Cultural and Linguistic Competence

When seeking or providing mental health services to a child, youth and/or their family, it is imperative to consider their culture and language preferences in order to ensure appropriate care.

Cultural and Linguistic Competence Defined

"Cultural Competence” is a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals that enables effective interactions in a cross-cultural framework.[i] "Culture” refers to a group's pattern of communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.[ii] "Competence” implies having the ability to serve clients effectively and with sensitivity in the context of the cultural beliefs, behaviors, and needs presented by the clients in their respective communities. "Linguistic Competence” means providing readily available, culturally appropriate oral and written language services to limited English proficiency members through such means as bilingual/bicultural staff, trained medical interpreters, and qualified translators.[iii] "Cultural and Linguistic Competence” is the ability of health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by the patient to the health care encounter.[iv]

The Importance of Cultural and Linguistic Competence

Respecting cultural identity is crucial to ensure interaction and involvement with mental health professionals and treatment. Cultural experience may shape a person's belief system, influence the way a person, and/or family, perceives mental illness and mental health professionals, impact the way a person describes symptoms of distress, and impact the service provided by a mental health professional who lacks training on working effectively with consumers with diverse cultural and linguistic backgrounds.[v]

Despite the fact that communities across the state have become more diverse as populations have increased, mental health care programs and professionals have failed to keep pace. To illustrate, a finding from the National Survey of American Families that Hispanic children have higher rates of unmet need in the area of mental health services, is of particular concern since national estimates suggest that Hispanic adolescents have higher rates of suicidal thoughts, depression and anxiety, as well as higher drop-out rates than white adolescents. This problem will particularly affect Texas because by the year 2020, it is estimated that more than 50% of Texas children will be Hispanic. Of additional concern is the fact that, of the total uninsured children in Texas, 52% are Hispanic.[vi]

Gay, Lesbian, Bisexual, or Transgender Youth

A special population for consideration of culture competence are gay, lesbian, bisexual, or transgender (GLBT) youth. Adolescence is a time of many transformations in a young person's life, including physical, mental, and emotional changes. Exploring sexuality is a natural part of this developmental process. Yet for those youth who have same-sex attractions or who identify as gay, lesbian, bisexual, or transgender, adolescence may be an even more turbulent time than usual as they cope with stigma and social prejudice related to their sexual orientation or gender identity.[vii] The effects of this stigma may cause GLBT youth to be more vulnerable to mental health problems such as depression, anxiety, substance abuse, and suicide. [viii]

The issues of familial support and rejection may be even more significant in the lives of racial or ethnic minority GLBT youth, as familial ties and connectedness tend to be more highly valued in most communities of color. Coming out, or disclosing one's sexual orientation, may mean not only losing connections to one's immediate family, but may also mean rejection from one's larger racial or ethnic community. GLBT youth of color must therefore negotiate an even more complicated set of issues when deciding if and when to "come out.”[ix]

Military Families

An emerging special population of children and youth in need of mental health services are children of military families due to daily stress surrounding the uncertainty of parents' safety. Anxiety, acting out, and/or withdrawal from typical daily routines or activities are typical ways in which children may "cope” with this daily stress. This is especially true for parents or family members that are deployed away from home, or in war-torn areas, more than once.

TEXAS RESOURCES

Hogg Foundation for Mental Health - Cultural Adaptation: Providing Evidence-Based Practices to Populations of Color is the first initiative in the Cultural Competence priority area. In July 2006, the Foundation announced awards of more than $2.9 million over three years to five organizations to adapt the delivery of evidence-based practices (EBPs) to be compatible with the cultures of their populations of color. See: http://www.hogg.utexas.edu/

OUTstanding Amarillo - OUTstanding Amarillo is the only non-profit in the Texas Panhandle exclusively committed to providing social services, education opportunities, and recreation activities for the Gay, Lesbian, Bisexual, Transgendered, and Questioning (GLBTQ) population with a specific focus on youth through age 25. See: http://www.outstandingamarillo.org/index.html

Out Youth – Out Youth is a non-profit organization whose mission is to support and provide services to gay, lesbian, bisexual, transgender, and questioning youth ages 12 to 19 in Austin and Central Texas. Out Youth offers peer support groups, counseling, educational programs, social activities, and community outreach. Visit: http://www.outyouth.org/

HATCH - Located in Houston, HATCH, is a non-profit organization formed in 1987 that is dedicated to empowering gay, lesbian, bisexual, transgender, intersex, questioning youth, and their allies (GLBTIQA), ages 13-20 to become positive contributors to society by providing a safe social environment for GLBTIQA youth, offering role models and peer support, and by sponsoring educational and community outreach opportunities. See: http://www.hatchyouth.org/index.html

NATIONAL RESOURCES

Technical Assistance Partnership for Child and Family Mental Health - The Technical Assistance Partnership for Child and Family Mental Health helps communities transform the way services are delivered to children and families. These values and principles emphasize family- and youth-driven services, cultural competence, effective and evidence-based interventions, and sustainability within a coordinated community-based service system. Visit: http://www.tapartnership.org/cc/default.asp

The National Technical Assistance Center Approach - The National Technical Assistance Center for Children's Mental Health promotes culturally and linguistically competent service delivery systems with the intent to effect change in organizational policies and service delivery practice in systems of care. See: http://gucchd.georgetown.edu/programs/ta_center/topics/cultural_linguistic_competence.html

Resources for Returning Veterans and Families – The federal branch, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a list of links and resources for veterans and their families. See: http://www.samhsa.gov/vets/index.aspx

National Military Family Association – The National Military Family Association provides information and resource for children's behavioral health issues for families of the military. See: http://www.nmfa.org/

American Academy of Child and Adolescent Psychiatry – The American Academy of Child and Adolescent Psychiatry provides information and resource for children's health and mental health issues for families of the military. See:

http://www.aacap.org/cs/root/facts_for_families/coming_home_adjustments_for_military_families

National Association for Mental Illness – provides links to resources for military families including resources for children. Visit:http://www.nami.org/Template.cfm?Section=Veterans_Resources&Template=/ContentManagement/ContentDisplay.cfm&ContentID=53587&lstid=878

RELATED REPORTS

Experts Watching the Mental Health of Army Children is a report from Washington and the Army News Service, Oct. 16, 2008 from Retired Col. Stephen J. Cozza, M.D., the associate director of the Center for the Study of Traumatic Stress and a professor at the Uniformed Services University School of Medicine's psychiatry department. He told the audience at the third and final Family Forum that experts need to know more about how multiple deployments and changes like combat injuries, death and post-traumatic stress disorder affect military children. See: http://www.army.mil/-news/2008/10/16/13343-experts-watching-mental-health-of-army-children/