Development of Culturally Competent Mental Health Care

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DESCRIPTION (provided by applicant): Recent national reports have called for the implementation of culturally competent mental health care. However the conceptual and empirical base of cultural competence is weak, thus limiting what our systems of care can do to respond to this call. The overall objective of this application is to address these noted limitations by (a) operationalizing an existing cultural competence model into a treatment approach, (b) producing a training protocol to accompany this model, (c) carrying out the training with a group of public mental health practitioners, and (d) assessing whether clinicians' cultural competence skills increase as a function of the training and whether patients' satisfaction, treatment retention, and functioning improve as a result of the clinicians' training. A conceptual model of cultural competence entitled "Shifting Cultural Lenses" (Lopez, 1997) will be translated into a systematic set of procedures. In addition, recent advances in culture theory will be integrated into this treatment manual. A training protocol will be produced to facilitate the implementation of the treatment approach. As a first step in developing this model, the focus of training will be in working with Latinos, the largest ethnic/racial minority group in the United States. A preliminary evaluation of the treatment manual/training protocol will be carried out with 30 mental health practitioners (nonpsychiatrists) who serve the public sector in Santa Cruz County California. A within subjects design will be applied such that both clinician and patient outcomes will be evaluated with Latino consumers in videotaped clinical interactions with a newly admitted patient prior to the training and another newly admitted patient after the training. We expect that clinicians' cultural competence skills, their therapeutic alliance, and their expression of warmth will increase after training. In addition, we expect that patients' satisfaction, treatment retention, and clinical functioning will increase after training. Qualitative (narratives) measures will also be used to assess the clinical encounter.