title: System-level change in cultural and linguistic competence (CLC): how changes in CLC are related to service experience outcomes in systems of care.
abstract: As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children's Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.
authors.affiliation: Maryland Child & Adolescent Community Innovations Institute, University of Maryland School of Medicine, Baltimore, MD, USA. cbarksda@psych.umaryland.edu
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Barksdale
authors.forename: Phyllis Gyamfi
authors.initials: PG
authors.lastname: Ottley
authors.forename: Robert
authors.initials: R
authors.lastname: Stephens
authors.forename: Tesfayi
authors.initials: T
authors.lastname: Gebreselassie
authors.forename: Imogen
authors.initials: I
authors.lastname: Fua
authors.forename: Melissa
authors.initials: M
authors.lastname: Azur
authors.forename: Christine
authors.initials: C
authors.lastname: Walrath-Greene
mesh_terms: D002648:Child; D003156:Community Mental Health Services; D054521:Cultural Competency; D003469:Culture; D019033:Delivery of Health Care, Integrated; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008037:Linguistics; D008297:Male; D017060:Patient Satisfaction; D014481:United States