In January, 2003, the Center for School Mental Health Assistance (CSMHA) sponsored a critical issues meeting focused on cultural competence in schools and school-based mental health (SBMH) programs. The CSMHA, at the University of Maryland, is one of two national centers providing leadership, training, technical assistance, and resources to advance mental health in schools in the United States (U.S.). The other center is at the University of California, Los Angeles. Both centers are funded by the Health Resources and Services Administration, with co-funding provided by the Substance Abuse and Mental Health Services Administration. Educators, policy makers, psychologists, medical personnel, family members, administrators and youth advocates attended the meeting and worked together to define cultural competence, consider its application to school mental health, and identify both barriers and solutions for culturally competent services. In the following, we review key themes and recommendations developed from the meeting. Couched in current literature on cultural competence, these thoughts highlight the imperative for cultural responsiveness in our schools and in the provision of school mental health (SMH) services (Clauss-Ehlers & Weist, 2004).

The increasing diversity of the U.S. supports the need for a significant agenda to enhance cultural competence of staff and programs in public schools. According to U.S. Census data, people of color now constitute 25% of the total population. In fact, this percentage is expected to continue to increase as Census figures show the non-White population grew at a rate eleven times greater than that of the White population between 1980 and 2000 (Hobbs & Stoops, 2002). In some states such as California, New Mexico, and Hawaii, as well as the District of Columbia, people of color now comprise more than 50% of the total population.

Cultural Competence in Mental Health

Within the area of mental health service provision, there has been a focus on cultural competence since the early 1970s, when the National Institute of Mental Health (NIMH) established the Minority Mental Health Research Center. Through that initiative, four separate research centers were funded to address four major racial/ethnic groups: African Americans, Asian Americans, Hispanic Americans, and Native Americans. In 1988, the NIMH Child and Adolescent Service System Program helped to further advance research in this area through the establishment of the Minority Initiative Resource Committee. The Initiative resulted in the publication of Towards a culturally competent system of care (Cross, Bazron, Dennis, & Isaacs, 1989), one of the first publications to define cultural competence. Concerns about the ability of practitioners to incorporate culturally competent practice also prompted the American Psychological Association (APA) to develop guidelines about the provision of services to racial/ethnic groups (American Psychological Association, 1993). These guidelines were revisited and updated to reflect current trends in the landmark APA publication entitled Guidelines on multicultural education, training, research, practice, and organizational change for psychologists (American Psychological Association, 2003).

In 1999, the Office of the Surgeon General produced the first ever report on mental health services in the U.S., Mental health: A report of the Surgeon General. In a telling comment made by the Surgeon General in the preface, he stated: “Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender” (Department of Health and Human Services, 1999). The disparities were so great, in fact, that a supplemental report, Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the Surgeon General, detailing the nature and extent of these disparities was issued in 2001. The report provided information on the need to reach underserved populations and new directions for research (U.S. Department of Health and Human Services, 2001) as well as federal support including the National Center for Cultural Competence to (http://www.georgetown.edu/research/gucdc/nccc/) and the Office for Minority Health (http://www.omhrc.gov) help guide practitioners in their efforts to provide more effective services for culturally diverse populations.

Cultural Competence in Education

Immigration has strongly shaped the development of public schools in the U.S. Early on, the nation’s public schools were seen as a place where “Americanization” of immigrant children could take place. Immigrants had to learn English and to think of themselves as Americans rather than as members of distinct racial/ethnic groups (Olneck, 1989). School districts across the country began to see efforts to “Americanize” in a different light as a result of the Great Depression and World War II. In fact, many school districts nationwide implemented programs in “intercultural education” by the early 1940s. The primary purpose of these programs was to foster acknowledgement of the contributions of diverse groups to U.S. life and history. The 1954 Supreme Court ruling in Brown v. Board of Education furthered intercultural education when the Supreme Court opposed the “separate but equal” doctrine. This was followed ten years later by the Civil Rights Act of 1964 that further protected individual and group rights (American Psychological Association, 2003). These historical events set the context for cultural competence in schools.

Recently, the emphasis on cultural diversity in education has shifted to the importance of culturally competent practice. The Office of Special Education Programs (OSEP) of the U.S. Department of Education, which provides leadership and financial assistance to state and local special education programs, has been a leader in recognizing the importance of cultural competence in education. In 1994, OSEP developed a National Agenda that included seven target areas including one designed to value and address diversity. In an effort to implement more culturally competent education services for children with special education needs, some OSEP-funded projects organized activities to promote cultural understanding between families and teachers.

Technical assistance and research centers such as the Center for Effective Collaboration and Practice (http://cecp.air.org) and several federally-funded regional lab schools (http://www.nwrel.org/national/) provide resources and perform research on culturally competent practice both in special education and in general education classroom settings. Pat Guerra, program associate for the Southwest Educational Development Laboratory (SEDL; one of the regional lab schools), speaks to the need for cultural competence in education, stating: “The low academic achievement and high dropout rate of cultural and linguistic minorities in public schools in the U.S. are well documented. While the cause of these challenges for minority populations remains the source of much debate, a significant body of research points to the need for the inclusion of students’ culture in the instructional settings for these populations to succeed” (SEDLetter, 2000).

Defining Cultural Competence

Given this history, it is important to define what is meant by cultural competence, which is viewed as an elusive term for many. In his writing, for instance, Sue (1998) talks about the “search for cultural competence.” Sue’s phrase certainly fits the myriad of attempts by scholars, educators, researchers, and practitioners to specify those characteristics that make up cultural competence. In this writing Sue’s (1998) definition of cultural competence is used which is defined as “the belief that people should not only appreciate and recognize other cultural groups but also be able to effectively work with them” (p. 440). This definition acknowledges that cultural competence refers not only to knowledge and awareness, but also to skill and application.

Each individual is uniquely multicultural. Each individual has membership in many cultural groups that influence worldview and the process of interacting with others. Cultural group influences include race, ethnicity, gender, sexual orientation, education, vocation, family structure (e.g., two parent, single-parent, blended), faith and religion, other institutional affiliations (e.g., social, political), class, leisure activities (e.g.,sports, arts, music), and traumatic experiences (e.g., abuse, injury, illness, addictions and combat), among others. These group memberships combine in unique ways to create the individual’s cultural personality.

In turn, each membership comes with a set of values and experiences that shape the individual’s worldview and thought processes. Each membership is also grounded in a set of assumptions about the nature of existence, humanity, and the change process. These assumptions consciously and unconsciously, overtly and covertly, influence the individual’s interactions with others including students and families. When the individual owns his or her “cultural personality” he or she becomes more self-aware and more capable of discerning which part of the cross-cultural interaction dynamic reflects the self and which belongs to the client.

Kagawa-Singer and Chung (1994) state that culturally competent care is achieved when the “therapist can effectively use the knowledge of his or her own culture and the client’s to negotiate mutually acceptable goals of therapy with the client/family” (p. 200). They further state that culturally based competent care involves working “in a manner which is culturally comprehensible and acceptable to the individuals and their families” (Kagawa-Singer & Chung, 1994). To pinpoint exact aspects of culturally competent care, meeting participants constructed a list of important characteristics and components of cultural competence. Characteristics fell under three general competency areas: knowledge (knowing about the community and family being served, recognizing the sociopolitical context of the client being served); awareness (of one’s own cultural values and biases, of the client’s worldview, and of nonverbal cues); and skill (ability to effectively engage in individual and cultural assessment, balance between clinical and cultural skill, ability to partner with client system, and ability to deliver services in the appropriate language). These three components fit with Sue and Sue’s (1990) view of a culturally skilled counselor as someone who is “aware of his/her own assumptions about human behavior…attempts to understand the worldview of his/her culturally different client [and is]…in the process of actively developing and practicing appropriate…skills” (p. 166). These same characteristics, developed for mental health practitioners, are relevant for educators.

Why Enhance the Focus on Cultural Competence in Schools?

Three major reasons are presented to address the question of why schools should enhance their focus on cultural competence. First, the changing demographic profile of African Americans, Latino Americans, Asian and Pacific Islanders, and Native American youth require school-wide programs, sensitivity to diverse learning styles, and linguistically relevant instruction for such groups of students in a culturally relevant educational environment. Second, mental health efforts within schools are growing progressively and have received significant federal support through the New Freedom initiative, that contains an explicit recommendation to “expand and improve school mental health programs” (see www.mentalhealthcommission.gov). These school mental health programs assist in responding to the diverse needs of students of various racial/cultural backgrounds, many of whom experience elevated mental health concerns (e.g., for immigrant students, related to traumatic experiences in their country of origin or during the immigration process). Further, there is evidence that enhancing the cultural competence of mental health efforts increases their effectiveness (U.S. Department of Health and Human Services, 1999).

Third, focusing on cultural competence will enhance the potential of schools and school mental health programs to increase resources. The resultant enhanced potential for additional resources relates to a number of factors, including: a) better understanding of students and families served by the school, enabling the tailoring of educational and mental health programs, b) increased involvement and support from school and community stakeholders, resulting in broadened networks to connect to individuals and agencies that may have resources to offer, c) an enhanced connection to federal regulations such as those in the No Child Left Behind Act (described in more detail later), and d) enhanced face validity of grant applications as clear attention to the cultural background of students and families served is documented.

Barriers and Strategies to Address Cultural Competence in School Mental Health

Given these potential benefits to enhance the cultural competence agenda for schools and school mental health programs, the question becomes, “Why is this agenda not developing?” Participants in the aforementioned critical issues meeting suggested a number of reasons that can roughly be grouped into categories focused on individual and school/program levels. These barriers and strategies to overcome them are presented below.

Individual Barriers

At the level of the individual, a number of factors commonly impede cultural competence. These include poor understanding of the concept, limited self-awareness of one’s own cultural background and the cultural background of others, absent or poor previous professional development, limited options for current training, “busyness” and associated disinterest in yet another topic that might increase job demands, and professional “aloofness” and pathologizing that may increase distance versus connection with youth and families.

School/Program Barriers

At the level of the school/school mental health program there are also a number of impediments. These include biases and stereotyping of particular racial/ethnic groups, limited time for and generally poor use of in-service professional development, limited ongoing supervision, limited resources for cultural competence initiatives, lack of leadership and role models that emphasize the importance of cultural competence, and other agendas (such as improving student behavior and academic performance) that may be viewed as competing versus complementary to a cultural competence enhancement agenda.

Strategies to Address Barriers

A commitment to cultural competence in education and mental health promotion can be cultivated through professional development. To address this void, graduate schools of psychology and education can provide trainees with coursework that promotes the three aspects of cultural competence: knowledge, skills, and awareness (Clauss-Ehlers, 2006). The first author, for instance, has taught a course entitled Individual and Cultural Diversity. The purpose of this course is to provide students enrolled in a 5-year teacher education program with a comprehensive understanding of diversity and how it plays out in the classroom. The course looks at dimensions of diversity such as race and gender, but moves beyond these variables that are typically associated with diversity efforts to also examine factors such as ethnicity, language, sexual orientation, age, social class, cultural values, exceptionality, and bullying.

Course content was presented in the context of a format that combined lecture, discussion, and skill-building activities, components thought to help develop the tripartite model of cultural competence. It is important to note, however, that having only one course designated as the “diversity course” fails to adequately meet the goals of a truly cross-cultural training curriculum. Rather, training in the area of cross-cultural competence is most effective when it is infused throughout a course of study. In this sense, trainees are learning about the relevance of cross-cultural competence as it relates to various perspectives and areas of study. A comprehensive approach also demonstrates the value that the training institution places on graduating culturally competent trainees.

To build on the foundation of pre-service professional development experiences to continue to promote culturally competent teaching and practice, ongoing professional development after graduation is necessary (Paternite & Johnston, 2005). Professional development opportunities that include mentoring, staff development days, guest speakers, roundtable discussions, supervision and attendance at professional conferences are ways that teachers and mental health professionals can continue to enhance cultural competence (Clauss-Ehlers, 2006).

Why a Cultural Competence Agenda in Schools?

To move towards providing professional development, mentoring and supervision that promotes cultural competence requires a commitment by schools and school mental health program leaders. How is this commitment developed and maintained? Essentially, this becomes an issue of advocacy for the cultural competence agenda. A starting point for advocacy in schools is to organize and present information that will help frame the idea of cultural competence in a way that helps school leaders consider it an integral part of school functioning (Aponte & Bracco, 2000; HoganBruen, Clauss-Ehlers, Nelson, & Faenza, 2003). Organizing and/or highlighting demographic information is a good first step that supports this argument. For example, almost all school systems maintain data on the student body including percentages of different racial/ethnic groups, students receiving reduced/free lunches, students receiving special education services, among other variables. In addition, as mentioned, the No Child Left Behind Act mandates that data is collected by racial/ethnic and other groupings to track school performance for diverse groups of students. Such data collection processes often reveal differences in performance across subgroups. Despite these findings, analysis and action planning to increase supports to diverse groups in a way that reduces barriers to learning is often limited to school leaders. Broadening this analysis and action planning to include educators, school mental health staff, families, and youth will enhance the quality of planning, raise awareness of the importance of cultural competence, improve relationships and school climate, and improve academic outcomes for student subgroups (Clauss-Ehlers & Wibrowski, 2007).

Within the mandates of the No Child Left Behind Act, each school and school system must analyze and report data on eight “cultural” groups. These are American Indian, Asian, African American, White, Hispanic, Economically Disadvantaged, Students with Disabilities and English Language Learners. These different groups must be assured equal achievement. The consequence of any of these groups not meeting certain expectations results in the entire school and or school system being designated as failing. As a result of this expectation, schools must examine how different each group is from others in terms of academic achievement and must provide remedies for the underachieving groups. These remedies must rise above the historical attempts at providing “good plans and good services” and now be evaluated in terms of adequate yearly progress by all students. Here, the definition of culturally competent education and service could be translated to address the question, “Do all children achieve?”

One of the primary tenets of No Child Left Behind is that if performance deficits for any of the eight “cultural” groups are identified, then a redistribution of resources must occur, either by enhancing resources to enable improved performance for groups identified as not achieving, or families are permitted to move their children to a new school. One method to enhance resources to schools that are “failing” in these dimensions is to increase the proportion of “highly qualified staff” (HQS). School systems have attempted to move HQS to failing schools by either providing incentives for HQS to work in these schools, to make it easier to transfer non-HQS to other schools, or to restrict the movement of HQS to other schools.

By defining how data should be analyzed and providing an expectation that all children achieve the No Child Left Behind Act has, to some extent, defined which “cultures” are essentially different and in need of assurance of equal treatment. It has also defined the measure of culturally competent education and treatment as those services that lead to equal achievement. Thus at the level of advocacy and policy influence, school and mental health leaders can site the provisions of the No Child Left Behind Act to justify why the school/school district should focus on enhancing cultural competence in the midst of all the other mandates and pressures of education. That is, culturally competent efforts will assist the school/district in understanding and responding to the needs of different cultural groups, to enable effective supports to these groups, promoting equal academic achievement as mandated by the act.

On a daily level, progress toward enhancing cultural competence in schools will require working closely with the school principal and administrative team (HoganBruen et al., 2003). Educators and school mental health staff invested in advancing the cultural competence agenda can prioritize relationship development with members of the school leadership team, and in individual interactions with them by: a) emphasizing the benefits of focusing on cultural competence (as above), b) offering ongoing assistance in analysis and action planning, and c) offering ongoing assistance in outreach activities to students, families and school staff representing the different cultural/ethnic groups of the school and surrounding community. Another significant agenda relates to relationship development with school board members and district leaders to convey the importance of focusing on cultural competence and to gain their support in moving forward.

This brings us to an essential dimension of this agenda—actual outreach to and involvement of youth, families, and people from the surrounding community in school improvement planning and action (Clauss-Ehlers & Weist, 2004). This outreach and involvement can be framed as a genuine effort to understand the perspectives of diverse school and community members towards school climate improvement and strategies to help students succeed while also supporting their families. This relates to perhaps the most significant recommendation of critical issues meeting participants; that is, cultural competence reflects an honest and committed approach to attain genuine empathy for the diverse groups of people served by the school.

Through such collaboration, the objective for educators and mental health professionals alike is to work toward what Aponte and Bracco (2000) call the development of “cultural competency with helping networks.” Cultural competency with helping networks refers to a network of contacts and relationships that are created between the school system and the surrounding community whose objective is to address a shared agenda.

The culturally competent helping network may focus more intensively on specific problems within the school or in the community such as discipline, community violence, and substance abuse, than on the development of cultural competence per se. It is therefore appropriate to identify issues that can be effectively alleviated by culturally competent interventions. As a result, collaboration can focus on specific community issues while simultaneously addressing the role and impact of cultural influences on the issue at hand (Clauss-Ehlers, 2008).

An important issue and caveat to this writing is that there is limited research literature that documents the empirical benefits of focusing on cultural competence in schools. Our recommendations are admittedly experience based and attempt to put forth a logic model of why this agenda should be of importance. From a scientific perspective there are many unanswered questions, including: (a) what are the best approaches to train staff in cultural competence?; (b) what is the most important content in such training?; (c) what are the qualitative (e.g., staff job satisfaction) and quantitative (e.g., changes in student achievement) outcomes from a strong focus on cultural competence?, and; (d) are there potential cost savings to such an agenda? These are but a few of the many questions that would benefit from systematic research.