Culture and Trauma

This annotated resource list is part of an ongoing and evolving project that aims to provide the NCTSN with a set of resources to utilize as a starting point in the dynamic process of enhancing cultural competence. While this list is extensive, it is not viewed as complete, all-encompassing, or exhaustive. One note about organization: we have identified references which address cultural competence generally, as well as for specific populations. This is not meant to stereotype groups or to suggest, in any way, that specific groups of individuals all respond to trauma and other experiences in the same way. In fact, biological science tells us that there is overwhelmingly greater genetic variation within a racial group than across racial groups. We hope that these resources will serve to begin a dialogue on issues related to trauma and cultural competence. We welcome your feedback and suggestions for additions.


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This annotated resource list is part of an ongoing and evolving project that aims to provide the NCTSN with a set of resources to utilize as a starting point in the dynamic process of enhancing cultural competence. While this list is extensive, it is not viewed as complete, all-encompassing, or exhaustive. One note about organization: we have identified references which address cultural competence generally, as well as for specific populations. This is not meant to stereotype groups or to suggest, in any way, that specific groups of individuals all respond to trauma and other experiences in the same way. In fact, biological science tells us that there is overwhelmingly greater genetic variation within a racial group than across racial groups. We hope that these resources will serve to begin a dialogue on issues related to trauma and cultural competence. We welcome your feedback and suggestions for additions.


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Models and Theory

Betancourt J.R., Green, A.R., & Carrillo, J.E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. New York, NY: The Commonwealth Fund. doi: 10.1377/hlthaff.24.2.499
Report: Evaluates current definitions of cultural competence, identifies models of culturally competent care, and provides recommendations for implementing interventions and improving the quality of health care.

Blasé, K.A., & Fixsen, D.L. (2003). Evidence-based programs and cultural competence. Tampa, FL: National Implementation Research Network, Louis de la Parte Florida Mental Health Institute, University of South Florida.
Consensus Statement: Summarizes the resulting commentary on implementation phases of evidence-based programs, including the exploration stage, site selection process, installation stage, initial and advanced implementation stages, and the sustainability stage.

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. doi: 10.1177/10459602013003003
Journal Article: Presents a model which views cultural competence as an ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client.

Cross, T. L., Benjamin, M. P., Isaacs, M. R., Portland State University & CASSP Technical Assistance Center. (1989). Towards a culturally competent system of care. Washington, D.C: CASSP Technical Assistance Center, Georgetown University Child Development Center.
Monograph: This document is part of a three-volume series. Volume I describes a philosophical framework for such a system, identifies principles, and offers some practical ideas for improving service delivery at policy, administrative, and clinical levels to children of color who are severely emotionally disturbed.

Holcomb-McCoy, C.C. (2000). Multicultural Counseling Competencies: An exploratory factor analysis. Journal of Multicultural Counseling and Development, 28(2), 83-97.
Journal Article Examines the underlying factors of the Association of Multicultural Counseling and Development's Multicultural Competencies through a survey of 151 professional counselors.

Isaacs, M.R., & Benjamin, M. (1991). Towards a culturally competent system of care: Programs which utilize culturally competent principles, volume II. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.
Monograph: Volume II of the series describes programs that utilize principles of cultural competence in serving children/families of color, provides an analysis of crosscutting issues, and makes suggestions and recommendations for future directions.

Markus, H.R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224-253. doi: 10.1037/0033-295X.98.2.224
Journal Article: Theories of the self from both psychology and anthropology are integrated to define in detail the difference between a construal of the self as independent and a construal of the self as interdependent. Relevant empirical literature is reviewed.

Minde, K.K., et al. (1982). Some aspects of disruption of the attachment system in young children: A transcultural perspective. In Anthony, E.J., & Chiland, C. (Eds.), The Child in his family: 7. Children in turmoil. - 1982. - XVI,  (pp. 215-233). New York, NY: John Wiley & Sons, Inc.
Book Chapter: Describes concepts about the loss of the primary attachment figure. Discusses the effect that disruption may have in children of different cultural backgrounds.

Ponterotto, J.G. (2001). Handbook of multicultural counseling. Thousand Oaks, CA: Sage Publications.
Book: Offers the perspectives of 85 scholars in the field of multicultural counseling. Presents historical perspectives, discusses ethical issues/oppression, theory/research, counseling/identities, and multicultural issues in counselor supervision and higher education.

Purnell, L. (2002). The Purnell model for cultural competence. Journal of Transcultural Nursing, 13(3), 193-196. doi: 10.1177/10459602013003006
Journal Article: The 12 domains comprising Purnell Model for Cultural Competence are briefly described along with the primary and secondary characteristics of culture, which determine variations in values, beliefs, and practices of an individual's cultural heritage.

Salzman, M. (2000). Promoting multicultural competence: A cross-cultural mentorship project. Journal of Multicultural Counseling and Development, 28(2), 119-124.
Journal Article: Describes a project designed to increase the multicultural competency of Euro-American graduate counseling students and to serve the interests of Native American students as defined by Native American educators in an urban school district.

Sue, D.W., & Sue, D. (Eds). (1999). Counseling the culturally different: Theory and practice. New York, NY: John Wiley & Sons, Inc.

Book: A standard reference for courses in minority mental health and treatment. Uses clinical and real-life examples to illustrate the concepts of multicultural counseling and therapy.

Tyler, F.B. Brome, D.R., & Williams, J.E. (1991). Ethnic validity, ecology, and psychotherapy: A psychosocial competence model. New York: Plenum Press.
Book: Presents the Ethnic Validity Model, a psychosocial competence model of conducting psychotherapy that builds upon the ethnic and racial heritage of both the therapist and client.

U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity--A supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.
Report: Addresses three foci: 1) To understand better the nature and extent of mental health disparities, 2) To present the evidence on the need for mental health services and on the provision of services to meet those needs, and 3) To document promising directions toward the elimination of mental health disparities and the promotion of mental health.


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Culture and Trauma

Athey, J. & Moody-Williams, J. (2003). Developing cultural competence in disaster mental health programs: Guiding principles and recommendations. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Guide: Provides background information, guiding principles, recommendations, and resources for developing culturally competent disaster mental health services.

Cohen, J.A., Deblinger, E., Mannarino, A. P., & de Arellano, M. A. (2001). The importance of culture in treating abused and neglected children: An empirical review. Child Maltreatment, 6(2), 148-157. doi: 10.1177/1077559501006002007
Journal Article: Reviews the available empirical evidence that addresses the influence of culture on symptom formation, treatment-seeking behaviors, treatment preference, and response following child maltreatment.

Ferrari, A.M. (2002). The impact of culture upon child rearing practices and definitions of maltreatment. Child Abuse & Neglect, 26(8), 793-813. doi:10.1016/S0145-2134(02)00345-9
Journal Article: The aim of the present study was to assess the relationship between a childhood history of abuse that a parent may have experienced and the cultural beliefs/factors that an individual may subscribe to with current parenting behaviors and attitudes.

Hill, H.M., Soriano, F.I., Chen, S.A., & LaFromboise, T. (1994). Sociocultural factors in the etiology and prevention of violence among ethnic minority youth. In L.D. Eron & J. H. Gentry, (Eds.), A reason to hope: A psychosocial perspective on violence and youth, (pp. 59-97). Washington, D.C.: American Psychological Association.
Book Chapter: Examines sociocultural factors as they apply to ethnic minority youth and suggests critical relations between culture, structural inequities, developmental mandates, and violence among ethnic minority youth.

Stamm, B., Stamm, H., Hudnall, A. C., & Higson-Smith, C. (2004). Considering a theory of cultural trauma and loss. Journal of Loss and Trauma, 9(1), 89-111.
Journal Article: The authors propose a model of cultural trauma and revitalization. The theory suggests a framework for understanding disruptions that an "original" culture might suffer at the imposition of an "arriving" culture resulting in vulnerabilities of individuals, families/small groups, communities, and the larger societies.

Korbin, J.E. (2002). Culture and child maltreatment: Cultural competence and beyond. Child Abuse & Neglect, 26(6-7), 637-644. doi:10.1016/S0145-2134(02)00338-1
Journal Article: Reviews the literature on culture and child maltreatment.

Manson S.M. (1997). Cross-cultural and multiethnic assessment of trauma. In J.P. Wilson & T.M. Keane (Eds.), Assessing psychological trauma and PTSD. (pp 239-266). New York, NY: The Guilford Press.
Book Chapter: Suggests ways to pursue work on the nature, recognition, and meaning of trauma, as well as its representation as posttraumatic stress disorder (PTSD), among different cultures.

Marsella A.J. (1996). Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications. Washington, DC: American Psychological Association.
Book: The purpose of this book is to explore and examine the role of ethnocultural aspects of PTSD through a thorough and comprehensive discussion of current theory, research, and practice.

Nader, K., Dubrow, N., & Stamm, B. H. (1999). Honoring differences: Cultural issues in the treatment of trauma and loss. Philadelphia, PA, US: Brunner/Mazel, Inc.
Book: Deals with the treatment of trauma and loss, while recognizing and understanding the cultural context in which the mental health professional provides assistance.

Roer-Strier, D. (2001). Reducing risk for children in changing cultural contexts: Recommendations for intervention and training. Child Abuse & Neglect, 25(2), 231-248. doi:10.1016/S0145-2134(00)00242-8
Journal Article: Proposes guidelines to both parents and professionals for the prevention and reduction of risk associated with cultural differences, conflicts and misinterpretations.

Stamm, B.H., & Friedman, M.J. (2000). Cultural diversity in the appraisal & expression of traumatic exposure. In A. Shalev, R. Yehuda, & A. McFarlane (Eds.), International handbook of human response to trauma (pp 69-85). New York: Plenum Press.
Book Chapter: Addresses the question about whether PTSD or some other idiom of distress is the best conceptualization of traumatic stress across varying racial/ethnic groups.

Amey, C. H., & Albrecht, S. L. (1998). Race and ethnic differences in adolescent drug use: The impact of family structure and the quantity and quality of parental interaction. Journal of Drug Issues 28(2): 283-298.
Journal Article: Curbing adolescent substance abuse is a national priority in the US. To effectively allocate resources it is imperative that antecedents and correlates of drug use across diverse populations be understood. Racial and ethnic differences in drug use have yet to be explained. Because family characteristics are known to vary across race/ethnic groups, and prior research suggests a connection between family characteristics and adolescent drug use, this study investigated the impact of family on race/ethnic differences in drug use. Results from a national household survey of 1,389 Black, White, and Latino adolescents (aged 10-17 yrs) show that although socioeconomic and demographic characteristics alone explained drug use differences between Latinos and non-Latino Whites, the differences between Black and White adolescents could not be explained by either structural or functional differences in the family. Furthermore, it appears that the single-parent Black family provides a greater protection against drug use than does the 2-biological-parent Black family. Findings suggest that the development of policy based on a knowledge of correlates of substance use within the White community may be both inefficient and ineffective when applied to minority communities. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Behl, L., Crouch, J. L., May, P. F., Valente, A. L., & Crouch, J. L. (2001). Ethnicity in child maltreatment research: A content analysis. Child Maltreatment 6(2): 143-147. doi: 10.1177/1077559501006002006
Journal Article: The present study represents a content analysis of 1,133 articles published between 1977 and 1998 in Child Abuse & Neglect, Child Maltreatment, and Journal of Child Sexual Abuse . Although there were indications of increased attention to ethnicity in child maltreatment research published between 1977 and 1998, the improvements were modest. Of the 1,133 articles examined, 6.7% focused on ethnicity. The percentage of studies that provided information on the ethnic composition of samples increased across time; however, only half of the studies published in the most recent years examined (1995-1998) reported information on the ethnicity of the participants. Although the percentage of articles that used ethnicity in analyses or as a control variable increased across time, three quarters of the articles published in the most recent years examined (1995-1998) did not include ethnicity in their analyses or design. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Boyer, D., & Fine D. (1992). Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Family Planning Perspectives. 24: 4-11. Journal Article: Found that White females had higher rates of victimization compared to Hispanic females.

Breslau, N., & Davis, G. C. (1992). Posttraumatic stress disorder in an urban population of young adults: Risk factors for chronicity. American Journal of Psychiatry 149(5): 671-675.
Journal Article: Identified characteristics of chronic posttraumatic stress disorder (PTSD) (symptoms for 1 yr or more) and examined whether any suspected risk factors for PTSD were associated with chronic PTSD in 1,007 21-30 yr old members of a health maintenance organization. The analysis was performed on interview data from 394 Ss who reported traumatic events, of whom 93 met criteria for PTSD. The 53 Ss with chronic PTSD had, on the average, a significantly higher total number of PTSD symptoms and higher rates of overreactivity to stimuli that symbolized the stressor and interpersonal numbing than persons with nonchronic PTSD. The rates of 1 or more additional anxiety or affective disorders and a variety of medical conditions were higher in Ss with chronic PTSD than in Ss with nonchronic PTSD. Family history of antisocial behavior and female sex were associated specifically with chronic PTSD. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Breslau, N., Davis, G. C., & Andreski, P. (1995). Risk factors for PTSD-related traumatic events: A prospective analysis. American Journal of Psychiatry 152(4): 529-535.
Journal Article: Used retrospective data to conduct a prospective examination of a model (Breslau et al; see record 1991-21437-001) of exposure to traumatic events (TEs) related to posttraumatic stress disorder (PTSD). Data were gathered from 769 White and 190 Black adults (369 men and 610 women) who were interviewed at baseline and at 3-yr follow-up. 19% of Ss reported TEs at follow-up. A history of past exposure to TEs signaled an increase in the liability to exposure during follow-up, independent of suspected risk factors. Exploratory reanalysis suggested that the discrepancy between the retrospective and prospective results may be explained by the inclusion of childhood exposure in the lifetime retrospective inquiry. The assumption that PTSD-related TEs are random phenomena was unsupported. Ss with less education, Blacks, men, and Ss with high neuroticism and extroversion scores are more likely than others to be exposed to TEs and are at greater risk for PTSD. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Collier, A. McClure F, Collier J, Otto C, & Polloi A. (1999). Culture-specific views of child maltreatment and parenting styles in a Pacific-island community. Child Abuse & Neglect 23(3): 229-244. doi:10.1016/S0145-2134(98)00129-X
Journal Article: Investigated how teachers in the Republic of Palau perceived the severity of potentially abusive incidents and what types of recommendations, if any, they would have for situations judged as severely abusive. Attitudes about child rearing practices were also evaluated. 141 public elementary school teachers (aged 23-58 yrs) were given: (1) a questionnaire consisting of 25 vignettes describing parent/child interactions that were potentially abusive and asked to rate the severity of abuse and recommended interventions for each vignette; and (2) a 40-item parenting styles questionnaires to evaluate attitudes about child-rearing practices. Results show that teachers identified and recommended interventions for more severe forms of abuse at rates similar to other international samples. Some traditional Palauan parenting practices that might be considered maltreatment by other cultures were not considered abusive. It is concluded that cultural values and practices play important roles in shaping the definition and interpretation of child maltreatment. Appendices of child abuse vignettes and their origins and modifications are provided. (Spanish abstract) (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Coohey, C. (2001). The relationship between familism and child maltreatment in Latino and Anglo families. Child Maltreatment 6(2): 130-142. doi: 10.1177/1077559501006002005
Journal Article: Familism, or familismo, refers to attitudes, behaviors, and family structures operating within an extended family system and is believed to be the most important factor influencing the lives of Latinos. Because of the complexity of the construct, this article begins by separating out and defining each dimension of familism, and then clarifies its relationship to the broader literature on social networks, social support, and child maltreatment. The analysis tests whether each dimension of familism is related to child maltreatment within and between 35 abusive Latino, 35 nonabusive Latino, 51 abusive Anglo, and 51 nonabusive Anglo families. Nonabusing Latinos appear to have a higher level of familism than the other 3 groups of mothers. However, when intraethnic comparisons were made, nonabusive Anglos, compared with abusive Anglos, had higher levels of familism on several variables. Hence, familism seems to characterize families-Latino and Anglo-who do not maltreat their children. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Cunningham, R. M., Stiffman, A., Doré, P., & Earls, F. (1994). The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: Implications for public health. Child Abuse & Neglect 18(3): 233-245. doi:10.1016/0145-2134(94)90108-2
Journal Article: Explores the relationship between changes in HIV risk behaviors and physical and sexual abuse. Face-to-face structured interviews conducted since 1984-85 with 602 youths (aged 13-18 yrs at 1st interview) provide a history of change in risk behavior from adolescence to young adulthood. Univariate and bivariate analyses assessed differences in demographic and number and type of risk behaviors between those experiencing single or multiple types of abuse and those with no abuse history at all. Results show that a history of physical abuse, sexual abuse, or rape is related to engaging in a variety of HIV risk behaviors and to a continuation or increase in the total number of these behaviors between adolescence and young adulthood. (French & Spanish abstracts) (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Davidson, J. R., Hughes, D., Blazer, D. G., & George, L. K. (1991). Post-traumatic stress disorder in the community: An epidemiological study. Psychological Medicine 21(3): 713-721. doi: 10.1017/S0033291700022352 
Journal Article: Examined posttraumatic stress disorder (PTSD) among 2,985 Ss (aged 18-95 yrs) in a community. Based on responses to the Diagnostic Interview Schedule, the lifetime and 6-mo prevalence figures for PTSD were 1.3% and 0.44%, respectively. Compared with non-PTSD Ss, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, experience of child abuse, and parental separation or divorce before age 10 yrs. PTSD was associated with greater psychiatric comorbidity, attempted suicide, social phobia, obsessive-compulsive disorder, generalized anxiety, and major depression. Compared with acute cases, chronic PTSD was accompanied by more social phobia and somatization disorder, impairment of subjective social support, and greater likelihood of physical attack with regard to initiating trauma. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

DeBruyn, L., M. Chino, Serna, P., & Fullerton-Gleason, L. (2001). Child maltreatment in American Indian and Alaska Native communities: Integrating culture, history, and public health for intervention and prevention. Child Maltreatment 6(2): 89-102. doi: 10.1177/1077559501006002002
Journal Article: Addresses child maltreatment (including abuse and neglect) intervention and prevention among American Indians and Alaska Natives. The authors argue that history and culture must be included as context and variables for developing and implementing prevention programs in Indian Country. They propose that the public health violence prevention model would benefit from incorporating tenets of the history and culture(s) of diverse groups, in this instance American Indians and Alaska Natives. The authors offer an approach that focuses on population- and individual-level risk and protective factors for child maltreatment intervention and prevention in American Indian/Alaska Native communities. They include suggestions and examples for doing the work in Indian Country. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Flaskerud, J. H. (2000). Ethnicity, culture, and neuropsychiatry. Issues in Mental Health Nursing 21(1): 5-29. doi:10.1080/016128400248248
Journal Article: Reviews the research on the relationships among ethnicity, culture, neuropsychiatric diagnosis, and treatment. Psychiatric nurses provide care to an ethnically and culturally diverse group of clients. It is argued that knowledge of ethnic and cultural differences is essential to diagnosis and treatment. Ethnic diversity affects psychiatric diagnosis. Cross-ethnic differences in genetics, diet, environmental exposure, and fetal, childhood, and adolescent development may result in varied experience psychiatric illness among ethnic groups. Ethnic and cultural diversity also affects psychiatric treatment. Cultural forces shape symptom formation and the expression of distress, creating sources for misdiagnosis based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The culture-bound syndromes represent unique illness forms with a natural history distinct from DSM classification. Culture also influences treatment expectations, therapeutic compliance, family involvement, and the interpretation of side effects. It is concluded that neuropsychiatric nurses can contribute to research by studying cross-ethnic differences and similarities in biological markers of mental illness. A 2nd area of research mentioned is that of ethnicity and psychotropic drug metabolism and pharmacodynamics. (PsycINFO Database Record (c) 2003 APA, all rights reserved).

Fluke, J. D., Yuan, Y. T., Hedderson, J., & Curtis, P. A. (2003). Disproportionate representation of race and ethnicity in child maltreatment: Investigation and victimization. Children & Youth Services Review 25(5-6): 359-373. doi:10.1016/S0190-7409(03)00026-4
Journal Article: Disproportionality of racial and ethic representation in investigation and disposition of child maltreatment was examined using National Child Abuse and Neglect Data System (NCANDS) data for more than 700,000 children in five states. State disproportionality representation indices (DRI) and disparity indices (DI) were constructed for children who were the subject of an investigation of child abuse and neglect and for children who were found to be victims of maltreatment by child protective services agencies. In all five states and for both indices, African American children were overrepresented and White children consistently underrepresented at the stage of investigation for each of states. At the determination of victimization, results for African Americans and Whites using the DRI varied greatly from county to county, but demonstrated little disproportionality. (PsycINFO Database Record (c) 2003 APA, all rights reserved) (journal abstract).

Fontes, L. A., Cruz, M., & Tabachnick, J. (2001). Views of child sexual abuse in two cultural communities: An exploratory study among African Americans and Latinos. Child Maltreatment 6(2): 103-118. doi: 10.1177/1077559501006002003
Journal Article: Investigated knowledge and ideas about child sexual abuse among African Americans and Latinos through focus group discussions. 56 20–60 yr old participants defined and described child sexual abuse, acknowledged that it occurred in their communities, and expressed their sense that family risk factors, risky institutions, and offender propensities were its root causes. Latino participants identified cultural transitions as another contributor. Responses and conversational style differed somewhat by gender and cultural identity. The authors discuss implications for child sexual abuse prevention, intervention, and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 

Garrison, C. Z., Bryant, E. S., Addy, C. L., & Spurrier, P. G. (1995). Posttraumatic stress disorder in adolescents after Hurricane Andrew. Journal of the American Academy of Child & Adolescent Psychiatry 34(9): 1193-1201. doi:10.1097/00004583-199509000-00017
Journal Article: Examined the rates and correlates of posttraumatic stress disorder (PTSD) in adolescents after Hurricane Andrew. Data were collected via 40-min telephone interviews on 158 Hispanics, 116 blacks and 104 white adolescents (12-17 yrs old), 6 mo after the hurricane. Interviews were focused on within-disaster experiences and emotional reactions, disaster-related loss, lifetime exposure to traumatic events, recent stressful experience, and psychiatric symptomatology. Results indicate that 7.3% of the Ss had PTSD symptoms. 3% of the males and 9% of the females met the criteria for PTSD. Rates of PTSD were highest among the blacks and Hispanics, and increased with age and the number of undesirable incidents reported. It was concluded that stressful events occurring after disasters were more strongly associated with PTSD than was the magnitude of contact with the actual disaster. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Hahm, H. C., & & Guterman, N. B. (2001). The emerging problem of physical child abuse in South Korea. Child Maltreatment 6(2): 169-179. doi: 10.1177/1077559501006002009
Journal Article: South Korea has had remarkably high incidence and prevalence rates of physical violence against children, yet the problem has received only limited public and professional attention until very recently. This article represents the first attempt in English to systematically analyze South Korea's recent epidemiological studies on child maltreatment. Discussed are sociocultural factors that have contributed both to delays in child protection laws and a low public awareness of the problem of child abuse. The article highlights methodological issues concerning the definition of physical abuse in South Korea and the complex attitudes toward violence. It also examines the role of the Korean women's movement in the reform of family laws and the recent establishment of new child protection legislation. Suggestions for future directions for the problem of child maltreatment within South Korea are presented. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Kuhn, J. A., Arellano, C. M. & Chavez, E. L. (1998). Correlates of sexual assault in Mexican American and White non-Hispanic adolescent males. Violence & Victims 13(1): 11-20.
Journal Article: Psychosocial and emotional characteristics were assessed in a survey of a nonclinical sample of 1,385 adolescent Mexican American and White non-Hispanic males. 54 males who reported being sexually assaulted one or more times were compared to 1,331 males who reported no history of sexual assault. Sexually assaulted male victims were more emotionally distressed, socially isolated, deviant (e.g., lying and stealing), likely to affiliate with deviant peers, and to come from homes in which there was parental substance use, than males who do not report sexual assault. Significant differences were not found between Mexican American and White non-Hispanic assault victims. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (1996). Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. Journal of Consulting & Clinical Psychology 64(4): 712-723. doi: 10.1037/0022-006X.64.4.712
Journal Article: The authors examined symptoms of posttraumatic stress in 3rd-5th grade children during the school year after Hurricane Andrew. From a conceptual model of the effects of traumatic events, 442 children were evaluated 3, 7, and 10 months postdisaster with respect to (a) their exposure to traumatic events during and after the disaster, (b) their preexisting demographic characteristics, (c) the occurrence of major life stressors, (d) the availability of social support, and (e) the type of coping strategies used to cope with disaster-related distress. Although symptoms of posttraumatic stress disorder (PTSD) declined over time, a substantial level of symptomatology was observed up to 10 months after the disaster. All 5 factors in the conceptual model were predictive of children's PTSD symptoms 7 and 10 months postdisaster. Findings are discussed in terms of the potential utility of the model for organizing thinking about factors that predict the emergence and persistence of PTSD symptoms in children. (PsycINFO Database Record (c) 2002 APA, all rights reserved) (journal abstract).

Marsella, A. J., Friedman, M. J., & Spain, E. (1994). Ethnocultural aspects of posttraumatic stress disorder. Pynoos, Robert S (Ed). (1994). Posttraumatic stress disorder: A clinical review. (pp. 17-41). Baltimore: US: The Sidran Press.
Book Chapter: Summarize and review critically the existing cross-cultural posttraumatic stress disorder (PTSD) literature, especially as it pertains to veterans and refugees / discuss some of the major conceptual and methodological issues involved in understanding the relationships between culture and PTSD / recommend conceptual and research approaches for studying ethnocultural aspects of PTSD (PsycINFO Database Record (c) 2003 APA, all rights reserved).

Mason, W., Zimmerman, L. & Evans, W. (1998). Sexual and physical abuse among incarcerated youth: Implications for sexual behavior, contraceptive use, and teenage pregnancy. Child Abuse & Neglect 22(10): 987-995. doi:10.1016/S0145-2134(98)00080-5
Journal Article: Examined physical and sexual abuse among incarcerated youth with respect to sexual activity, contraceptive use, and pregnancy. The self-report survey data were collected from 62 females and 334 males aged 12-17 yrs old who were incarcerated. Of the males, 46.8% reported a history of physical abuse and 9.9% reported sexual abuse. Whereas 73% of the females reported a history of physical abuse and 68.3% reported sexual abuse. Results indicated that female Ss who reported a history of sexual abuse had an earlier mean age of first intercourse than those who reported no sexual abuse. In addition, male and female Ss with a history of physical and/or sexual abuse reported using no method of contraception as compared to Ss with no history of abuse. Despite the decreased likelihood of using contraception, no evidence was found of increased pregnancy and parenthood among abused respondents. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Mennen, F. E. (1995). The relationship of race/ethnicity to symptoms in childhood sexual abuse. Child Abuse & Neglect 19(1): 115-124. doi:10.1016/0145-2134(94)00100-9
Journal Article: Evaluated the relationship of race/ethnicity to the nature and severity of symptoms in sexually abused girls. 51 White, 38 Latina, 35 African-American, 8 Asian-American, and 2 other race/ethnicity girls and adolescents (all Ss aged 6-18 yrs) completed measures of depression, anxiety, and self-worth. Race/ethnicity had a relationship with the duration of the abuse, with White Ss tending to be abused longer than Latina or African American Ss. There was no general effect of race/ethnicity on symptom level in sexual abuse. However, there was a significant interaction effect, with Latina Ss reacting differently according to the kind of abuse they suffered. Latina Ss who had experienced penetration abuse had significantly higher symptom levels on measures of depression, anxiety, and self-worth than did Latina Ss who were abused without penetration. (French & Spanish abstracts) (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Moisan, P., Sanders-Phillips, A. K., Moisan, P. M. (1997). Ethnic differences in circumstances of abuse and symptoms of depression and anger among sexually abused Black and Latino boys. Child Abuse & Neglect 21(5): 473-488. doi:10.1016/S0145-2134(97)00007-0
Journal Article: Ethnic differences in the circumstances of the abuse, depression, and anger, as measured by the Children's Depression Inventory and the State-Trait Anger Expression Inventory, were assessed in 60 Black and Latino sexually abused males (aged 13-18 yrs). Factors related to levels of depression and anger in these 2 groups were also identified. A goal of this study was to enhance the theoretical understanding of the impact of sexual abuse on Black and Latino boys, and to improve efforts to develop effective strategies of intervention that address the specific needs of these male victims of abuse. Results show that Latino Ss were more likely to have been sexually abused by an extended family member, experienced more genital fondling, and were exposed to more sexually abusive behaviors. Black Ss were more likely to be abused by an immediate family member. Black Ss had higher anger scores than Latino Ss. Both ethnicity and the relationship to the perpetrator were significantly related to scores on the State-Trait Anger Expression Inventory. Ethnic differences in the circumstances of abuse were related to psychological outcome and the relationship of ethnicity to anger scores was independent of ethnic differences in the circumstances of abuse. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Nettle, S. M., & Pleck, J. H. (1996). Risk, resilience, and development: The multiple ecologies of black adolescents in the United States. Haggerty, Robert J (Ed); Sherrod: risk, and resilience in children and adolescents: Processes, mechanisms, and interventions.
Book Chapter: Examines protective factors and the process of "resilience" . . . as it applies to black adolescents / begin with an overview of the incidence of health- and life-compromising outcomes among black youths / discuss resilience, risk, and protection against risk at the individual and ecological levels and review research on these concepts as they pertain to black adolescent populations (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Nettle, S. M. and J. H. Pleck (1993). "Risk, resilience, and development: The multiple ecologies of Black adolescents." Johns Hopkins University, Center for Research on Effective Schooling for Disadvantaged Students No 44: 28, US: Center for Research on Effective Schooling for Disadvantaged Students.
Article: Examines protective factors and the process of resilience as they apply to Black adolescents. Risk factors at the individual and the community levels are reviewed, as is the incidence of health- and life-compromising risk outcomes in Black adolescents. Individual-level risk factors include personality, sociodemographic factors, and problem behaviors. Community-level risk factors include neighborhood factors, school characteristics, and racial discrimination. Health- and life-compromising risk outcomes in Black adolescents include health, school completion and school-related problems, employability, police involvement, risky sexual behavior, alcohol and drug use, psychological symptoms and suicide. Also discussed is resilience as it relates to adolescent parenthood. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Parfenoff, S. H., Paikoff, R. L. (1997). Developmental and biological perspectives on minority adolescent health. Wilson, Dawn K (Ed); Rodrigue: 388pp.
Book Chapter: Reviews the developmental and biological aspects of minority adolescents' maturational transitions from childhood through adolescence / consider race and sociocultural context (i.e., poverty) as key elements that affect whether adolescents will engage in health risk behaviors / research has suggested that early maturational development may lead to increased sexual activity among female minority adolescents / the importance of involving family, peers, and the community in health promotion efforts is also emphasized / however, as youth enter later adolescence, such issues as the pursuit of adult responsibilities and the need for establishing independence from parents become more prominent / thus, at this stage, intervention efforts should focus on the unique individual needs of adolescents, who are faced with complex choices (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Pfefferbaum, B. (1997). Posttraumatic stress disorder in children: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry 36(11): 1503-1511. doi:10.1016/S0890-8567(09)66558-8
Journal Article: This article reviews the literature of the past 10 yrs on the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. The authors found PTSD described in children exposed to a variety of traumatic experiences. Little has been studied about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are discussed. A variety of factors were revealed to influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches used to treat the condition are presented. The authors conclude that while assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. They also suggest that biological correlates of the condition also warrant greater attention. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Phillips-Sanders, K., Moisan, P. A., Wadlington, S. (1995). Ethnic differences in psychological functioning among Black and Latino sexually abused girls. Child Abuse & Neglect 19(6): 691-706. doi:10.1016/0145-2134(95)00027-6
Journal Article: Conducted psychological assessments of 23 Black and 19 Latino sexually abused girls (aged 8-13 yrs). Latinas received significantly higher scores for depression than Blacks. These differences in depression appeared to be related to ethnic differences in the circumstances of the abuse. Latinas were abused at a younger age, more likely to be abused by a relative, and more likely to have had a sibling abused. Latinas were also more likely to report high levels of family conflict and lower levels of maternal support. Ethnicity was also related to psychological functioning independently of the impact of other factors such as the circumstances of the abuse. Cultural and social factors that may influence psychological functioning subsequent to sexual abuse among Black and Latino girls are discussed. (French & Spanish abstracts) (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Shannon, M. P., Lonigan, C. J., Finch, A. J. & Taylor, C. M. (1994). Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal of the American Academy of Child & Adolescent Psychiatry 33(1): 80-93. doi:10.1097/00004583-199401000-00012
Journal Article: 5,687 school-aged children (aged 9-19 yrs) were surveyed about their experiences and reactions related to Hurricane Hugo. Significant variation in the prevalence of posttraumatic stress disorder (PTSD) symptoms was found across race, gender, and age groups. Self-reported symptoms were used to derive a post-traumatic stress syndrome classification according to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) guidelines for the diagnosis of PTSD. More than 5% of the sample reported sufficient symptoms to be classified as exhibiting this post-traumatic stress syndrome. Females and younger children were more likely to receive this classification. At the symptom level, females reported more symptoms associated with emotional processing and emotional reaction to the trauma. Males were more likely to report symptoms related to cognitive and behavioral factors. Younger children were more likely to report symptoms overall. (PsycINFO Database Record (c) 2003 APA, all rights reserved).

Taussig, H. N., & Talmi, A. (2001). Ethnic differences in risk behaviors and related psychosocial variables among a cohort of maltreated adolescents in foster care. Child Maltreatment 6(2): 180-192. doi: 10.1177/1077559501006002010
Journal Article: This study examined the cross-ethnic equivalence of measures and the relationships between psychosocial variables and risk behaviors in an ethnically diverse sample of 149 maltreated 13-17 yr olds 6 yrs after their placement in foster care. Overall, there was cross-ethnic measurement equivalence, except for the self-destructive behavior and perceived opportunities constructs, which did not demonstrate internal consistency for African American youth. The authors found few differences between White (non-Latino), Hispanic, and African American youth on levels of engagement in risk behaviors and across domains of psychosocial functioning. The relationships between the psychosocial variables and risk behaviors were then examined across ethnic groups. The pattern of results was different as a function of ethnicity, as fewer of the psychosocial variables were significantly related to the risk behavior variables for African American youth. Possible explanations for these differences are presented and implications for intervention discussed. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Terao, S. Y., Borrego, J. J. R., & Urquiza, A. J. (2001). A reporting and response model for culture and child maltreatment. Child Maltreatment 6(2): 158-168. doi: 10.1177/1077559501006002008
Journal Article: As our society becomes increasingly culturally diverse, there is a growing concern in the mental health field as to whether clinicians are able to accurately distinguish different cultural parenting discipline practices from child maltreatment. Clinicians in various fields continue to differ on what is reportable. Although there is literature describing characteristics of various ethnic minority groups, there are limited data to support why clinicians do what they do and no decision-making model to guide clinicians' reporting behavior when working with clients from different cultures. This article focuses on cultural discipline practices rather than healing practices that may be challenging to assess. The authors propose a model to guide clinicians through the decision-making process and discuss interventions and clinical responses that may be most appropriate when presented with different scenarios involving cultural parenting discipline practices and child maltreatment. Finally, limitations of the presented model along with future clinical and research directions are discussed. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Tyler, K. A. (2002). Social and emotional outcomes of childhood sexual abuse: A review of recent research. Aggression & Violent Behavior 7(6): 567-589. doi:10.1016/S1359-1789(01)00047-7
Journal Article: A total of 41 articles examined the social and emotional outcomes of childhood sexual abuse. The outcomes examined included suicide and substance use, gang involvement, pregnancy, running away, post-traumatic stress disorder (PTSD), risky sexual behavior, and behavioral problems. Results for each of these outcomes tended to vary by developmental period. However, problems of internalizing and externalizing behavior appeared to be specific to sexually abused children of all age groups. Some studies found differences in outcome according to gender, race, and age. Although findings related to abuse characteristics were found to vary from study to study, severity of the abuse, use of force, and victim's relationship to the perpetrator were found to be especially important. Other factors, such as family support and parental monitoring, were found to mitigate a negative outcome. Limitations are discussed along with suggestions for future research. (PsycINFO Database Record (c) 2002 APA, all rights reserved).

Williams, J., Goebert, D., Hishinuma, E., Miyamoto, R., Anzai, N., Izutsu, S., & ... Baker, F. M. (2002). A conceptual model of cultural predictors of anxiety among Japanese American and part-Japanese American adolescents. Cultural Diversity & Ethnic Minority Psychology 8(4): 320-333. doi: 10.1037/1099-9809.8.4.321
Journal Article:A model integrating Japanese ethnicity, cultural identity, and anxiety was developed and assessed in Japanese American and part-Japanese American high school seniors (N = 141). Using measures from the Hawaiian High Schools Health Survey, the model incorporated the State-Trait Anxiety Inventory, the Major Life Events Scale, and the Japanese Culture Scale (JCS). Japanese American adolescents scored higher on the JCS and reported fewer anxiety symptoms than part Japanese American adolescents. Predictors for anxiety were being Japanese American versus part, Japanese American, income, and culturally intensified events. A significant interaction of behavior by self-identification was obtained. The model had good overall fit, suggesting that cultural identity formation may contribute to anxiety experienced particularly by adolescents of mixed heritage. (PsycINFO Database Record (c) 2002 APA, all rights reserved) (journal abstract).

Wissow, L. S. (2001). Ethnicity, income, and parenting contexts of physical punishment in a national sample of families with young children. Child Maltreatment 6(2): 118-129. doi: 10.1177/1077559501006002004
Journal Article: Nearly half of US parents use physical punishment for child discipline. Although some studies relate physical punishment and later dysfunction, others suggest that its effects depend on the context in which it is used. The authors analyzed data from the Commonwealth Fund Survey of Parents With Young Children, a national sample of 2,017 parents with children younger than 3. Parents reported their use of spanking, 5 other disciplinary practices, and 4 nurturing interactions. The authors used cluster analysis to define 4 groups of parents with distinct patterns of discipline and nurturing. Two groups with above-average use of spanking shared a high prevalence of parent depressive symptoms and a low level of nurturing but had markedly different demographic profiles and use of nonphysical punishment. Parents who used average levels of spanking made frequent use of nonphysical disciplinary strategies and had high levels of nurturing interactions. Parents who reported below-average spanking had relatively low levels of both disciplinary and nurturing interactions. (PsycINFO Database Record (c) 2002 APA, all rights reserved).


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Language and Literacy

Center for Linguistic and Cultural Competence in Health Care
Website: Office of Minority Health. This site provides information on standards, policies, initiatives, laws, resources, archives, and what's new in the cultural competence arena.

Lee, S.M., & Pope, C.R. (2001). Patients who don't speak English: Improving language minorities' health care with professional interpreters. Rockville, MD: U.S. Department of Health and Human Services, Office of Minority Health.
Report: Presents results from a study of the effects of professional interpreter services on health utilization for a sample of limited English proficient (LEP) patients, over a four-year period.

National Institutes of Health. (1994). Clear & simple: Developing effective print materials for low-literate readers. Bethesda, MD: National Cancer Institute.
Guide: Outlines a process for developing publications for people with limited literacy skills.

Perkins J. (2003). Ensuring linguistic access in health care settings: Legal rights and responsibilities. Los Angeles, CA: The National Health Law Program.
Manual: Shows advocates and providers how to overcome language barriers, outlines language access responsibilities under federal and state law, as well as in the private sector, and offers recommendations for addressing identified problems.

Peterson, E., & Coltrane, B. (2003). Culture in second language teaching. Center for Applied Linguistics. Washington, D.C.
Website: This Digest discusses the importance of incorporating culture into second language teaching and recommends strategies for infusing cultural issues in classroom instruction.

U.S. Department of Health and Human Services. (2001). National standards for culturally and linguistically appropriate services in health care. Final report. Washington, D.C.: Office of Minority Health.
Report: Provides recommendations for national standards for culturally and linguistically appropriate services (CLAS) in health care. Based on an analytical review of key laws, regulations, contracts, and standards currently in use by federal and state agencies and other national organizations.

U.S. Department of Health and Human Services. (2003). A practical guide for implementing the recommended national standards for culturally and linguistically appropriate services in health care. Washington, D.C.: Office of Minority Health.
Website: Provides suggestions for using this step-by-step guide to help health care organizations create a health care environment that would meet the very real needs and expectations of an increasingly diverse patient/consumer population.


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Behrman, R.E., & Shields, M.K. (2004). Children of immigrant families: Analysis and recommendations. The Future of Children, 14(2), 1-161. doi: 10.2307/1602791
Journal: Focuses on the growing number of immigrant families in the United States, and the challenges faced by their children as the next generation of Americans.

Foster, R.M. (2001). When immigration is trauma: Guidelines for the individual and family clinician. American Journal of Orthopsychiatry, 71(2), 153-170. doi: 10.1037/0002-9432.71.2.153
Journal: Considers two pertinent strands in the contemporary immigrant mental health literature using case vignettes highlighting research findings and practice recommendations.


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Berry, J.W. (1990). Psychology of acculturation: Understanding individuals moving between cultures. In R.W. Brislin, (Ed.), Applied cross-cultural psychology, (pp. 232-253). Newbury Park, CA: Sage Publications.
Book Chapter: Focus on how individuals negotiate their course through the process of acculturation, by outlining the process, considering variations in acculturating groups and strategies, and reviewing a number of specific phenomena, including acculturation attitudes and the stresses associated with the process.


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Allen, J. (2002). Assessment training for practice in American Indian and Alaska Native settings. Journal of Personality Assessment, 79(2), 216-225. doi: 10.1207/S15327752JPA7902_05
Journal Article: The collaborative assessment model is extended as a training model. Development of local norms and emic tests are emphasized.

Child Welfare League of America. (2002). Cultural competence agency self-assessment instrument - revised edition. Washington, D.C., Child Welfare League of America.
Assessment Tool: Aims to help child service organizations identify, improve, and enhance cultural competence in staff relations and client service delivery.

Cultural Competency Assessment Tool.
Assessment Tool: Intended to assist community based agencies of all sizes in becoming more culturally competent by identifying strengths and weaknesses, and developing an action plan for improvement. The underlying principle of the assessment tool is to enhance services and programs to ethnocultural communities.

Dana, R.H., Aguilar-Kitibutr, A., Diaz-Vivar, N., & Vetter, H. (2002). A teaching method for multicultural assessment: Psychological report contents and cultural competence. Journal of Personality Assessment, 79(2), 207-215. doi: 10.1207/S15327752JPA7902_04
Journal Article: This model was applied in courses with multicultural students by contrasting standard and multicultural assessment and using data sets from multicultural assessees.

Mason, J.L. (1995). Cultural competence self-assessment questionnaire - A manual for users. Portland OR: Portland State University, Research and Training Center on Family Support and Children's Mental Health.
Assessment Tool: Describes competency in terms of four dimensions: attitude, practice, policy, and structure. The instrument helps child- and family-serving agencies assess their cross-cultural strengths and weaknesses in order to design specific training activities or interventions that promote greater competence across cultures.

Ponterotto, J.G., Rieger, B. P., Barrett, A. & Sparks, R. (1994). Assessing multicultural counseling competence: A review of instrumentation. Journal of Counseling and Development, 72(3), 316-322.
Journal Article: The Cross-Cultural Counseling Inventory-Revised, the Multicultural Counseling Awareness Scale-Form B, the Multicultural Counseling Inventory and the Multicultural Awareness-Knowledge-and Skills Survey were each critically reviewed in terms of item development, psychometric properties and pragmatic utility.

Sattler, J.M. (2001). Assessment of culturally and linguistically diverse children: Background considerations and dynamics. Assessment of children: Cognitive applications, 4th ed. (pp. 635-655). San Diego, CA: Author.
Book Chapter: Emphasizes the need to consider cultural variables when assessing culturally and linguistically diverse children.

Siegel, C., Haugland, G., & Chambers, E. (2003). Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery. Administration and Policy in Mental Health, 31(2), 141-170. doi: 10.1023/B:APIH.0000003019.97009.15
Journal Article: A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked.

Siegel, C., Davis-Chambers, E., Haugland, G., Bank, R., Aponte, C., & McCombs, H. (2000). Performance measures of cultural competency in mental health organizations. Administration and Policy in Mental Health, 28(2), 91-106. doi: 10.1023/A:1026603406481
Journal Article: Numerous documents were utilized to develop performance measures for assessing the cultural competency of mental health systems. Indicators, measures and data sources for needs assessment, information exchange, services, human resources, plans and policies, and outcomes were identified.

U.S. Department of Health and Human Resources. (2002). Indicators of cultural competence in health care delivery organizations: An organizational cultural competence assessment profile. Rockville, MD: The Health Resources and Services Administration.
Report: Project objectives: 1) Develop an analytic framework for assessing cultural competence in health care delivery organizations; 2) Identify specific indicators that can be used in connection with this framework; and 3) Assess the utility, feasibility and practical application of the framework and its indicators.


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Development and Implementation: Examples from Programs

California Institute for Mental Health. (2002). Many voices, one direction: Building a common agenda for cultural competence in mental health - A report to the community. Proceedings from the California Mental Health Directors Association Conference. Sacramento, CA.
Report: Describes infusion of cultural competence at the organizational level, and includes a comprehensive listing of website references and several appendices.

Health Resources and Services Administration. (2002). Cultural competence: A journey. Bethesda, MD: Bureau of Primary Health Care.
Report: Summarizes the evolving experiences of community programs affiliated with the Health Resources and Services Administration's Bureau of Primary Health Care (BPHC) in providing services to culturally diverse populations.

Isaacs, M.R., & Benjamin, M. (1998). Towards a culturally competent system of care: The state of the states: Responses to cultural competence and diversity in child mental health, Volume III. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.
Monograph: Volume III of the series provides an overview of the status of cultural competence development and implementation within state and local child mental health systems over a five-year period. It includes a review of activities undertaken to address federal funding mandates, shifting demographics, and increasing concerns for more efficient and effective services from state legislators and taxpayers.

U.S. Department of Health and Human Services. (2001). Cultural competence works: Using cultural competence to improve the quality of health care for diverse populations and add value to managed care arrangement. Rockville, MD: Health Resources and Services Administration.
Report: Provides examples of HRSA-funded programs that illustrate the range of culturally competent methods and practices that nominees have implemented to enhance their ability to serve linguistically and culturally diverse populations. It also describes the impact that these programs have had on the nominees' relationships with managed care organizations.

U.S. Department of Health and Human Services. (2003). Serving diverse communities in hospitals and health systems. Washington, D.C.: National Public Health and Hospital Institute.
Report: Presents strategies from the various programs and approaches currently underway in the National Association of Public Hospital's (NAPH) hospitals and health systems, using case studies, focus group findings, and toolkits. Includes recommendations to strengthen culturally and linguistically appropriate services in safety net institutions.


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Policy Issues

McDonough, J.E., Gibbs, B. K., Scott-Harris,J. L., Kronebusch, K., Navarro, A. M. & Taylor, K. (2004). A state policy agenda to eliminate racial and ethnic health disparities. New York, NY: Commonwealth Fund.
Report: Focuses on states' role in advancing the disparities-elimination policy agenda by providing a menu of policy interventions that have been implemented at the state level to address disparities in minority health and health care.


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Teaching and Training

American Psychological Association. (1993). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. American Psychologist, 48(1), 45-48. doi: 10.1037/0003-066X.48.1.45
Journal Article: Presents guidelines formulated by the American Psychological Association to provide psychological service providers with the requisite skills for multicultural assessment and intervention and to assist them in understanding the role that culture and ethnicity/race play in the sociopsychological and economic development of culturally diverse populations.

Arredondo, P., & Arciniega, M. (2001). Strategies and techniques for counselor training based on the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 29(4), 263-273.
Journal Article: A framework is outlined for infusing multiculturalism into curricula through the application of specific strategies and techniques.

Downing-Hansen, N., Pepitone-Arreola-Rockwell F, & Greene A. (2000). Multicultural competence: Criteria and case examples. Professional psychology: research and practice, 31(6), 652-660. doi: 10.1037/0735-7028.31.6.652
Journal Article: Identifies 12 minimal multicultural competencies for practice and illustrates their usefulness through three case examples.

Hays, P.A. (1995). Multicultural applications of cognitive-behavior therapy. Professional Psychology: Research and Practice, 26(3), 309-315. doi: 10.1037/0735-7028.26.3.309
Journal Article: Discusses the need for greater attention to cultural influences and minority cultures in the field of cognitive-behavior therapy. Ethnic minority cultures and concerns are emphasized.

Lopez, S.R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C. E. Watkins, Jr. (Ed.), Handbook of psychotherapy supervision, (pp. 570-588). New York: Wiley.
Book Chapter: Discusses variables influencing supervision, including cultural competence. Also offers guidelines on effective supervision practices.

Richardson, T.Q., & Molinaro, K.L. (1996). White counselor self-awareness: A prerequisite for developing multicultural competence. Journal of Counseling & Development, 74(3), 238-242.
Journal Article: Literature review examines White counselor self-awareness as an important variable in developing multicultural competence. The self-dimension discussed in this article includes worldview, cultural values, and racial identity.

Ridley, C.R., Chih D, & Olivera R. (2000). Training in cultural schemas: An antidote to unintentional racism in clinical practice. American Journal of Orthopsychiatry, 70(1), 65-72. doi: 10.1037/h0087771
Journal Article: Proposes cultural schema as a useful construct for helping clinicians identify, organize, interpret, and integrate cultural data into clinical practice.

Sandhu, D.S., & Looby, E.J. (2003). Multicultural competency interventions for bulding positive racial identity in White counselor trainees. In G. Roysircar, D. S. Sandhu, & V. E. Bibbins (Eds.), Multicultural competencies: A guidebook of practices. (pp 17-28). Alexandria, VA: Association for Multicultural Counseling & Development.
Book Chapter: Discusses the relationship between White counselor trainees racial identity development and its impact on their multicultural counseling competencies. Helms' White Identity Development Model is discussed as are the multicultural competencies.

Sue, D.W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70, 477-486.
Journal Article: Explores the need and rationale for a multicultural perspective in counseling and education. Proposes specific multicultural standards and competencies that should become part of what can be defined as a culturally competent counselor.


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Cultural Case Formulation

Daniels, J.A. (2001). Conceptualizing a case of indirect racism using the White Racial Identity Development Model. Journal of Mental Health Counseling, 23(3), 256-268.
Journal Article: Describes how one might use a model of White racial identity development to conceptualize and treat a White client who has experienced racism directed toward his ethnic minority friend.

Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux.
Book: A compelling account of a recent Hmong immigrant family and the tragic cultural miscommunication that resulted from attempts to negotiate the American medical system.

Guindon, M.H., & Sobhany, M.S. (2001). Toward cultural competency in diagnosis. International Journal for the Advancement of Counseling, 22(4), 269-282. doi: 10.1023/A:1014443901294
Journal Article: The importance of cultural competency during the diagnostic phase of counseling is discussed, the nature of culture and its influence on diagnosis is reviewed, and a practical conceptual framework that can assist counselors in making systematic, culturally sensitive diagnosis is presented.

Manson, S.M. (1996). The wounded spirit: A cultural formulation of post-traumatic stress disorder. Culture, Medicine & Psychiatry, 20(4), 489-498. doi: 10.1007/BF00117089
Journal Article: Discusses the cross-cultural assessment and treatment of a 45-yr-old Native American male with combat-related posttraumatic stress disorder (PTSD), alcohol dependence, and a history of childhood physical abuse and bereavement.

Turning to the past to face the end: Caught in cultural limbo.
Report: A brief case description and discussion of the intersection of American Indian culture and treatment of terminally ill patients.

Novins, D.K.,  Bechtold, D. W., Sack, W. H., Thompson, J., Carter, D. R., & Manson, S. M. (1997). The DSM-IV outline for cultural formulation: A critical demonstration with American Indian children. Journal of the American Academy of Child & Adolescent Psychiatry, 36(9), 1244-1251. doi:10.1097/00004583-199709000-00017
Journal Article: The use of the Outline for Cultural Formulation (from the DSM-IV, Appendix I) with American Indian children is reviewed critically.

Woldeguiorguis, I.M. (2003). Racism and sexism in child welfare: Effects on women of color as mothers and practitioners. Child Welfare, 82(2), 273-288.
Journal Article: This article details the story of a mother involved with child protective services (CPS) and the experience of a CPS practitioner who is a woman of color, with the recommendation that understanding these interrelated experiences is a prerequisite for inclusive, equitable systems reform.

Worlds apart: A four-part film series on cross-cultural healthcare
Short Films: The four short films and accompanying study guide are designed to trigger discussions among health professionals about health care services for culturally and ethnically diverse patients. The filmmakers followed four individuals from their homes, neighborhoods, and places of worship to community clinics and hospitals.


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Culture and Identity Development

Arredondo, P. (1999). Multicultural counseling competencies as tools to address oppression and racism. Journal of Counseling & Development, 77(1), 102-108.
Journal Article: Addresses racism and other forms of interpersonal and institutional oppression in the counseling profession. The Dimensions of Personal Identity Model is discussed as a reference point to recognize various personal criteria that are often the focal point of discriminatory behavior.

Casas, J.M., & Pytluk, S.D. (1995). Hispanic identity development: Implications for research and practice. In Ponterotto, J.G., et al. (Eds.), Handbook of multicultural counseling, (pp. 155-180). Thousand Oaks, CA: Sage Publications.
Book Chapter: Directs attention to two of the major processes that a growing number of researchers contend must be taken into consideration in both research and clinical endeavors, ethnic identity development and acculturation. Demonstrates how clinicians might use the models to better understand Hispanics and thus to plan more effective interventions.

Dubow, E.F., et al. (2000). Initial investigation of Jewish early adolescents' ethnic identity, stress, and coping. Journal of Early Adolescence, 20(4), 418-441.
Journal Article: Examines ethnic identity as a source of stress and as a coping resource among Jewish sixth through eighth graders. doi: 10.1177/0272431600020004003

Glickman, N.S., & Carey, J.C. (1993). Measuring deaf cultural identities: A preliminary investigation. Rehabilitation Psychology, 38(4), 275-283.
Journal Article: Explains the development of the Deaf Identity Development Scale (DIDS), which measures how deaf people identify with the deaf community and deaf culture. doi:10.1016/S1077-7229(03)80032-9

Helms, J.E. (1984). Toward a theoretical explanation of the effects of race on counseling: A Black and White model. The Counseling Psychologist, 12(4), 153-165. doi: 10.1177/0011000084124013
Journal Article: Examines the development of racial consciousness. The model proposes separate stagewise processes for Blacks and Whites, hypothesizes counseling predispositions for each of these stages are formulated with implications for same and cross-race dyads.

Helms, J.E. (Ed). (1990). Black and White racial identity: Theory, research, and practice. Westport, CT: Greenwood Press, Inc.
Book: Demonstrates that race can be studied from a psychological perspective. Combines relevant literature that has been scattered in nontraditional social science and behavioral science. Examines the utility of racial identity models for understanding the behavior of Blacks and Whites, while considering the usefulness of racially/culturally explicit models for guiding research and practice.

Herring, R.D. (1995). Developing biracial ethnic identity: A review of the increasing dilemma. Journal of Multicultural Counseling & Development, 23(1), 29-38.
Journal Article: Describes the current status of biracial youth in the US in order to enhance awareness of the existence of this population and its increasing numerical significance. Models of identity development are presented, and relevant sociocultural issues are discussed. W.S.C. Poston's Biracial Identity Development Model (1990) is presented.

Markstrom-Adams, C., & Spencer, M.B. (1994). A model for identity intervention with minority adolescents. In Archer, S.L. (Ed.), Interventions for adolescent identity development, (pp. 84-102). Thousand Oaks, CA: Sage Publications.
Book Chapter: Describes three models that are useful for understanding minority identity formation. Examines the effects of poverty, threats posed by inner-city living, inequities in schooling, limited employment, pressures to assimilate and immigration-related issues on various minority groups.

Markus, H., & Nurius, P. (1986). Possible selves. American Psychologist, 41, 954-969.
Journal Article: A discussion of the nature and function of possible selves is followed by an exploration of their role in addressing several persistent problems, including the stability and malleability of the self, the unity of the self, self-distortion, and the relationship between the self-concept and behavior. doi: 10.1037/0003-066X.41.9.954

Phinney, J.S. (1990). Ethnic identity in adolescents and adults: Review of research. Psychological Bulletin, 108(3), 499-514.
Journal Article: A review of 70 studies of ethnic identity published in refereed journals since 1972. Discusses the ways in which ethnic identity has been defined and conceptualized, the components that have been measured, and empirical findings. doi: 10.1037/0033-2909.108.3.499

Phinney, J.S. (1989). Stages of ethnic identity development in minority group adolescents. Journal of Early Adolescence, 9(1-2), 34-49.
Journal Article: Stages of ethnic identity development were assessed through in-depth interviews with 91 Asian-American, Black, Hispanic, and White tenth-grade students, all American-born, from integrated urban high schools. doi: 10.1177/0272431689091004

Pope-Davis, D.B., et al. (2000). African American acculturation and Black racial identity: A preliminary investigation. Journal of Multicultural Counseling and Development, 28(2), 98-112.
Journal Article: Examines the relationship between acculturation and racial identity among African Americans using the Black Racial Identity Attitude Scale and the African American Acculturation Scale.

Quintana, S.M. (1998). Children's developmental understanding of ethnicity and race. Applied & Preventive Psychology, 7(1), 27-45. doi:10.1016/S0962-1849(98)80020-6
Journal Article: A review of research on children's development of ethnic cognition from preschool through adolescence. Describes four developmental levels and their applied implications.

Rotheram, M.J. & Phinney, J.S. (1987). Definitions and perspectives in the study of children's ethnic socialization. In Phinney, J.S. & Rotheram, M.J. (Eds.) Children's ethnic socialization: Pluralism & development, (pp. 10-28). Beverly Hills, CA: Sage Publications.
Book Chapter: Discusses ethnic socialization, the developmental processes by which children acquire the behaviors, perceptions, values, and attitudes of an ethnic group, and come to see themselves and others as members of such groups. Theoretical perspectives are reviewed in order to clarity their meaning.

Rotheram, M.J. & Phinney, J.S. (1987). Ethnicity and the young child: Awareness, attitudes, and self-identification. In Phinney, J.S. & Rotheram, M.J. (Eds.) Children's ethnic socialization: Pluralism & development, (pp. 29-31). Beverly Hills, CA: Sage Publications.
Book Chapter: Examines the impact of ethnicity in early and middle childhood. Addresses childrenâ??s awareness of the characteristics of ethnic groups and their understanding of their own ethnic group membership.

Rotheram-Borus, M.J. (1990). Adolescents' reference-group choices, self-esteem, and adjustment. Journal of Personality and Social Psychology, 59(5), 1075-1081. doi: 10.1037/0022-3514.59.5.1075
Journal Article: A review of a survey of 330 Black, Hispanic, Asian, and White high school students reported their reference-group label as mainstream, bicultural, or strongly ethnically identified. The generational status of minority students is discussed as a potential influence mediating the impact of reference group on adjustment.

Rowe, W., et al. (1994). White racial identity models: A critique and alternative proposal. The Counseling Psychologist, 22(1), 129-146. doi: 10.1177/001100009422100
Journal Article: Existing models of White racial identity development are challenged as being deficient in terms of: a) being based on the oppression-adoptive models of minority identity development, b) focusing primarily on attitudes toward racial/ethnic outgroups, not on White identity attitudes; and c) depicting the process as developmental in nature. An alternative conceptualization is presented as a more parsimonious explanation for the role of racially oriented attitudes.

Sabnani, H.B., et al. (1991). White racial identity development and cross-cultural counselor training: A stage model. The Counseling Psychologist, 19(1), 76-102. doi: 10.1177/0011000091191007
Journal Article: Integrates the work of cross-cultural counselor-training development theorists, racial-identity development specialists, and cross-cultural counseling competency experts in the formation of a comprehensive multicultural training model for majority-group counselors.

Troiden, R.R. (1989). The formulation of homosexual identities. Journal of Homosexuality, 17 (1-2), 43-73. doi: 10.1300/J082v17n01_02
Journal Article: Elaborates a four-stage model of homosexual identity formation: Sensitization, identity confusion, identity assumption, and commitment.


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Culture and Ethnicity
Website: Substance Abuse Mental Health Services Administration (SAMHSA). A section of the website focuses on culture and ethnicity. It includes fact sheets, reports, pamphlets, booklets, summaries and articles.

Cultural Competence Compendium
Resource Guide: Aims to help physicians and other health professionals communicate with patients and provide individualized, respectful, patient-centered care.

Cultural Competence in Medicine
Website: American Medical Student Association. Includes definitions, explanations, case studies, tips, guidelines, and references on cultural competency in medicine.

Cultural Competence Standards in Managed Mental Health Care
Website: Western Interstate Commission for Higher Education. Four national panels produced these standards, guidelines and cultural competencies for managed behavioral health services for racial/ethnic populations.

Website: Promotes language and cultural competence to improve the quality of health care for minority, immigrant, and ethnically diverse communities.

Framework for Cultural Competence, Our Current Health Care System and Barriers to Cultural Competence
Website: A summary of literature reviews and key informant interviews (with a link to references). Identifies barriers that might affect quality and contribute to disparities in care.

Health Resources and Services Administration. (1998). Cultural competence: An essential ingredient for quality, access & elimination of disparities. Bethesda, MD: Bureau of Primary Health Care.
PowerPoint Presentation: Provides information from HRSA about race, ethnicity, income, and the importance of culturally competent care.

Health Resources and Services Administration. (2001). Health resources and services administration study on measuring cultural competence in health care delivery settings - A review of the literature. Bethesda, MD: The Lewin Group, Inc.
Literature Review: The goal of this effort is to contribute to an understanding of how the complex construct of cultural competence can be measured and advance the capacity of organizations to carry out such measurement.

Lopez, S.R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C. E. Watkins, Jr. (Ed.). Handbook of psychotherapy supervision. New York: Wiley.
Book Chapter: Discusses variables influencing supervision, including cultural competence. Also offers guidelines on effective supervision practices.

NASW National Committee on Racial and Ethnic Diversity. (2001). NASW Standards for Cultural Competence in Social Work Practice. Washington, D.C.
Website: National Association of Social Workers. The Standards for Cultural Competence in Social Work Practice are based on the policy statement "Cultural Competence in the Social Work Profession" published in Social Work Speaks: NASW Policy Statements (2000) and the NASW Code of Ethics (1997), which charges social workers with the ethical responsibility to be culturally competent.

National Center for Cultural Competence
Website: The mission of the National Center for Cultural Competence (NCCC) is to increase the capacity of health and mental health programs to design implement, and evaluate culturally and linguistically competent service delivery systems. Their website includes general information, as well as organization assessment tools to evaluate cultural competency.

National Resource Center on Homelessness and Mental Illness. (2003). Cultural competence. Washington, DC: Center for Mental Health Services.
Reference List: The National Resource Center on Homelessness & Mental Illness has compiled an extensive list of 137 references on cultural competence.

The Providers Guide to Quality and Culture
Website: Provides information on the culture, health strengths, and health challenges of people from different regions and cultural groups of the world, including minority, refugee, and immigrant populations.

Research and Training Center on Family Support and Children's Mental Health, Portland State University. (2002). Assessing and addressing cultural competence. Focal Point: A National Bulletin on Family Support and Children's Mental Health, 16(2), 1-40.
Journal: Special issue on cultural competence.

Research and Training Center on Family Support and Children's Mental Health. (2003). Cultural competence, strengths, and outcomes. Focal Point: A National Bulletin on Family Support and Children's Mental Health, 17(1), 1-24.
Journal: Special issue on cultural competence.


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Working with Specific Populations

American Indian and Alaskan Native Communities

Braveheart-Jordan, M., & DeBruyn, L. (1995). So she may walk in balance: Integrating the impact of historical trauma in the treatment of Native American Indian women. In J. Adleman, & G.M. Enguidanos (Eds.), Racism in the lives of women: Testimony, theory, and guides to antiracist practice (pp 345-368). New York, NY: Harrington Park Press/Haworth Press, Inc.
Book Chapter: Discusses the effectiveness of psychoeducational groups that are semistructured, based on an empowerment model of providing coping skills and other skills development for Native American Indian women.

Cross, T.L., & Ollgaard, S. (1999). The status of child abuse and neglect prevention in American Indian communities. Portland, OR: National Indian Child Welfare Association.
Report: The report examines the types of prevention activities in use in the 11 Indian communities that participated. While not all-inclusive, these programs highlight promising practices and demonstrate several culturally based child abuse prevention approaches in American Indian communities.

Dana, R.H. (2000). The cultural self as locus for assessment and intervention with American Indians/Alaska Natives. Journal of Multicultural Counseling and Development, 28(2), 66-82.
Journal Article: Compares mental health services from Anglo-American and Native perspectives, focusing on the cultural self as a locus for greater credibility and increased use of these services. Discusses cultural competence of Anglo-American providers with tribal populations.

Duran, E., & Duran, B. (1995). Native American postcolonial psychology. Albany NY: State University of New York Press.
Book: This book presents a theoretical discussion of problems and issues encountered in the Native American community from a perspective that accepts Native knowledge as legitimate. Includes an imperative to understand intergenerational trauma and internalized oppression in order to understand the issues facing Native Americans today.

Hudnall-Stamm, B., & Stamm, H.E. (1999). Trauma and loss in Native North America: An ethnocultural perspective. In K. Nader & N. Dubrow (Eds.), Honoring differences: Cultural issues in the treatment of trauma and loss (pp 49-75). Philadelphia, PA: Brunner/Mazel, Inc.
Book Chapter: Draws from scientific research, traditional stories, and ethnohistory to discuss trauma and loss within the Native North American culture.

Jones, M.C., et al. (1997). Trauma-related symptomatology among American Indian adolescents. Journal of Traumatic Stress, 10(2), 163-173. doi: 10.1023/A:1024852810736
Journal Article: The Diagnostic Interview Schedule for Children (DISC), including the posttraumatic stress disorder (PTSD) module, was administered to American Indian students from a Northern Plains reservation. The reporting of traumatic events was associated with increased prevalence of behavioral disorders and substance abuse or dependence diagnoses. There was, however, no significant difference in academic performance between those who reported traumatic events and those who did not.

Manson, S.M. (Ed.). (1998). American Indian and Alaska Native mental health research. The Journal of the National Center for American Indian and Alaska Native Mental Health Research (8)2, 1-100.
Journal: Compilation of 5 articles which discuss issues related to education among Navajos, the concept of historical unresolved grief and historical trauma among American Indians, and an example of a cultural formulation using Western and First Nations method.

Manson, S.M. (2004). Cultural diversity series: Meeting the mental health needs of American Indians and Alaska Natives. Alexandria, VA: National Association of State Mental Health Program Directors - National Technical Assistance Center.
Report: Highlights the mental health needs of American Indians and Alaska Natives, describes the service ecologies that have emerged to address these needs, discusses Native peoples' access to and use of mental health services, and identifies "lessons learned" so that states can properly address the mental health needs of this population.

Morrissette, P.J., & Naden, M. (1998). An interactional view of traumatic stress among First Nations counselors. Journal of Family Psychotherapy, 9(3), 43-60. doi: 10.1300/J085V09N03_04
Journal Article: The purpose of this article is to discuss systemic intervention with vicariously traumatized First Nations (Native) counselors who listen to stories of abuse that are shared by former students of residential schools.

Sanchez-Way, R., & Johnson, S. (2000). Cultural practices in American Indian prevention programs. Juvenile Justice, 7(2).
Journal Article: Reviews cultural interventions and preventions programs for substance abuse among American Indian populations.

Stiffman, A.R., et al. (2003). American Indian youth: Who Southwestern urban and reservation youth turn to for help with mental health or addictions. Journal of Child and Family Studies, 12(3), 319-333. doi: 10.1023/A:1023991811519
Journal Article: Describes interviews concerning mental health need and service use with 401 Southwestern American Indian youth using questions from the Diagnostic Interview Schedule and the Service Assessment for Children and Adolescents.

U.S. Department of Health and Human Services. (2000). Volume 1: Cultural strengths and challenges in implementing a system of care model in American Indian communities. Washington, D.C.: The Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
Monograph: Examines five American Indian children's mental health projects funded by the Center for Mental Health Services (CMHS) and presents the strengths and challenges of community-based service designs that draw on culture as a primary resource.

Weaver, H.N., & Yellow Horse Brave Heart, M. (1999). Examining two facets of American Indian identity: Exposure to other cultures and the influence of historical trauma. Journal of Human Behavior in the Social Environment, 2(1-2), 19-33. doi: 10.1300/J137v02n01_03
Journal Article: Examined factors shaping cultural identity for Native Indians and the implications of Native cultural identity for social work practice.

Yellow Horse Brave Heart, M. (2003). Addressing the impact of historical trauma upon American Indian children: Native family strengthening intervention. Snowbird, Utah: Child Trauma Treatment Network-Intermountain West.
Video Presentation: The workshop (1) describes historical trauma for American Indians and the historical trauma response, (2) presents a psychoeducational group intervention aimed at addressing the trauma response with Native parents, increasing protective factors and reducing risk factors for mental health and substance abuse problems, (3) describes a current proposed project to address child trauma through working with both children and parents, and (4) presents preliminary research findings suggesting successful parenting interventions and suggests areas for future work.

Arab and Middle Eastern Communities

Abudabbeh, N., & Nydell, M.D. (1993). Transcultural counseling and Arab-Americans. In McFadden, J. (Ed.), Transcultural counselling: Bilateral and international perspectives (pp. 261-284). Alexandria, VA: American Counselling Association.
Book Chapter: Presents new trends in transcultural theory, expanded cultural paradigms, innovative counseling techniques for working with diverse ethnic groups, and a comprehensive discussion of professional issues.

Al-Krenawi, A. & Graham, J.R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health and Social Work, 25(1), 9-22.
Journal Article: Provides the basis for specific guidelines in working with ethnic Arab mental health clients. Explains treatments options, communication patterns, and integration of modern and traditional healing systems.

Budman, C.L., et al. (1992). The cultural consultant in mental health care: The case of an Arab adolescent. American Journal of Orthopsychiatry, 62(3), 359-370. doi: 10.1037/h0079347
Journal Article: A case involving the psychiatric hospitalization of an adolescent from Iraq is described, as are the role of a cultural consultant in clarifying cultural issues and the positive consequences for diagnosis and treatment.

El-Islam, M.F. (1983). Cultural change and intergenerational relationships in Arabian families. International Journal of Family Psychiatry, 4, 321-329.
Journal Article: Describes Arabian culture, cultural changes, and implications of intergenerational conflicts in family therapy.

Faragallah, M. H., et al. (1997). Acculturation of Arab-American immigrants: An exploratory study. Journal of Comparative Family Studies, 28(3), 182-203.
Journal Article: Results from a survey of a nonrandom sample of 39 Arab-American immigrants with respect to measures of acculturation, satisfaction with life in the United States, family life satisfactions, and various independent variables.

Jabbra, N.W. (1983). Assimilation and acculturation of Lebanese extended families in Nova Scotia. Canadian Ethnic Studies, 15(1), 54-72.
Journal Article: Presents a description of Lebanese in Nova Scotia based on ethnographic fieldwork and documentary materials. Three case studies are examined with reference to several aspects of assimilation and acculturation.

Jackson, M.L. (1997). Counseling Arab Americans. In Lee, C.C., & Richardson, B.L. (Eds.), Multicultural Issues in Counseling: New Approaches to Diversity, (pp. 197-206). Alexandria, VA: American Association for Counseling and Development.
Book Chapter: Presents information on important dynamics of Arab culture. Prepares professionals for effective work with members of the Arab American population.

Kulwicki, A. (1996). Health issues among Arab Muslim families. In Aswad, B.C., & Bilge, B. (Eds.), Family and gender among American Muslims: Issues facing Middle Eastern immigrants and their descendants, (pp. 187-207). Philadelphia, PA: Temple University Press.
Book Chapter: Describes issues related to health-care beliefs, values, practices, and expectations among Muslim Arab families of Dearborn, Michigan.

Qouta, S., et. al. (1995). The impact of the peace treaty on psychological well-being: A follow-up study of Palestinian children. Child Abuse & Neglect, 19(10), 1197-1208. doi:10.1016/0145-2134(95)00080-R
Journal Article: Examines the impact of the Israeli-Palestinian peace treaty and Palestinian children's perception of it on their self-esteem and neuroticism.

Savaya, R. (1998). The under-use of psychological services by Israeli Arabs: An examination of the roles of negative attitudes and the use of alternative sources of help. International Social Work, 41(2), 195-209. doi: 10.1177/002087289804100207
Journal Article: Focuses on the under-use of professional services by the Arabs of Jaffa, a mixed Arab-Jewish section of Tel Aviv.

Timmi, S.B. (1995). Adolescence in Immigrant Arab Families. [Special issue on adolescent treatment: New frontiers]. Psychotherapy, 32(1), 141-149. doi: 10.1037/0033-3204.32.1.141
Journal Article: Reviews mental health problems encountered in adolescents from immigrant Arab families. Clinical issues relating to help seeking behavior, engaging families, the impact of migration, professional boundaries, individual work, and eating disorders are also discussed.

Asian and Pacific Islander Communities

Association of Asian Pacific Community Health Organizations (AAPCHO)
Website: Guidance in providing culturally competent, linguistically accessible and affordable primary health care services to Asian American and Pacific Islander populations across the country.

Du, N. & Lu, F.L. (1997). Assessment and treatment of posttraumatic stress disorder among Asian Americans. In E. Lee (Ed.). Working with Asian Americans: A guide for clinicians (pp. 275-294). New York: Guilford Press.
Book Chapter: Highlights the relationship between cultural and interpersonal issues in the assessment and treatment of PTSD among Asian American clients.

Shiang, J. et al. (1998). Developing cultural competency in clinical practice: Treatment considerations for Chinese cultural groups in the United States. Clinical Psychology, 5, 182-210. doi: 10.1111/j.1468-2850.1998.tb00143.x
Journal Article: Discusses the relative influence of cultural beliefs and behaviors on patient characteristics, relationship variables, and treatment context. Also describes a model and discusses its application in the treatment of a Chinese woman.

Sue, D.W., & Sue, D. (1999). Counseling the culturally different. New York: Wiley.
Book: A resource to help students understand different cultures, attitudes, and lifestyles. Includes many clinical examples.


Black and African American Communities

Baker, F.M. & Bell, C.C. (1999). Issues in the psychiatric treatment of African Americans. Psychiatric Services, 50, 362-368.
Journal Article: Describes issues in the assessment and evaluation of African Americans, including diagnostic bias, need for appropriate screening instruments, challenges in establishing rapport in interethnic situations, racial identity as a focus in psychotherapy, awareness of biological characteristics that affect response to medications, and the impact of high exposure to violence.

Bell, C.C. (1997). Stress-related disorders in African-American children. Journal of the National Medical Association, 89(5), 335-340.
Journal Article: Children exposed to traumatic stress are vulnerable to a variety of stress-related disorders other than classical post-traumatic stress disorder. Several case histories are presented to illustrate some of the diversity of how traumatic stress may manifest in children.

Clark, R. et al. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54, 805-816. doi: 10.1037/0003-066X.54.10.805
Journal Article: Outlines a biopsychosocial model to describe how intragroup and intergroup racism can be significant stressors for many African Americans.

Fitzpatrick, K.M. & Boldizar, J.P. (1993). The prevalence and consequences of exposure to violence among African-American youth. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 424-430. doi:10.1097/00004583-199303000-00026
Journal Article: Examines the relationship between chronic exposure to community violence and PTSD symptoms among a sample of low-income African-American youth.

Snowden, L.R. (1999). African American folk idiom and mental health services use. Cultural Diversity and Mental Health, 5, 364-369. doi: 10.1037/1099-9809.5.4.364
Journal Article: Describes use of three scales of culturally defined symptom distress to predict mental health service use in African American communities. Anxiety and somatic expressions of distress were associated with help-seeking among African Americans.


Developmentally Disabled Communities

Charlton, M., et al. (2004). Facts on traumatic stress and children with developmental disabilities. Los Angeles, CA: National Child Traumatic Stress Network, Adapted Trauma Treatment Standards Work Group.
Fact Sheet: Includes the Federal definition of developmental disability, incidence of disability in the general population, statistical information regarding the incidence of trauma for this population, and special characteristics of the population that may influence the incidence of trauma.

National Council on Disability. (2003). People with disabilities on tribal lands: Education, health care, vocational rehabilitation, and independent living. Washington D.C.: Author.
Report: Discusses views and perspectives of American Indian/Alaskan Native people with disabilities, tribal leaders, and federal agency representatives identified as important in meeting the needs of people with disabilities residing in tribal lands.

Tallant, B. & Charlton, M. (2003). Adapted cognitive-behavioral trauma treatment of children who have developmental disabilities: Suggested modifications to phase treatment. Aurora CO: Aurora Mental Health Center.
Report: Developed in conjunction with the National Child Traumatic Stress Network's Adapted Trauma Treatment Work Group, this report details case vignettes through the different CBT treatment stages for children who are developmentally disabled.


Gay, Lesbian, and Bisexual Communities

American Psychological Association. (2000). Guidelines for psychotherapy with lesbian, gay, and bisexual clients. American Psychologist. 55(12), 1440-1451. doi: 10.1037/0003-066X.55.12.1440
Journal Article: Provides guidelines intended to assist psychologists in seeking and using appropriate education and training in their treatment of lesbian, gay, and bisexual clients.

Herek, G.M. et al. (2002). Victim experiences in hate crimes based on sexual orientation. Journal of Social Issues, 58(2), 319-339. doi: 10.1111/1540-4560.00263
Journal Article: Describes varieties of victim experiences in hate crimes based on sexual orientation. Victims' concerns about police bias and public disclosure of their sexual orientation were important factors in decisions to report crimes.

Lock, J., & Steiner, H. (1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry, 38(3), 297-304. doi:10.1097/00004583-199903000-00017
Journal Article: Documents results from a community school-based health survey (questionnaire) that included an opportunity to self-identify as gay, lesbian or bisexual.

Morrow, S.L. (2000). First Do No Harm: Therapist Issues in Psychotherapy with Lesbian, Gay, and Bisexual Clients. In Perez, R.M., et al. (Eds.), Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients, (pp. 137-156). Washington, D.C.: American Psychological Association.
Book Chapter:Examines current issues that affect psychotherapy with lesbian, gay, and bisexual people. Professional standards/ethics, background and personal factors influencing therapy, and therapist orientation to psychotherapy is discussed.

Perrin, E.C. (2002). Sexual orientation in child and adolescent health care. New York: Kluwer Academic/Plenum Publishers.
Book: Provides information on sexuality and sexual orientation relevant for the medical treatment of children and adolescents and their families. Includes discussion of common scenarios encountered in clinical practice and suggestions for care.

Rivera, M. (2002). Informed and supportive treatment for lesbian, gay, bisexual and transgendered trauma survivors. Journal of Trauma and Dissociation, 3(4), 33-58. doi: 10.1300/J229v03n04_03
Journal Article: Highlights the importance of providing a therapeutic context in which expressions of gender identity and sexual orientation are acknowledged and clearly supported.


Hispanic and Latino Communities

Arroyo, W., & Eth, S. (1984). Children traumatized by Central American warfare. In S. Eth & R. Pynoos (Eds.). Posttraumatic stress disorder in children. (pp. 101-120). Washington, D.C.: American Psychiatric Press.
Book Chapter: Focuses on childhood PTSD secondary to war-related trauma among children from Central America.

Bernal, G. et al. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23, 67-82. doi: 10.1007/BF01447045
Journal Article: Presents a framework for developing culturally sensitive treatments that can be adapted to specific ethnic minority groups.

Pew Hispanic Center
Website: The Pew Hispanic Center's mission is to improve understanding of the diverse Hispanic population in the United States and to chronicle Latinos' growing impact on the nation. The Center strives to inform debate on critical issues through dissemination of its research to policymakers, business leaders, academic institutions, and the media.

Schechter, D.S., et al. (2000). Ataque de nervios and history of childhood trauma. Journal of Traumatic Stress, 13(3), 529-534. doi: 10.1023/A:1007797611148
Journal Article: Ataque de nervios is a common, self-labeled Hispanic folk diagnosis. It typically describes episodic, dramatic outbursts of negative emotion in response to a stressor, sometimes involving destructive behavior. Assessment of psychiatric diagnoses, history of ataque, and childhood trauma in treatment-seeking Hispanic outpatients are reviewed.

U.S. Department of Health and Human Services. (2000). Quality health services for Hispanics: The cultural competency component. Washington, DC: Health Resources and Services Administration.
Monograph: Describes the impact of culture on the provision of high-quality and accessible services for Hispanic populations. It discusses the importance of traditions and language in cross-cultural communication.


Refugee Communities

Bridging Refugee Youth and Children's Services (BRYCS): The Importance of Cultural Competency
Website: A national technical assistance project working to broaden the scope of information and collaboration among service providers - in order to strengthen services to refugee youth, children and their families. The website includes information for service providers, manuals, program descriptions, and a clearinghouse of resources designed specifically for service providers.

Cultural Orientation Resource Center, Center for Applied Linguistics, Washington, D.C.
Website: This website was established to create linkages between overseas providers of cultural orientation and domestic resettlement programs. The website provides trainers overseas with links to information about resettlement in the United States, informs resettlement caseworkers on type and length of training provided to refugees overseas, provides basic facts about new refugee groups arriving in the U.S., and offers cultural orientation activities for trainers overseas and in the U.S.

Gerber, L. (1994). Psychotherapy with Southeast Asian refugees: Implications for treatment of Western patients. American Journal of Psychotherapy, 48(2), 280-293.
Journal Article: Discusses how culture impacts notions of health, psychopathology, and psychotherapy. Includes case examples.

Harvard Program in Refugee Trauma
Website: The Harvard Program in Refugee Trauma (HPRT), originally founded at the Harvard School of Public Health, is a multi-disciplinary program that has been pioneering the health and mental health care of traumatized refugees and civilians in areas of conflict/post-conflict and natural disasters for over two decades.

Kelen, J.A., and Kelen, L.G. (2002). Faces and voices of refugee youth. Salt Lake City, UT: Center for Documentary Arts.
Book: Provides essays, interviews, and stories about refugee youth. Identifies the challenges refugee youth face inside and outside of the classroom and the cultural gifts they bring into the community. Describes the journeys of refugee youth from their country of origin to the United States.

Kinzie, J.D. et al., (1986). The psychiatric effects of massive trauma on Cambodian children: I. The children. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 370-376. doi:10.1016/S0002-7138(09)60259-4
Journal Article: Describes the psychiatric effects of separation from family, forced labor, starvation, and exposure to violence on Cambodian students in the United States who escaped the Pol Pot regime.

Lustig, S.L., et al. (2003). Review of child and adolescent refugee mental health. Los Angeles, CA: National Child Traumatic Stress Network, Refugee Trauma Task Force.
White Paper: Reviews the most recent empirical studies of pathology and services among refugees. Information on data and treatments are organized by phase of the refugee experience and contextualized in cultural and developmental frameworks.

Sack, W.H., et al. (1997). Does PTSD transcend cultural barriers? A study from the Khmer adolescent refugee project. Journal of the American Academy of Child & Adolescent Psychiatry, 36(1), 49-54. doi:10.1097/00004583-199701000-00017
Journal Article: Objective of this study was to determine whether the factor structure of posttraumatic stress disorder (PTSD) among Cambodian refugee youth resembles earlier reported factor studies among Caucasian samples.

Stow-Bolea, P., et al. (2003). Trauma of children of the Sudan: A constructivist exploration. Child Welfare, 82(2), 219-233.
Journal Article: Examines the trauma of Sudanese refugee children living in a Midwestern city from a social constructivist view.

Tor, S. & Mollica, R.F. Sun and moon. Cambridge, MA: Harvard Program in Refugee Trauma.
Picture Book: Tells the story of two Cambodian children whose parents were enslaved in concentration camps by the Pol Pot regime.

Weaver, H.N., and Burns, B.J. (2001). 'I shout with fear at night': Understanding the traumatic experiences of refugees and asylum seekers. Journal of Social Work, 1(2), 147-164. doi: 10.1177/146801730100100203
Journal Article: Presents the results of a study conducted at the largest refugee shelter in the US. Fifty-eight adult asylum seekers staying at the shelter were interviewed about their experiences, including trauma and subsequent physical and emotional symptoms.


Rural Communities

Lambert, D.D. et al. (2003). Rural mental health outreach: promising practices in rural areas. Washington, D.C.: U.S. Department of Health and Human Services.
Monograph: Describes successful approaches to providing rural mental health outreach.

Markstrom, C., et al. (2003). Ethnicity and rural status in behavioral healthcare. In B.H. Stamm (Ed). Rural behavioral health care: An interdisciplinary guide. Washington, DC: APA Books.
Book Chapter: Discusses the needs and resources of the often overlooked individuals who live in rural and frontier areas, paying particular attention to cultural competence and the ability to provide behavioral healthcare services to recently arrived immigrant groups.

Rural Health Policy
Website: Office of Rural Health Policy (ORHP). Promotes better health care service in rural America. Provides information about funding opportunities, policy, news and events, publications, and links to other resources.


Spiritual and Religious Communities

Grame, C.J., et al. (1999). Addressing spiritual and religious issues of clients with a history of psychological trauma. Bulletin of the Menninger Clinic, 63(2), 223-239.
Journal Article: Underscores the growing necessity for psychotherapists and clergy to collaborate in the treatment of clients with psychological trauma. Illustrates the spiritual and religious issues of clients and the necessity for spiritual and religious assessment and treatment plans for this population.

Kemper, K.J., & Barnes, L. (2003). Considering culture, complementary medicine, and spirituality in pediatrics. Clinical Pediatrics, 42(3), 205-208.
Journal Article: Illustrates the complexities of providing sensitive and appropriate care in a culturally and spiritually diverse healthcare system in which patients and clinicians have ready access to a variety of complementary therapies and healers.

McCarthy, M.K., & Peteet, J.R. (2003). Teaching residents about religion and spirituality. Harvard Review of Psychiatry, 11(4), 225-228. doi: 10.1080/10673220303948
Journal Article: Discusses teaching psychiatry residents about religion and spirituality. Describes methods that training programs are developing to engage residents in the impact of religious and spiritual issues on themselves and their treatment of patients.

Weaver, A.J., et al. (2000). Research on religious variables in five major adolescent research journals: 1992 to 1996. Journal of Nervous and Mental Disease, 188(1), 36-44. doi:10.1080/10673220303948   doi: 10.1097/00005053-200001000-00007
Journal Article: A review of quantitative research studies published between 1992 and 1996 in five major adolescent journals. Suggests that adolescent research journals are more sensitive to the role of religious factors on mental health than research in related disciplines.


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