Developing Cultural Competence in Disaster Mental Health Programs:
Guiding Principles and Recommendations
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The document was written by Jean Athey, Ph.D., and Jean Moody-Williams, Ph.D.,
under Contract No. 99M00619401D with the Center for Mental Health Services (CMHS),
Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department
of Health and Human Services (DHHS). Portland Ridley was a contributing author
and also served as the Government Project Officer. Susan R. Farrer, M.A., was
the content editor of the guide. The SAMHSA Disaster Technical Assistance Center
operated by ESI, under contract with the Emergency Mental Health and Traumatic
Stress Services Branch (EMHTSSB)/CMHS, edited the document and designed the
cover and layout for the publication. Numerous people contributed to the
development of this document. (See the textbox at the end of this page.)
The views, opinions, and content of this publication are those of the authors
and do not necessarily reflect the views, opinions, or policies of SAMHSA or
DHHS. The authors and the staff of CMHS acknowledge, appreciate, and respect
the diverse terminology associated with cultural competence and related issues,
and regret any inadvertent omission of information or inclusion of statements
that may be unfamiliar to our readers.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced
or copied without permission from SAMHSA or CMHS. Citation of the source is
appreciated. However, this publication may not be reproduced or distributed
for a fee without the specific, written authorization of the Office of Communications,
Electronic Access and Copies of Publication
This publication may be accessed electronically through the following Internet
World Wide Web connection: www.samhsa.gov. For additional free copies of this
document, please contact SAMHSA’s National Mental Health Information Center
at 1-800-789-2647 or 1-866-889-2647 (TDD).
U.S. Department of Health and Human Services. Developing Cultural Competence
in Disaster Mental Health Programs: Guiding Principles and Recommendations.
DHHS Pub. No. SMA 3828. Rockville, MD: Center for Mental Health Services,
Substance Abuse and Mental Health Services Administration, 2003.
Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services
1 Choke Cherry Road Room 6-1057, Rockville, MD 20850
DHHS Publication No. SMA 3828
Contributors and Reviewers: Lourdes Arellano-Carandang,
Ph.D.; Robert Benedetto, D.P.A., L.C.S.W.; Marisa Brown, M.S.N., R.N.; Nan Carle,
Ph.D.; Deborah DeWolfe, Ph.D., M.S.P.H.; Kana Enomoto, M.A.; Linda Fain; Renee
Georg; Elzbieta Gozdziak, Ph.D.; Rachel Guerrero, L.C.S.W.; Robert Hammaker,
Ed.D.; Angelia Hill; Joseph Hill; Carol Kardos, M.S.S.W.; E’layne Koenigsberg;
Harriet McCombs, Ph.D.; Patricia Mendoza, Ph.D.; Mary Elizabeth Nelson, M.S.W.;
Wanetta Noconie; Gladys Padro, M.S.W.; Constance Peters, M.S.P.A.; Steven Shon,
M.D.; Anthony Simms, Ph.D.; Karen Stengle; Suganya Sockalingam, Ph.D.; Cecilia
Rivera-Casale, Ph.D.; and Katherine White, M.Div., R.N., C.C.C.
Table of Contents
This guide includes two sections and six appendices.
SECTION ONE explores the nature
of culture and disaster. It begins by defining culturally related terms, discussing
diversity within racial and ethnic minority groups, and describing cultural
competence. It then discusses cultural competence in the context of disaster
mental health services. Section One also presents the Cultural Competence Continuum
and a list of questions to address in a disaster mental health plan. Readers
seeking more detail about crisis counseling or disaster response and recovery
may refer to other CMHS/FEMA publications. For example, the Training Manual
for Mental Health and Human Service Workers in Major Disasters (DHHS, 2000e)
provides a comprehensive overview of and essential information on training concepts
on crisis counseling, including a training curriculum. Disaster Response
and Recovery: A Strategic Guide (DHHS, Rev. ed., in press) also is a useful
SECTION TWO sets forth nine
guiding principles for culturally competent disaster mental health services
and related recommendations for developing these services. It also presents
the key concepts of disaster mental health; important considerations when working
with people of other cultures; staff attributes, knowledge, and skills essential
to the development of cultural competence; and a cultural competence self-assessment
for disaster crisis counseling programs. In addition, Section Two provides suggestions
for working with refugees and guidelines for using interpreters.
The appendices provide additional information that may be useful in developing
cultural competence in disaster mental health.
APPENDIX A is an annotated bibliography
of cultural competence resources and tools. Many of these resources provide
detailed information about individual populations’ histories, immigration
patterns, and experiences with stress and trauma.
APPENDIX B lists disaster mental
health technical assistance resources and publications available through CMHS.
Some of these materials discuss the needs and provision of services for special
APPENDIX C lists online resources
that provide community-specific demographic and statistical information.
APPENDIX D lists Federal, private-sector,
professional, and other organizations with cultural competence expertise.
APPENDIX E is a glossary of
terms associated with disaster mental health and cultural competence.
APPENDIX F is a Cultural Competence
Checklist for Disaster Crisis Counseling Programs. Based on concepts discussed
throughout this guide, the checklist covers essential principles for ensuring
a culturally competent disaster mental health program.