A TREATMENT IMPROVEMENT PROTOCOL Improving Cultural Competence TIP 59 A TREATMENT IMPROVEMENT PROTOCOL Improving Cultural Competence TIP 59 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 Improving Cultural Competence Acknowledgments This publication was produced by The CDM Group, Inc., under the Knowledge Application Program (KAP) contract numbers 270-99-7072, 270-04-7049, and 270-09-0307 with the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Andrea Kopstein, Ph.D., M.P.H., Karl D. White, Ed.D., and Christina Currier served as the Contracting Officer’s Representatives. Disclaimer The views, opinions, and content expressed herein are those of the consensus panel and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. No official support of or endorsement by SAMHSA or HHS for these opinions or for particular instruments, software, or resources is intended or should be inferred. Public Domain Notice All materials appearing in this volume except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726- 4727) (English and Español). Recommended Citation Substance Abuse and Mental Health Services Administration. Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Originating Office Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 14-4849 First Printed 2014 ii Please share your thoughts about this publication by completing a brief online survey at: https://www.surveymonkey.com/r/KAPPFS The survey takes about 7 minutes to complete and is anonymous. Your feedback will help SAMHSA develop future products. Contents Consensus Panel ............................................................................................................. vii KAP Expert Panel and Federal Government Participants ...................................................ix What Is a TIP? .................................................................................................................xi Foreword ....................................................................................................................... xiii Executive Summary ......................................................................................................... xv Chapter 1—Introduction to Cultural Competence ............................................................. 1 Purpose and Objectives of the TIP........................................................................................... 2 Core Assumptions..................................................................................................................... 4 What Is Cultural Competence? ................................................................................................ 5 Why Is Cultural Competence Important? .............................................................................. 7 How Is Cultural Competence Achieved? ................................................................................. 9 What Is Culture? .................................................................................................................... 11 What Is Race? ......................................................................................................................... 13 What Is Ethnicity? ................................................................................................................. 15 What Is Cultural Identity? .................................................................................................... 16 What Are the Cross-Cutting Factors in Race, Ethnicity, and Culture? ................................ 16 As You Proceed ....................................................................................................................... 33 Chapter 2—Core Competencies for Counselors and Other Clinical Staff ...........................35 Core Counselor Competencies ............................................................................................... 36 Self-Assessment for Individual Cultural Competence ........................................................... 55 Chapter 3—Culturally Responsive Evaluation and Treatment Planning .............................57 Step 1: Engage Clients............................................................................................................ 59 Step 2: Familiarize Clients and Their Families With Treatment and Evaluation Processes . 59 Step 3: Endorse Collaboration in Interviews, Assessments, and Treatment Planning ........... 60 Step 4: Integrate Culturally Relevant Information and Themes ............................................ 61 Step 5: Gather Culturally Relevant Collateral Information .................................................. 64 Step 6: Select Culturally Appropriate Screening and Assessment Tools................................ 65 Step 7: Determine Readiness and Motivation for Change .................................................... 69 Step 8: Provide Culturally Responsive Case Management .................................................... 70 Step 9: Integrate Cultural Factors Into Treatment Planning ................................................. 71 iii Improving Cultural Competence Chapter 4—Pursuing Organizational Cultural Competence ..............................................73 Cultural Competence at the Organizational Level ................................................................ 74 Organizational Values ............................................................................................................. 76 Governance ............................................................................................................................. 78 Planning .................................................................................................................................. 80 Evaluation and Monitoring .................................................................................................... 84 Language Services ................................................................................................................... 88 Workforce and Staff Development ......................................................................................... 90 Organizational Infrastructure ................................................................................................. 96 Chapter 5—Behavioral Health Treatment for Major Racial and Ethnic Groups ................ 101 Introduction .......................................................................................................................... 102 Counseling for African and Black Americans ...................................................................... 103 Counseling for Asian Americans, Native Hawaiians, and Other Pacific Islanders .............. 116 Counseling for Hispanics and Latinos ................................................................................. 128 Counseling for Native Americans......................................................................................... 138 Counseling for White Americans ......................................................................................... 150 Chapter 6—Drug Cultures and the Culture of Recovery .................................................. 159 What Are Drug Cultures? .................................................................................................... 161 The Role of Drug Cultures in Substance Abuse Treatment ................................................ 171 Appendix A: Bibliography ............................................................................................. 177 Appendix B: Instruments To Measure Identity and Acculturation .................................... 253 Appendix C: Tools for Assessing Cultural Competence ................................................... 259 Appendix D: Screening and Assessment Instruments ...................................................... 277 Appendix E: Cultural Formulation in Diagnosis and Cultural Concepts of Distress .......... 283 Appendix F: Cultural Resources ..................................................................................... 287 Appendix G: Glossary .................................................................................................... 295 Appendix H: Resource Panel .......................................................................................... 299 Appendix I: Cultural Competence and Diversity Network Participants ............................ 301 Appendix J: Field Reviewers ..........................................................................................