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Cultural competency: Ready or not?

December 1, 2007
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Managers can improve preparedness by using a Stages of Change approach

The extent to which an organization practices cultural competency is the precise extent to which the door to high-quality substance abuse services is open to minority groups. Research drawn heavily from the health and behavioral health communities has consistently reported better outcomes for ethnically, linguistically, and racially diverse clients served in organizations that strategically prepare and provide for their distinct needs. To underscore, one can predict that outcomes will be more favorable in organizations that effectively deliver care to a diversity of clients.

Before our eyes, we are experiencing a phenomenal shift in the demographic face of America. The minority population now comprises more than one-third of the total U.S. population. It follows that the necessity for culturally competent systems of care in the addiction field is no less than imminent. A culturally competent system of care has highly inclusive policies, practices, and attitudes, and an emotional climate that demonstrates regard, respect, and responsiveness to the distinct needs of minorities.

However, there is strong evidence that local, state, and national systems of care are not yet prepared to meet the challenge. The federal Center for Mental Health Services (CMHS) stated in a report entitled Cultural Competency Standards in Managed Mental Health Care Services: For Underserved/Underrepresented Racial/Ethnic Groups that a “significant disconnect has arisen between behavioral health care need and the availability and accessibility of effective services for the minority consumer.”

Can substance abuse agencies afford to remain lacking in this core component of proficient care? And what is the role of the senior-level manager in being accountable to all stakeholders in providing equitable access to effective care for all? Program managers must devote energy and resources to establish comprehensive and flexible systems of care for clients of color, as well as a culturally responsive environment in which these systems can flourish.

Shortfall of response

My experience as a trainer and consultant in cultural competency has led me to believe that the collective lack of preparedness I have seen is directly tied to low motivation and incentive. Here are a few supporting observations that have led me to this conclusion:

  • Most senior leaders concur that cultural competency training is important, and yet I have spoken with many who say they have no budget for this kind of training. What is puzzling is that many agencies have budgets that rely heavily on government funding, which requires of them a written cultural competency development plan of action. This alone would seem to require that cultural competency training be as prominent in budget planning as staff salaries.

  • Occasionally I receive a request to facilitate a one-hour session to satisfy an agency's requirement for diversity training. Most of these requests are coming from agencies that have not invested a great deal in training in the past. Would these same managers believe that a one-hour outcomes-based documentation training every two years would be sufficient to create better documentation standards within the organization?

  • In a world where economic viability hinges on collaboration and cooperation, one might presume that cultural competency would be a higher priority. Although the business case for becoming culturally competent is compelling, it is shocking that the substance abuse field appears to remain so far behind the curve with preparedness efforts.

Borrowing from the Stages of Change model of Prochaska and DiClemente, here is how I see managers’ outlook on cultural issues. In the precontemplation stage, organizational leaders might be uninformed about culturally competent systems of care, or might work in a community that rarely serves clients of color. In contemplation, organizational leaders have a heightened awareness of cultural factors and their implications for expanding capacity to offer effective care. The awareness may be driven by a literature review, a conference workshop, or perhaps a crisis involving a minority client. Audits and accreditation reviews might spark questions, concerns, or the need for corrective action planning.

In the preparation stage, organizational leaders are purposeful about information seeking, strategizing, and the planning of organizational interventions necessary for culturally effective service delivery. The preparation stage includes an ongoing assessment of pros and cons and of implications for the manager, the organization, and clients/families.

In the action stage, organizational leaders execute a plan of action, such as scheduling a training series for the agency, hiring a consultant, and revamping marketing materials to reflect the diversity of the client population. With commitment and organizational buy-in, the manager aggressively engages in a long-term implementation of tangible competency-building activities. Some managers while in the action stage for building a culturally competent infrastructure might not engage in their own effort to become more culturally sensitive.

Finally, in the maintenance stage, organizational leaders understand the critical importance of cultural competency and therefore find it imperative to continue to look for fresh, out-of-the-box ways to open the doors wider to serve the increasing numbers of diverse clients.

From the manager's perspective, it is vital to continue to engage in one's own personal and spiritual development as well as those activities that support cultural enrichment throughout the organization. It has been said that an effective leader cannot expect to manage beyond his/her own personal, emotional, spiritual, and cross-cultural health, energy, and sensibility.