backgrounds. It was designed as a train-the-trainer program for in-service training for mental health professionals. The program has two aims: (1) to improve mental health outcomes of non-English speaking people by increasing awareness among professionals of cultural and linguistic factors that impact on mental health problems; and (2) to instill a greater understanding of the impact of culture on assessment, diagnosis, and treatment. Description: the program is divided into two major sections with two modules in each section. The entire program takes a minimum of 16 hours of training which is broken down into four units: (1) cross-cultural issues; (2) language; (3) assessment and diagnosis; (4) treatment. This Australian program offers a comprehensive overview of cultural issues in the field of mental health. Its focus on language issues brings an important dimension to the area of training that seems less of a focus in other training programs. As well, its focus on mental health, and issues of diagnosis, treatment, and the effects of trauma and torture are valuable contributions to the training domain. Their presentation on narrative therapy offers a novel perspective on issues of treatment and allowing for the reframing of pathology into more positive solution oriented approaches.

Seelye, E., Ed. (1996). Experiential Activities for Intercultural Learning. Yarmouth, Maine, Intercultural Press.

A resource book consisting of exercises and activities to be used in intercultural training.

Spielvogel, A., Dickstein, L. et al. (1995). "A Psychiatric Curriculum about Gender and Women's Issues. Academic Psychiatry 19(4): 187-201.

This article outlines a curriculum for teaching psychiatry residents about gender and women's issues. This paper is the second in a series of six commissioned by the APA assembly on minority and underrepresented populations within the United States.

Thompson, J. W. (1996). "A curriculum for learning about American Indians and Alaska Natives in psychiatric residency training." Academic Psychiatry 20(1): 5-12.

This is the third article in a series of six, commissioned by the APA on minority groups in the United States. The article outlines a 4 years curriculum for residents and specifies learning objectives for each year. A detailed and useful appendix provides seventy pertinent references.

Toumishey, H. (1991). Culture and Health : Curricula For Health Professionals Report of the Multicultural Health Curriculum Project Committee.

This report gathered information on the state of recognition and levels of action taken to incorporate multicultural health content in curricula for the education of health educators, physicians, nurses, practitioners, and social workers. A national survey on the state of multicultural health content was conducted and a report was written from the proceedings of a two-day consultation workshop held in Toronto in May, 1991. Six working groups were established that represented the following areas within the health sector: Health Education, Medicine, Nursing, Rehabilitation, Social Work. Recommendations and model curricula are proposed by each of the working groups

Transcultural Mental Health Centre (1996). Enhancing Cultural Competence. Brisbane.

This training program was developed at the Transcultural Mental Health Centre at Cumberland Hospital, NSW, Australia. Aim: It promotes the enhancement of cultural competence within health, community and welfare sectors. Focus: deals primarily with communication and mental health issues and aims to help practitioners develop cultural competencies in these areas. Videotaped scenarios of patient-clinician interactions based on adaptations from actual cases are presented and used as demonstration and discussion tools. Content: training topics are divided into two areas Essential Topics and General Topics. The first area covers topics ranging from transcultural counseling, concepts of culture , ethnicity, communication, etc. The General topics include a variety of subjects that relate to cultural issues in the personal, family, social, and legal domains. As well consideration is given to working with interpreters, and survivors of violence and torture. An important strength of this training program manual is the fact that it was constructed through a process of ongoing consultation and dialogue with experts and community members who represent various cultural sectors.

Transkulturelit Centrum. http://www.vssosll.se/tc

The Transcultural Centre in Stockholm has a commission from the Swedish health system to focus on "culture". The centre does not currently have an affiliation to any university within Sweden but has organized in collaboration with the Division of Social and Transcultural Psychiatry, McGill University, a one-week cross-cultural training program in the area of mental health.

Vancouver Association for Survivors of Torture (1995). Basic Document Report. Vancouver, Vancouver Association for Survivors of Torture.

Describes the mandate and services offered by Vancouver Association for Survivors of Torture (V.A.S.T.); an association initiated by local clinical professionals and human rights activists. Comprised of psychologists, psychiatrists, general practitioners, social workers with origins from all over the world.

Welch, M. (1997). "Enhancing awareness of diversity and cultural competence: A Workshop Series for department chairs and course directors." Academic Medicine 72(5/May): 461-462.

Describes a cross-cultural workshop designed and implemented at UCSF for directors and department heads.

Western Washington University Center for Cross-Cultural Research, Center for Cross-Cultural Research.

The Center for Cross-Cultural Research (CCCR) is housed within the Department of Psychology at Western Washington University. This department has a long tradition of cross-cultural psychology and many of its faculty have specific areas of interest in cross-cultural research.

Wun Jung, K. (1995). "A training guideline of cultural competence for child and adolescent psychiatric residents." Child Psychiatry and Human Development 26(2): 125-136.

The author embraces the cultural competence model and lays out a curriculum guideline for psychiatry residents in child psychiatry. The article provides a concise description of cultural competence principles and delineates the optimal objectives and methods for such a program. An appendix provides a detailed didactic syllabus.

Yutrzenka, B., Todd-Bazemore, E. et al. (1999). "Four Winds: The evolution of culturally inclusive clinical psychology training for Native Americans." International Review of Psychiatry 11: 129-135.


The authors describe a culturally inclusive training program in the Department of Psychology at the University of South Dakota, which aims to increase Native American participation in graduate study. The program, called 'Four Winds', attempts to develop a training model that promotes the inclusion of Native Culture and culturally relevant material and approaches to an academic context.

Zatzick D and Lu, F. (1991). "The Ethnic/Minority focus unit as a training site in transcultural psychiatry." Academic Psychiatry 15(4): 218-225.

The article describes a twenty-two bed "Asian Focus Unit" that was established to address the in-patient psychiatric needs of San Francisco's Asian population and discusses the resident educational goals.

Section III. Interpreter Training Programs & Materials

Asian Health Services and Cross Cultural Health Care Program (2000). Interpreter Training Programs. http://www.xculture.org/training/overview/interpreter/programs.html




Provides syllabi of various interpreter programs in Colleges across Canada as well as various community programs.

Apostolakis, J. Interpreters in Mental Health Course: Report and Recommendations, Migrant Health Services of the South Australian Health Commission.

This monograph report contains feedback and suggestions regarding an interpreter-training program. A curriculum outline is included. Recommendations include having a briefing and de-briefing meeting when an interpreter is engaged to work with a person and a clinician.

Asian Counseling and Referral Service (1995). Training Manual for Interpreters of Southeast Asian Languages. Seattle, WA, Asian Counseling and Referral Service.

Jackson-Caroll, L., Elinor, G. et al. (1998). Beyond Medical Interpretation : The role of Interpreter Cultural Mediators (ICMS) in building bridges between ethnic communities and health institutions, Community House Calls, Harbourview Medical Center.


This manual provides a basic overview of the steps one may take in order to develop an interpreter cultural mediator (ICM) program. This approach integrates ethnographic and medical anthropological principles with current medical care practices and medical education goals.

Mesa, A. (1997). L'Interprète culturel: un professionnel apprecié. Montréal, Régie régionale de la santé et des services sociaux.

This document documents a study that looked at the need for interpreter services in the city of Montreal. Focus groups are established to discuss various aspects of interpreter service needs. Five levels of need were identified. These included: linguistic knowledge, correct interpretation, neutrality and confidentiality, cultural explanations, and personal qualities of the interpreter. Each of these dimensions was expanded on. Surveys across several language groups were also established. Results of the survey indicated that interpreter services most in demand were Russian, Arab, Spanish, Vietnamese, Cambodian, Bengali, Laotian, and Turkish.

Okahara, L. and Roat, C. (1998). Directory Of Health Care Interpreter Training Programs in the United States and Canada, Asian Health Services and Cross-Cultural Health Care Program. http://www.xculture.org/training/overview/interpreter/programs.html



This document contains comprehensive program descriptions of medical interpreter training programs in the US and Canada. It does not include training programs aimed towards the Mental Health sector.

Ontario Ministry of Citizenship (1989). Cultural Interpreter Training Manual.

Provides a step by step guide in how to organize a cultural interpreter service and training program. Sections cover four training modules covering a range of topics including basic skills, cross-cultural communication, personal growth, interpersonal skills and knowledge about institutions.

Pollard, R. (1997). Mental Health Interpreting: A Mentored Curriculum. Rochester, University of Rochester.

A curriculum designed to be used in the context of a mentor-interpreter relationship. Brings focus to an ongoing dialogue between teacher and student. The manual covers a range of nine topics, including the following: the role of interpreter, ethics in mental health, mental illness and the DSM IV, interpreting dysfluent patients, psychodynamic and cross cultural issues in mental health. A video accompanies the manual.

Roat, C. and Okahara, L. (1998). Survey of Twenty-three Medical Interpreter Training Programs in the United States and Canada. Seattle, Oakland, The Cross-Cultural Health Care Program.


This study evaluated twenty-three interpreter programs and had the following goals: 1. To identify Interpreter training programs in the U.S. and Canada; 2. To compare these programs; 3. To document experiences of trainers; to provide resource information about existing programs. Over half of the sample and six of the seven Canadian interpreter programs surveyed were geared towards the medical venue. The study indicated that this undoubtedly a growing field.

South Australian Health Commission (1991). "The Migrant Health Unit: Language Services Manual."

This manual outlines how to set up procedures for an interpreter service. An existing interpreter service in South Australia is used as a example. It includes information on how to identify the need for a language service as well as information on various interpretation tools.

The Health Care Interpreter Partnership Project (1996). Interpreter Services in Health Care Settings: A Handbook and Training Manual. Vancouver, B.C.

A handbook designed for health care services and other agencies that do not have access to professionally trained interpreter services. The course consists of seventy-two hours of part-time instruction at a local college in Vancouver and is aimed to help such agencies to draw from internal and volunteer resources.

Section IV. University Curricula

Alliant University, California School of Professional Psychology (CSPP). The Multicultural Education Research Intervention and Training Institute (MERIT). http://www.cspp.edu/cspp/

The clinical psychology program at Alliant University offers two possibilities for cross-cultural clinical training. Students may choose specialization areas which include a cultural psychology emphasis or multicultural and community emphasis. The first option is designed as an inter-disciplinary approach to the study of culture, behavior and cognition, and the second option emphasizes research and intervention skills necessary for working with multicultural populations.

Culhane-Pera, K., Reif, C. et al. (1997). "A Curriculum for Multicultural Education in Family Medicine." Family Medicine 29(10): 719-723.

The article describes and evaluates a three -year curriculum to increase residents knowledge, skills, and attitudes in multicultural medicine. Three curriculum goals were established and arranged into five levels of cultural competence. Residents completed pre and post self-evaluations, which were positively correlated, with faculty completed evaluations. The results indicated that there was an increase in residents' cultural knowledge and attitudes.

Graduate Programs in Cross-Cultural Psychology and Education (2000). Wilmington, USA, University of North Carolina.

This document is posted by Carolyn Simmons, University of Carolina on the internet and lists various national graduate programs with an emphasis in cross-cultural psychology.



McGill University M.Sc. in Transcultural Psychiatry.



1. M.Sc. degree in Psychiatry with a focus on transcultural psychiatry and an emphasis on developing research skills in this area. 2. McGill Summer Program in Social and Transcultural Psychiatry, Department of Psychiatry. A three-weeks program that takes place in May. The pro-gram provides the conceptual background for research and clinical work in social ad cultural psychiatry. Associated with the Division of Transcultural Psychiatry, McGill University.

Tilburg University, Department of Psychology. Cross-Cultural Psychology at Tilburg University.


Cross-cultural psychology is a long-standing tradition in the Department of Psychology at Tilburg University, the Netherlands. Program elements include emphasis on psychological processes in cultural context, psychological reactions to new or changing environments, and social processes in intercultural contexts.

Tizard Centre, University of Kent. (2000/2001). European MA in Migration, Mental Health, and Social Care, University of Kent at Canterbury, UK

http://www.ukc.ac.uk/tizard/EuroCent.htm Description: This is a joint MA program between the universities of Utrecht (The Netherlands) and Orebro (Sweden) and is designed for those who work in multi-ethnic mental Health services. Focus: to develop knowledge and good practice in the mental health and social care of refugees and minority groups. Description: Program is divided into thirteen modules over a two-year period. Three of these are partner European workshops of which two take place in Sweden and the Netherlands. Course content includes modules in such areas as migration, refugees, social and mental health needs of refugees, cultural diversity, transcultural psychiatry, service provision, research methods.

University College London and Department of Psychiatry and Behavioral Science (2001/2002). M.Sc. in Culture and Mental Health. London.

Course Description: offers study in advanced cultural psychiatry particularly in relation to Britain and Europe. Target Group: students with a background in anthropology, counseling, mental health or related areas. Aim: Designed to give advanced theoretical training in the concepts and theory of cultural psychiatry and research methods required for research in this area. Application information: Gloria Jones, Course Administrator, M.Sc. in Culture and Mental Health, Department of Psychiatry and Behavioral Sciences, Wolfson Building, UCL, Riding House Street, London WIN 8AA. Tel: 020 7679 478. Fax 020 7679 9426

University of Kent European Centre for the Study of the Social Care of Minority Groups and Refugees, Tizard Centre. http://www.ukc.ac.uk/tizard/Euro/cent.html

The European Centre for the Study of the Social Care of Minority groups and Refugees was established at the University of Kent within the Tizard Centre in recognition of the need to establish a focal point for a range of activities in research, consultancy, and teaching related to minority ethnic groups and refugees in Europe. In addition to the European masters program in Migration, Mental Health and Social Care, the Centre is involved in research and evaluation. The Breathing Space project is one initiative, which involves collaboration between the Medical Foundation for the Care of Victims of Torture and the Refugee Council. One of the aims of this project is to develop innovative and culturally appropriate approaches to mental health services.

University of Melbourne Graduate Diploma in Mental Health Services (Transcultural Mental Health). http://ariel.ucs.unimelb.edu.au/~atmhn

The Master's of Health sciences requires an area of research in cross-cultural mental health. The didactic program focuses on the following topics: transcultural notions of mental illness; cross-cultural assessment and treatment; ethnicity, culture, migration; research design and methodology.

University of Michigan "Culture and Cognition."


Description: A program jointly supported by Anthropology, Psychology, and the Institute for Social Research. Aim: To create an inter-disciplinary program, which examines the cultural context of human mental life and the mental foundations of culture.

University of South Florida (2000). Multicultural Mental Health Training Program (MMHTP), Florida Mental Health Institute(FMHI). Department of Child and Family Studies University of South Florida. http://www.fmhi.usf/mmhtp/program.html

This program is directed towards students and workers in mental health and specifically members of minority groups and has three main components. (1) A mental health practice, involving field work in clinical based-settings; (2) Class-room based cultural diversity training, (3) Professional development training including areas such as leadership, interpersonal skills, and career development. This is not a degree program but is directed to students at the under-graduate and graduate levels of study of related disciplines.

Utrecht University and Department of Cross-Cultural Studies (2000/2001). Mental Health and Social Care for Migrants, Refugees and Asylum Seekers. Utrecht, The Netherlands.

This program is designed within the context of the joint European training initiative between Tizard Centre (University of Kent), and the University of Orebro. It has three blocks with several themes that include: Migration; Refugees and their needs; mental health and social care for migrant and refugees; and interculturalism in practice. A final block is devoted to themes that have emerged throughout the course and from the three international conferences that take place over the course of the program. (See also Tizard Centre)

Universiteit van Amersterdam. Faculty of Social and Behavioural Sciences, Medical Anthropology Unit. Culture, Psychology and Psychiatry: an Executive Course in Medical Anthropology. Oudeziids Achterburgwal 185, 1012 DK Amsterdam, Netherlands.

An intensive, two-week course that attempts to draw the link between culture and psychiatric phenomena. This course is part of an international study program: the Amsterdam Master's in Medical Anthropology Unit (AMMA). The program is organized by the Medical Anthropology Unit (MAU) of Social and Behavioral Services at the University of Amsterdam, in co-operation with Centrum'45, The Netherlands national centre for the treatment of war victims and persecuted people.

Section V. Cultural Competence Standards

American Medical Association (1999). Cultural Competence Compendium. American Medical Association.

This book provides a comprehensive overview of up to date organizations, services, and resources in the domain of cultural competence. A section on curriculum and training materials is included in this manual and a listing of organizations, institutions and publications that touch on this area is provided.

American Psychological Association (1990). APA Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations, American Psychological Association.

American Psychological Association (1993). "Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations." American Psychologist: 45-47.

Center For Health Services and U.S. Department of Health and Human Services (2000). Cultural Competence Standards: Final Report from Working Groups on Cultural Competence in Managed Health Care Services. Washington, Western Interstate Commission for Higher Education.

Center for Mental Health Services (2000). Cultural Competence Standards in managed care mental health services: Four underserved/underrepresented racial/ethnic groups. Washington, U.S. Department of Health and Human Services.

These cultural competence standards represent "four underserved/underreprepresented racial/ethnic groups". These include: African Americans, Hispanics, Native Americans/Alaska Natives, and Asian/Pacific Islander Americans. Four national panels were convened and a set of standards on culturally competent managed care were reached by consensus.The document profiles each of the four groups, delineates a list of 16 guiding principles, and proposes specific recommendations for cultural competence under three broad categories, including overall system standards, clinical standards and Provider competencies.

Cross, T., Bazron K, et al. (1989). Towards a Culturally Competent System of Care, Volume I: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington,DC, National Technical Assistance Center for Children's Mental Health, Georgetown University Child Development Center.

The first volume in a series of three that addresses cultural comptence in Health and Mental Health services in the United States. This volume is an early initiative of what can be considered the Cultural Competence movement and sets out to define the terms and meaning of Cultural Competence. The first author of this report is Terry L. Cross who is generally cited in currnet definitions of Cultural Competence.

Dana, R. (1998). "Cultural competence in three human service agencies." Psychological Reports 83: 107-112. http://www.ama-assn.org/ethnic/diversity/index.html

This article documents the use of a self-assessment checklist across five dimensions of cultural competence. It provides an interesting tool for evaluation research.


Gopaul-McNicol, S. and Brice-Baker, J. (1998). Cross-Cultural Competencies in Cross-Cultural Training. Cross Cultural Practice. New York, John Wiley & Sons.

This chapter provides an excellent summary table and discussion of multicultural competencies needed for a psychologist to work with families from diverse families. An original aspect of the way competencies are delineated is the inclusion of areas such as ethical competence, assessment, conflict resolution, ability to work with interpreters and a discussion on special education.

Hernandez, M. and Isaacs, M. Eds. (1998). Promoting Cultural Competence in Children's Mental Health Services. Paul H. Brookes.

This book is divided into 4 sections and contains seventeen chapters. The first section concerns organizational levels of cultural competence, the second deals with community issues, the third focus' on specific issues such as impact of violence, substance abuse, clinical issues, etc. The last section considers pertinent evaluation and research questions. Chapter one provides an interesting discussion of the history of cultural competence and the origins of its intended meaning. Organizations are considered competent according to the authors if they incorporate five esssential elements. These include: valuing diversity, cultural-self assessment, cross-cultural dynamics, institutionalization of cultural knowledge, and adaptation to diversity. The authors also point out that cultural competence exists within a continuum. In addition they point out the negative possibilities of cultural blindness, destructiveness, incapacity and they make distinctions between precompetence, basic competence and advanced competence.

Isaacs, M. (1998). Towards A Culturally Competent System Of Care, Volume III: The State of the States: Responses to Cultural Competence and Diversity in Child Mental Health. Washington, D.C., The National Technical Assistance Center for Children's Mental Health, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center.

This is the third in a three volume series on cultural competence. This monograph brings the discussion on cultural competence to the level of institutional reform. The monograph takes a look at cultural competence initiatives, state by state, and describes what training initiatives, research, and reforms are taking place at the community, institutional and government levels.

Isaacs, M. and Marva, B. (1991). Towards A culturally Competent System of Care: Volume II Programs which utilize Culturally Competent Principles. Washington, D.C., National Technical Assistance Center for Children's Mental Health, Center for Child Health and Mental Health Policy George Town University Child development Center. II.

This monograph is the second of a three-volume series on culturally competent systems of care. While volume one addresses a conceptual framework for cultural competence, the current volume highlights examples of programs and systems that exemplify various components of cultural competence. Eleven programs are presented across the U.S. Examples of these include the Asian/Pacific Center for Human Development Child and Adolescent Program in Denver, Colorado; Black Family Development Inc in Detroit, in Michigan and; the Roberto Clemente Family Guidance Center in New York city. An appendix offers a table of profiles of some 98 programs and agencies across the U.S. that use cutural competency principles in their planning and delivery of services.

Jackson, V. and Lopez, L. Eds. (1999). Cultural Competency in Managed Behavioral Care. Dover, New Hampshire, Fraser. A. Lang.

A cross-section of practicioners contribute to this edited book, which is intended to provide a tool to acquaint the mental health practioner with culturally competent managed behavioral care systems. The book is divided into three parts. Part one deals with specific populations-children, adolescents, and seniors. Part two focuses on culturally competenct services which include domains such as: the public mental health system, substance abuse services, employee assistance programs, primary care settings and urban schools. Finally, in part three the authors authors address specific behavioral health care issues such as diagnosis, psychopharmacology, and psychological testing. Issues of social class, racism, acculturation, assimilation, and language are woven into the discussions on what constitutes culturally competent mental health care. The book is intended as a practical guide to practioners, administrators and policy makers in the field. This volume also traces the history of cultural competence within the U.S. and the authors credit the federal Child and Adolescent Service system Program( CASSP) as bringing this notion to the mainstream.

Jordan, D. (1998). Cultural Competence and the Systems of Care Planning Model. Promoting Cultural Competence in Children's Mental Health Services. R. Isaacs.

This chapter offers a method by which an organization may evaluate its level of cultural competence ranging from overt destructiveness on one end of the continuum to advanced cultural competence standards at the other end. A grid at each level of competence describes how services are applied to cultural groups.

Lopez, S. (1997). Cultural Competence in Psychotherapy : A Guide for Clinicians and their Supervisors. Handbook of Psychotherapy Supervision. J. C. E. Watkins. New York, John Wiley and Sons.

Cultural competence is characterized as the ability to move between cultural frameworks at the culture-specific (emic ) and culture-general (etic) level of belief systems. This author describes this ability as the central point of cultural competence and represents the the capacity of the therapist to move between cultural perspectives. Further emphasis is placed on process (meaning) as in how a therapist ascribes meaning vs what they may know about a particular cultural group.

Lu, F. (2000). Clinical Cultural Competence: DSM-IV Outline for Cultural Formulation and Guidelines. San Francisco, Department of Psychiatry, San Francisco General Hospital.

Luntz, J. (2000). Cultural Competence in CAMHS : Stage 2, Victorian Child and Adolescent Mental Health Sevices (CAMHS).

Mason, J. L., Braker, K., et al. (1995). An Introduction to Cultural Competence Principles and Elements. An Annotated Bibliography. Portland,OR, Portland State University, Research and Training Center on Family Support and Children's Mental Health:.

This annotated bibliography is divided into five areas of cultural competence. These include cultural self-assessment, dynamics of difference, valuing diversity, adaptation to diversity and incorporation of cultural knowledge. Cultural competence is described as a developmental process which is seen as a vehicle towards greater appreciation of diversity in general. The monograph provides brief annotations which are intended to help the service provider in the practice of designing and maintaining cultural competence practices in the area of mental health. A very useful guide which should be updated to reflect more current literature.

National Center for Cultural Competence (NCCC). Washington, Georgetown University Child Development Center. http://www.dml.georgetown.edu/depts/pediatrics/gucdc/cultural.html

The NCCC is a component of the Georgetown University Child Development Center,Center for Child Health and Mental Health Policy under the Department of Pediatrics of the Georgetown University Medical Center. Under the direction of Tawara D. Goode, this center has produced a number of monographs and programs that aim to increase cultural competence in health services. This center distinguishes itself from previous initiatives by its broad based definition of culture and its rejection of a model that focuses on the officially recognized minority groups.

National Center for Cultural Competence (NCCC) (1999). Cultural Competence: Implications for the Development of Policy and Guidelines for Serving Children with Special Needs and Their Families, Resource Manual, Georgetown University Child Development Center.

Resource Manual gathered from a National Conference in Washington in June\1999, on the subject of Cultural Competence sponsored and sponsored by the NCCC in Washington. The manual offers conceptual frameworks, information and strategies to address institutional bias.

New York State Office of Mental Health and The Research Foundation for mental Hygiene (1998). Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs, The Center for the Study of Issues in Public Mental Health.

Conceptual Framework: cultural competence is defined within five domains: 1. needs assessment, 2. information exchange,3. services,4. human resources, 5. plan and policies, 6. outcomes. Three levels of organizational structure are also identfied :(1) the administrative level, (2) the provider network of mental health organizations, individual providers, groups of providers; and (3) individuals at any level who are involved in the delivery of service.

Puebla Fortier, J. and Shaw Taylor, Y. (1999). Assuring Cultural Competence in Health Care: Recommendations for National Standards and Outcomes-Focused Research Agenda, HHS Office of Minority Health and Resources for Cross Cultural Health Care.


Richards, P. and Bergin, A. (1997). A Spiritual Strategy For Counseling and Psychotherapy. Washington, DC, American Psychological Association.

Included in this book is a checklist of ethical guidelines for education and training standards. In addition to these standards the authors recommend four basic components for a training program that include; a study of values, psychology of religion, comparative religions, and clinical training in this area.

Robinson E, R. (1999). "Impact of Race, Poverty, and Ethnicity on Services for Persons with Mental Disabilities: Call for Cultural Competence." Mental Retardation: 333-338.

The impact of race, poverty and ethnicity in services to people with mental disabilities are considered from a historical perspective as well as from current research data. Cultural competence is defined within a context of services for mentaly disabled people.

The Center For Cross-Cultural Health (1998). Professional Interpreter Standards, Training and Skills Assessment. http://www.crosshealth.com/blg.cover.html

A report from the Working Group of the Minnesota Interpreter Standards Advisory committee. Report is divided into four sets of standards: Competencies, Ethics, Training, and Proof of Professional Skills.

The Office of Minority Health, P. H. s., U.S. Department of Health and Human Services (2000). Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda. http://www.omhrc.gov/CLAS/ds.htm

Wing Sue, D., Arredondo, P. et al. (1992). "Multicultural Counselling Competencies and Standards: A Call to the Profession." Counselling and Development 70(March/April): 477-486.

Advocates "universal" and "focused" multicultural approaches and maintain that there is no contradiction between broad based definitions of culture and those which delineate racial or ethnic categories as the mainstay of cultural work. The authors maintain that all forms of counseling are multicultural but also advocate for a specialty area as well. The authors represent the opinions of the Association for multicultural Counselling (AMCD) and recommend a proposed series of multicultural competencies and standards be adopted by the American Association for Counseling and Development. An appendix provides a detailed list of proposed competencies.

Section VI. Research & Evaluation

Blake, B., Heslin, R. et al. (1996). Measuring Impacts of Intercultural Training. Handbook of Intercultural Training. D. Landis and S. Bhagat. San Franciso, California, Sage.

The chapter sets out to make two contributions to the field of cross-cultural training evaluation studies. The authors outline conceptual and design schema, which pertain to cross-cultural training evaluation process and practices. The main thrust of the chapter is devoted to establishing models of research that can be applied to the cross-cultural training.

Cross Cultural Health care Program, (CCHCP). Cultural Competency Assessment Tools.


A bibliography of cultural competency assessment tools is provided, including individual and organizational self-assessment instruments.

Dana, R. (1998). "Cultural competence in three human service agencies." Psychological Reports 83: 107-112.

This article documents the use of a self-assessment checklist across five dimensions of cultural competence. It provides an interesting tool for evaluation research.

Escobar Javier, Nervi, C. H. et al. (2000). "Immigration and Mental Health: Mexican Americans in the United States." Harvard Review of Psychiatry 8(2): 64-72.

This study examined current literature and epidemiological studies pertaining to the mental health of people of Mexican descent in the United States. The review highlights the accrued evidence of the negative impact of "acculturation" or "Americanization" on the mental health of person living in the United States. From the standpoint of training, the epidemiological emphasis represents one current of focus in culture and mental health training.

Fernando, S. (2000). Research Into Counseling for Ethnic Minorities Schedule for Interview. London: 4.

An unpublished research schedule proposed by Dr. Fernando aimed towards gathering information on training and clinical practice in cross-cultural mental health domains

Goode Tawara, D. (2000). Promoting Cultural Diversity and Cultural Competency: Self-Assessment Checklist for Personnel Providing Primary Health Care Services, Georgetown University Child Development Center National Center for Cultural Competence. http://gucdc.georgetown.edu/ncc7.html

The author provides a checklist for personnel to evaluate the degree of cultural competence in their human service setting. This checklist was adapted from an earlier publication by the author entitled "Promoting Cultural Competence and Cultural Diversity in Early Intervention and Early childhood Settings".

Goode Tawara, D. (2000). Promoting Cultural Competence and Linguistic Competency: Self-Assessment Checklist for Personnel Providing Health Care Services, Georgetown University Child Development Center National Center for Cultural Competence.


Checklist intended to increase awareness and sensitivity of personnel to the importance of cultural and linguistic competence in health and human services.

Gopaul-McNicol, S. and Brice-Baker, J. (1998). A comprehensive instrument to assess cross-cultural competencies. Cross Cultural Practice. New York, John Wiley &Sons.

This instrument is intended to provide students and trainers with a tool to assess their levels of cross-cultural competencies. Using a Likert scale, the instrument is a self-report measure, which assesses attitudes towards cross-cultural competence within the discipline of Psychology.

Hills, H. and Strozier, A. (1992). "Multicultural Training in APA-Approved Counseling Psychology Programs: A Survey." Professional Psychology 23(1): 43-51.

This paper documents a study survey conducted within forty-nine APA counseling approved programs regarding the degree to which multicultural issues were addressed in course work, practical and research. The authors conducted a correlational analysis and findings indicate that a clear attempt is being made to include multicultural material in counseling psychology curricula.

Ponterotto, J., Rieger, B. et al. (1994). "Assessing multicultural counseling competence: A review of instrumentation." Journal of Counseling 72(January/February): 316-322.

This paper describes and critiques four instruments that were designed to measure multicultural training programs in the field of counseling. All four instruments incorporate a definition proposed by Sue et al (1982) which, specifies that multicultural competence consists of awareness, knowledge, and skills. The main finding of the paper is that these measures show promise but require more empirical validation.

Pope-Davis, D. and Dings, J. (1995). The Assessment of Multicultural Counseling Competencies. Handbook of Multicultural Counseling. J. G. Ponterotto and J. Casas, Sage.

This chapter describes four self-report measures that have been developed to assess student levels of cultural competence and to measure success of training programs in this area. The authors draw their criteria of cultural competence from a previously defined construct (Sue et al., 1992) that has been adopted by the national counseling association.

Ptak, C., Cooper, J. et al. (1995). "Cross cultural training programs: Advice and Insights from Experienced Trainers." International Journal of Intercultural Relations 19(3): 425-453.

This article summarizes the findings of a qualitative study that identified the theoretical trends and practices amongst a research group of ninety-four professionals who were considered to be experienced in the field on inter-cultural training. Participants were asked a series of seven questions and responses were categorized into themes, which were presented in the paper. Three major training categories emerged, which include issues regarding the implementation of training programs and the personal and professional development of training. The paper offers useful distinctions between the terms cross-cultural, intercultural, and multicultural. Practical guidelines are offers to trainers. The value of this paper is its successful attempt to identify areas of divergence and convergence in current training practices. It does not, however, address the more fundamental issues of their ideological underpinnings and makes no attempt to distinguish between the notions of race, culture, ethnicity. In this way the research remains at the surface of debate and discussion in this area.

Rousseau, C. (1995). "Residents' perceptions of transcultural psychiatric practice." Community Mental Health 31(1): 73-85.

Sue, S. (1998). "In Search of Cultural Competence in Psychotherapy and Counseling." American Psychologist(April): 442-448.

The author defines cultural competence as the ability and skills of a particular culture to deliver effective interventions to members of that culture. The author describes a study that addresses characteristics of cultural competence. Three specific questions were of interest: 1. Is there evidence that ethnic clients benefit from seeing ethnically similar therapists? 2. Are there better outcomes with ethnic-specific services? 3. Does cognitive match create better outcomes? Results indicated that cognitive match was

Switzer, G., Scholle, S. et al. (1998). "The client cultural competence inventory: an instrument for assessing cultural competence in behavioral managed care organizations." Journal of Child and Family Studies 7(4): 483-491.

Based on previous research, nine components of cultural competence are identified that reflect client perceptions of their experiences with managed care services. A research inventory was developed that broadly divided competencies into three areas which include the following: respect for ethnic differences, easy access to care, and community and family involvement.