title: Addressing mental health disparities through clinical competence not just cultural competence: the need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services.
abstract: Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.
authors.affiliation: University of Southern California, School of Social Work, MRF 102C, Los Angeles, CA 90089-0411, United States. amyamada@usc.edu
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Yamada
authors.forename: John S
authors.initials: JS
authors.lastname: Brekke
mesh_terms: D002983:Clinical Competence; D003431:Cross-Cultural Comparison; D054521:Cultural Competency; D055317:Evidence-Based Practice; D005195:Family Relations; D054625:Healthcare Disparities; D006801:Humans; D007206:Individuality; D001523:Mental Disorders / Q000208:ethnology* / Q000534:rehabilitation*; D020380:Needs Assessment; D010552:Personality Assessment; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D012944:Social Support; D016896:Treatment Outcome
references.citation: Acad Med. 2003 Jun;78(6):577-87
references.pmid: 12805036
references.citation: J Abnorm Psychol. 2004 Aug;113(3):428-39
references.pmid: 15311988
references.citation: Cult Med Psychiatry. 1996 Jun;20(2):133-44
references.pmid: 8853962
references.citation: J Gen Intern Med. 2006 May;21(5):476-80
references.pmid: 16704391
references.citation: Schizophr Bull. 1997;23(2):305-16
references.pmid: 9165639
references.citation: Br J Psychiatry. 2004 Jan;184:79-83
references.pmid: 14702232
references.citation: J Nerv Ment Dis. 2002 May;190(5):315-23
references.pmid: 12011612
references.citation: Schizophr Bull. 2000;26(3):667-80
references.pmid: 10993405
references.citation: Schizophr Bull. 2004;30(2):193-217
references.pmid: 15279040
references.citation: Aliment Pharmacol Ther. 2005 Apr 15;21(8):1029-39
references.pmid: 15813839
references.citation: Annu Rev Clin Psychol. 2005;1:143-66
references.pmid: 17716085
references.citation: J Consult Clin Psychol. 1991 Aug;59(4):533-40
references.pmid: 1918557
references.citation: Ann Intern Med. 1979 Jun;90(6):957-64
references.pmid: 443692
references.citation: J Nerv Ment Dis. 2004 Sep;192(9):623-8
references.pmid: 15348979
references.citation: Ethn Dis. 2003 Fall;13(4):499-512
references.pmid: 14632270
references.citation: Dis Manag. 2005 Apr;8(2):93-105
references.pmid: 15815158
references.citation: Am J Psychiatry. 1995 Nov;152(11 Suppl):63-80
references.pmid: 9565542
references.citation: Public Health Rep. 2003 Jul-Aug;118(4):293-302
references.pmid: 12815076
references.citation: Clin Psychol Rev. 2008 Feb;28(2):211-27
references.pmid: 17587473
references.citation: J Adolesc Health. 2004 Aug;35(2):101-7
references.pmid: 15261638
references.citation: Am J Public Health. 1995 May;85(5):638-43
references.pmid: 7733422
references.citation: J Nerv Ment Dis. 2006 Jan;194(1):10-4
references.pmid: 16462549
references.citation: Acad Med. 2002 Mar;77(3):193-7
references.pmid: 11891153
references.citation: Home Health Care Serv Q. 2006;25(1-2):115-48
references.pmid: 16803741
references.citation: Fam Med. 2002 May;34(5):325-30
references.pmid: 12038713
references.citation: Behav Modif. 2005 May;29(3):488-507
references.pmid: 15784751
references.citation: Psychiatr Serv. 1999 Feb;50(2):248-56
references.pmid: 10030485
references.citation: Schizophr Bull. 2006 Jul;32(3):432-42
references.pmid: 16461575
references.citation: Ann Intern Med. 1999 May 18;130(10):829-34
references.pmid: 10366373
references.citation: Patient Educ Couns. 2006 Dec;64(1-3):21-34
references.pmid: 16427760
references.citation: Ann Intern Med. 1998 Sep 1;129(5):406-11
references.pmid: 9735069
references.citation: Int J Methods Psychiatr Res. 2004;13(4):208-20
references.pmid: 15719529
references.citation: Annu Rev Clin Psychol. 2005;1:113-42
references.pmid: 17716084
references.citation: Cochrane Database Syst Rev. 2000;(2):CD000409
references.pmid: 10796542
references.citation: J Subst Abuse Treat. 1997 Mar-Apr;14(2):133-40
references.pmid: 9258857
references.citation: Community Ment Health J. 2008 Feb;44(1):57-74
references.pmid: 18026876
references.citation: Psychol Med. 1998 May;28(3):543-50
references.pmid: 9626711
references.citation: Psychiatr Serv. 2007 Dec;58(12):1588-90
references.pmid: 18048561
references.citation: Psychiatr Serv. 2005 Feb;56(2):209-11
references.pmid: 15703351
references.citation: Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):161-8
references.pmid: 16516067
references.citation: Cultur Divers Ethnic Minor Psychol. 2005 May;11(2):113-29
references.pmid: 15884983
references.citation: Br J Psychiatry Suppl. 2007 Aug;50:s21-8
references.pmid: 18019040
references.citation: Community Ment Health J. 2000 Apr;36(2):161-78
references.pmid: 10800865
references.citation: Psychiatr Serv. 2008 Jan;59(1):96-9
references.pmid: 18182546
references.citation: Psychiatr Serv. 2005 Mar;56(3):292-300
references.pmid: 15746503
references.citation: Psychiatr Serv. 1997 Mar;48(3):381-6
references.pmid: 9057242
references.citation: Adm Policy Ment Health. 2000 Mar;27(4):211-20
references.pmid: 10911670
references.citation: Community Ment Health J. 1995 Oct;31(5):463-73
references.pmid: 8556853
references.citation: Psychiatr Serv. 2003 Sep;54(9):1264-70
references.pmid: 12954944
references.citation: Schizophr Res. 2004 Jan 1;66(1):59-70
references.pmid: 14693353
references.citation: Arch Gen Psychiatry. 2001 Jan;58(1):55-61
references.pmid: 11146758
references.citation: Psychiatr Serv. 2001 Sep;52(9):1216-22
references.pmid: 11533396
references.citation: Med Care. 2005 Apr;43(4):356-73
references.pmid: 15778639
references.citation: Am J Psychiatry. 2002 Feb;159(2):201-7
references.pmid: 11823259
references.citation: Psychiatr Serv. 1999 Mar;50(3):362-8
references.pmid: 10096640
references.citation: Psychiatr Serv. 2005 Dec;56(12):1600-2
references.pmid: 16339626
references.citation: J Nerv Ment Dis. 2001 Oct;189(10):676-84
references.pmid: 11708668
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1996 Jun;31(3-4):109-13
references.pmid: 8766455
references.citation: Cult Med Psychiatry. 2003 Dec;27(4):467-86
references.pmid: 14727681
references.citation: J Consult Clin Psychol. 1997 Jun;65(3):464-75
references.pmid: 9170770
references.citation: Am Psychol. 2003 May;58(5):377-402
references.pmid: 12971086
references.citation: Community Ment Health J. 1995 Apr;31(2):127-37
references.pmid: 7789121
references.citation: Psychiatr Serv. 2004 Mar;55(3):284-9
references.pmid: 15001729
references.citation: Psychiatr Q. 2002 Winter;73(4):271-95
references.pmid: 12418357
references.citation: Schizophr Bull. 2000;26(1):5-20
references.pmid: 10755667
references.citation: JAMA. 2003 Jul 2;290(1):57-65
references.pmid: 12837712
references.citation: Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):446-50
references.pmid: 16271660
references.citation: J Nerv Ment Dis. 2005 Jun;193(6):359-68
references.pmid: 15920376
references.citation: JAMA. 1990 Jan 26;263(4):549-56
references.pmid: 2104640
references.citation: Schizophr Bull. 2002;28(4):703-17
references.pmid: 12795500
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Mar;40(3):233-9
references.pmid: 15742229
references.citation: Psychiatr Rehabil J. 2002 Spring;25(4):350-8
references.pmid: 12013263
references.citation: Psychol Serv. 2006 Feb;3(1):61-72
references.pmid: 17183411
references.citation: Psychiatr Serv. 2007 Oct;58(10):1362-5
references.pmid: 17914018
references.citation: Psychol Med. 2008 Jan;38(1):123-33
references.pmid: 17537280
references.citation: Schizophr Res. 2001 May 30;50(1-2):105-19
references.pmid: 11378319
references.citation: Patient Educ Couns. 2007 Jul;67(1-2):214-23
references.pmid: 17481844
references.citation: Br J Psychiatry. 1995 Oct;167(4):473-9
references.pmid: 8829715
references.citation: Psychiatr Serv. 1999 Apr;50(4):535-9
references.pmid: 10211736
references.citation: Schizophr Bull. 1988;14(4):555-67
references.pmid: 3064282