A key to effective, responsive and respectful care

What is cultural competence?

In disaster mental health, cultural competence is the ability of counseling, education and outreach workers to understand and respond effectively to the cultural and linguistic needs of individuals and families most affected by a disaster.

Why is cultural competence important?

According the Department of Health and Human Services, “ … culture bears upon whether people even seek help in the first place, what types of help they seek, what coping styles and social supports they have and how much stigma they attach to mental illness.”

Culture influences how individuals perceive and interpret traumatic events. It influences how they, their families and their communities respond. Access to and acceptance of disaster crisis counseling services may be affected by a number of important factors, including:

• Diversity of cultural values and beliefs about illness, healing and help seeking
• Differences in language and use of English
• Socioeconomic conditions
• Suspicion of governmental programs
• Rejection of outside assistance
• Reluctance to seek help due to stigma
• Variations in responses to loss and expressions of grief
• Lack of information about available services
• Immigration status
• Physical limitations, disabilities or other stressors
• Location of service delivery
• History of previous abuse or trauma

What are significant cultural considerations?

Ethnicity, race, country of origin, gender, age, socio-economic status, education, primary language, English proficiency, spirituality/religion, immigration status, literacy level, employment, sexual orientation, geographic location, and physical disability or limitations.

What do agencies need to do?

• Implement a strategic plan to increase organizational cultural competence and integrate components into the mission and activities of the agency.
• Understand the history, language, norms, traditions and beliefs of the cultural groups present in the community.
• Recruit and retain education and outreach workers and natural leaders who are representative of the community and who are fluent in the preferred languages of the community.
• Use approaches to counseling and education that are naturally occurring and acceptable to the groups in your community (e.g., offering services at places of worship or in schools).
• When bilingual staff are not available, rely on trained interpreters to provide language assistance services.
• Ensure that disaster-related information, educational materials, and messages are translated into the languages of the community.
• Rely on naturally occurring media outlets to make education and counseling services known to the community (e.g., ethnic newspapers, TV, radio).
• Develop partnerships with community leaders, “cultural brokers” and natural networks to guide disaster response efforts and to facilitate access to services within the community.
• Integrate knowledge of alcohol and substance abuse trends and treatment into the development of tailored disaster prevention and supportive counseling strategies.
• Monitor access to crisis counseling services and design specific strategies to reach the unengaged.
• Conduct ongoing assessments of organizational cultural competence at the provider and administrative levels and examine the effectiveness of disaster crisis counseling and education activities.

What do outreach, crisis counseling and education workers need to do?

• Implement an organizational plan to increase cultural competence and strive each day to provide culturally relevant crisis counseling services.
• Be knowledgeable of the history, language, norms, traditions and beliefs of the cultural groups in the community.
• Rely on the people served to be the best source of information about their experiences with traumatic events. Ask individuals and families how they respond to crisis and about their history with prior trauma.
• Be conscious of personal cultural biases and how they may influence cross-cultural interactions.
• Understand and accept the need for ritual and customs in coping and dealing with stress.
• Understand cultural uniqueness in expressions of distress.
• Become educated about behaviors shaped by culture (e.g., not making direct eye contact).
• Maintain respect for the beliefs and values that are important to people coping with a disaster. In particular, be aware of individual spiritual beliefs and practices.
• Understand the role of families and communities in supporting people affected by disaster.
• Be mindful that a child’s perception of a disaster is closely linked to how the parents or significant others react.
• Appreciate that there is large variation across cultures in how people respond to death and loss.
• Guard against stereotyping based on knowledge of general characteristics of a group.
• Be aware of the impact of oppression and historical trauma on the daily lives of people.
• Learn about the extent of alcohol and substance abuse in community cultural groups and rely on strategies that are tailored to the groups and that promote healthy coping.
• Be attentive to aspects of non-verbal communication (e.g., knowledge of personal space, body language).
• Acknowledge your limitations in understanding aspects of culture and language and encourage the people you are counseling to let you know if you unknowingly upset them or do something wrong.
• Consider alternative approaches to missed or cancelled appointments.
• Be respectful, well informed and follow through with what you say you will do.

Resources

Doherty, G. Cross-cultural counseling in Disaster Settings. Australasian Journal of Disaster and Trauma Studies. Available at http://www.massey.ac.nz/~trauma/issues/1999-2/doherty.htm

Center for Mental Health Services. Field Manual for Mental Health and Human Service Workers in Major Disasters. [DHHS Publication No. ADM 90-537]. Copies are available at no charge from the Knowledge Exchange Network, P.O. Box 42490, Washington, D.C. 20015. Toll-Free Information Line 1-800-789-2647. Also available at http://www.mentalhealth.org/publications/allpubs/ADM90-537/Default.asp

Center for Substance Abuse Treatment. A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual and Transgender Individuals. [DHHS Publication No. SMA 01-3498]. Available at http://www.health.org/govpubs/bkd392/index.pdf

National Association of School Psychologists. Cultural Perspectives on Trauma and Critical Response. Available at http://www.nasponline.org/NEAT/neat_cultural.html

New York State Office of Mental Health. See Cultural Competency in the chapter, “Designing Services for Children and Their Families before and after Disaster.” Available at http://www.omh.state.ny.us/omhweb/crisis/crisiscounseling.html

National Technical Assistance Center for State Mental Health Planning. Cultural Competence/Diversity. Alexandria, VA: National Association of State Mental Health Planners. Available at http://www.nasmhpd.org/ntac/topics/culturalCompetence.html

Office of Minority Health, U.S. Department of Health and Human Services. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Available at http://www.omhrc.gov/clas/finalcultural1a.htm#final1

Office of the Surgeon General, U.S. Department of Health and Human Services. Mental Health: Culture, Race and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Available at http://www.surgeongeneral.gov/library/mentalhealth/cre/default.asp

Saldaña, D. Cultural Competency: A Practical Guide for Mental Health Service Providers. Hogg Foundation for Mental Health, University of Texas at Austin. Available at http://www.hogg.utexas.edu/hfweb/comm/publications/webpubs/cultural.html

University of Michigan. Enhancing Your Cultural Communication Skills. Available from the University of Michigan Patient Education Resources for Health Professional site:
http://www.med.umich.edu/pteducation/cultcomp.htm

For Additional Information and Assistance, contact:

Cathy Cave, Project Liberty Cultural
Competence Coordinator, New York State
Office of Mental Health, 44 Holland Avenue
Albany, New York 12229
Phone 518-408-2026, Fax 518-486-7988
ccave@omh.state.ny.us

Support for this program comes from the Federal Emergency Management Agency and the Center for Mental Health Services.