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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, SAMHSA, DHHS.

Electronic Access and Copies of Publication
This publication may be accessed electronically through the following Internet World Wide Web connection: 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).

Recommended Citation
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.

Originating Office
Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services
1 Choke Cherry Road Room 6-1057, Rockville, MD 20850
Phone: 240-276-1310
Phone: 1-800-789-2647

DHHS Publication No. SMA 3828
Printed 2003

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 resource.

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 populations.

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.



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