National Center for Mental Health Promotion and Youth Violence Prevention

1. OVERVIEW
At its core, cultural and linguistic competence (CLC) is based on the premise of respect for individuals and the inclusion of multiple perspectives. On a personal level, it is the development of skills and values that enable a person to live and work with, educate and serve diverse individuals and communities. On an organizational level, CLC is the willingness and ability of a system to value the importance of culture in the delivery of services to all segments of the population. Effective service delivery to everyone in a community depends on organizations being responsive to diversity at all levels, i.e., policy, governance, administration, work force, provider, and consumer/client.

2. INTRODUCTION
The goal of the Safe Schools/Healthy Students (SS/HS) Initiative is to support the positive development of children and families through the implementation of services, activities, and interventions based on a model of community collaboration. As culture is woven into the fabric of all communities, every Safe Schools/Healthy Students Initiative, regardless of the location or demographic makeup of the communities it serves, can benefit from being culturally and linguistically competent. CLC is a recognizable thread in all aspects of a successful SS/HS Initiative. The effectiveness of this Initiative is intrinsically connected to the development of cultural and linguistic competence (CLC) among its leaders as well as other community members.

While working to create a framework for understanding CLC in the context of the Safe Schools/Healthy Students Initiative, we came upon an image from an unexpected source. This image came from central Turkey, where there are enormous underground Byzantine churches and caves.

These underground spaces are not only beautiful, but also provide a foundation for the communities that rest above them. The architects discovered that while an individual arch could not sustain the weight of the city above, three arches joined together could provide the necessary strength. This model of intertwined and connecting supports inspired us to envision a way of thinking about CLC as it relates to the SS/HS Initiative.

Thinking in this way, the three “arches” of CLC in the context of SS/HS are:

By building up and connecting these three key areas, the Initiative can create a solid foundation to serve the community in a culturally competent manner that promotes safer schools and healthier students, families and communities. Drawn arches

Strength in these three arches allows Initiatives to conduct the continuum of activities involved in cultural and linguistic competence: needs assessment, planning, and identification of appropriate services; service delivery and implementation of activities and interventions. “Unlearning” the biases and stereotypes that have been acquired over time, in order to be open to the acquisition of new information, knowledge, and wisdom, is often the first step in developing these strengths. This in turn leads to a broader perspective that will enhance our ability to recognize needs, address challenges, celebrate strengths, and provide services to diverse communities.

CULTURALLY AND LINGUISTICALLY COMPETENT ORGANIZATIONAL STRUCTURE
A culturally competent organizational environment is created through policies and practices that support a diverse staff and emphasize inclusive processes. Considering cultural competence when creating the Initiative’s infrastructure goes a long way towards ensuring the cultural competence of the Initiative itself.

Recruitment and professional development: Policies and procedures that provide guidance for the recruitment and professional development of diverse staff, as well as organizational assessments of CLC, reflect an organization’s commitment to cultural competence. Procedures that outline how to list open positions in a variety of media that reach out to diverse audiences, including non-English media, will help with the recruitment of a culturally representative staff. As communities undergo demographic changes such as growing immigrant populations or greater economic disparities, it becomes more important for school districts’ hiring practices to reflect those changes.

Capacity Building: It is equally important for mental health providers to enhance their capacity to work with linguistic minorities and other underserved groups. Policies that ensure ongoing, high-quality professional development often begin with self-assessment instruments, and may include specific topics as well as skill-building activities to foster cultural awareness among staff. Common topics for professional development include increased understanding of different cultures, e.g., cultural histories, mental health constructs, nonverbal cues, diversity within and between groups, experiences of racism, and the dynamics of immigration and refugee status. Additional topics extend to issues of economic diversity including poverty, single-parent families, lack of support networks, and education levels which may have implications for the types of services needed in order to meet student and family needs.

Leadership: Leaders set the tone for how important CLC is within the Initiative, and model when and how to consider issues related to diversity. Leaders can address resistance to CLC issues through cultivating relationships with allies who in turn can influence others to recognize and respond to diversity issues. In addition, written policies can support the development of leadership among diverse staff members so that individuals from varied economic and cultural backgrounds can occupy senior staff positions. Internal procedures for performance reviews, conflict resolution strategies, and grievance procedures can accommodate and allow for differences in communication styles, values, and behaviors.

Planning: SS/HS Initiatives typically use many types of plans that address strategic planning, communications, sustainability, implementation, and evaluation goals. Creating a process for an inclusive, grass-roots approach helps to ensure that these plans are reflective and responsive to the variety of groups and perspectives present in a community. For example, creating a mechanism that gives consumers and direct service staff an opportunity to review and comment on proposed data collection methods (gaining consent, surveying students and parents, etc.) can maximize success. Similarly, having a policy to include community participation in the planning process provides important information about how well the Initiative’s plans are responding to community needs and values. Community and staff input, as well as active participation in the implementation and evaluation components of the program, add tremendous value to the overall Initiative throughout the life of the grant and beyond.

Budget: Policies and procedures that have specific resource allocations in the budget speak to the overall commitment of an organization. Budget items that reinforce a culturally competent organizational structure include funds for professional development, language services such as translation of program materials or the use of interpreters, and communications strategies to reach diverse audiences.

Review: As the Initiative’s work progresses, a regular review of policies and procedures can ensure alignment with the changing needs of the community. Evaluation of the organization’s adherence to policies and procedures is also important, because good policies and procedures can only be successful if they are followed.

CULTURALLY AND LINGUISTICALLY COMPETENT ENGAGEMENT
Engaging parents, youth, community members, educators, service providers, and businesses in an effective way may be the most challenging aspect of cultural and linguistic competency. Youth are often more willing than adults to give voice to diversity related issues that are affecting them negatively. Parents are more likely to become involved on behalf of their children, rather than engaging around disparities in services or access that affect them directly.

An authentic awareness of the background, struggles, hopes, and fears of our community allows programs to effectively serve all people involved in the process. Whether recruiting staff to reflect the populations being served, working with cultural agencies, encouraging parents to attend school functions, or asking local merchants to support prevention efforts, a process is being established that involves three steps essential to effective engagement: Outreach; Involvement; and Empowerment.

Outreach: The Safe Schools/Healthy Students Initiative promotes collaboration with multiple stakeholders. Effective outreach strategies target intended audiences in an appropriate manner, with messages that are meaningful, relevant, and communicate the concept of mutual benefit (i.e. participating in this Initiative will benefit you as an individual/family AND the community as a whole). Whether communication is in the form of a phone call, a flyer, or a radio announcement, it should take into account the educational and literacy levels of the audience, as well as the actual language spoken. Parents who arrive in the U.S. with only an elementary school education are unlikely to read a long publication even if it has been translated into their native language, but they might listen to a radio interview with a community leader on school policy changes that impact their children. Business owners might respond to a letter if it is brief and explains how involvement would expand their client base, rather than a visit from a staff member during busy after-school hours. Matching the medium to the message, and the strategy to the intended recipient, is key to successful community outreach.

Involvement: Consumers, students, family members and community stakeholders are much more likely to stay involved with SS/HS if they feel that they are welcome, that their contributions are valued, and that their culture-specific needs are being met. Before tools such as surveys and focus groups are used to determine what strategies will keep them engaged, consideration should be given to whether these tools, which may be quite accurate and effective with mainstream populations, are equally useful with the populations being served. If adjustments are not made to accommodate schedules, family structure, or language, the assessment may be inaccurate or incomplete. This may lead to funds being spent on an ineffective intervention. It also helps to structure projects in ways that provide the kind of support mechanisms that will enable all parents to attend events (transportation, child care, scheduling flexibility, etc.) and will encourage children and families to access the services they need (school-based mental health, evening hours at clinics, bilingual staff, etc.). Additionally, cultural organizations can play an important role, as they have already built a level of trust with their communities. By partnering with them, larger institutions such as the public schools can gain valuable insights into the best strategies for outreach and engagement.

Empowerment: In order to ensure that diverse stakeholders help to guide an SS/HS Initiative, it is important for them to become agents of change, or, at the very least, integral parts of the system. Key to this process is the cultivation of leadership skills and opportunities. For example, when community members are hired as parent liaisons or given an active role in planning activities, they might come to see themselves as valuable assets to the schools or the community, and feel encouraged to take on even more responsibility. A Youth Development model can also help to empower youth who are being negatively affected and engage them in a process that contributes to their schools and community. Staff members from underrepresented racial or ethnic groups may need additional support to prevent them from feeling isolated and/or be provided with training in certain work skills; meanwhile, the entire Initiative can benefit from the abilities and experiences that they bring to the table. By having leaders who mirror the community being served, children receive a strong message that change is possible, that their voices will be heard, and that they have the potential to become leaders themselves.

CULTURALLY AND LINGUISTICALLY COMPETENT SERVICES/ACTIVITIES/INTERVENTIONS
Providing culturally and linguistically competent services, activities and interventions begins with a clear and comprehensive understanding of the community. Equipped with such a foundation, an Initiative can put together a full menu of appropriate services, interventions and activities that meet children, youth and parents where they are, with service providers who understand their needs and are able to fulfill them.

Needs Assessment: An accurate, comprehensive and inclusive needs assessment can provide critical information to help the selection process. The effectiveness of an evidence-based intervention (EBI) may be enhanced if adaptations are implemented that satisfy the needs of students and their parents. It is important to note, however, that the fidelity of the EBI must be preserved. Additionally, not all adaptations have been found to be effective and sometimes it may be better to keep the intervention in its original form.

Adaptations: Examples of adaptations that may better meet the needs of students and families include:

Access/Availability: Making services available is often not sufficient. Utilization of services can be greatly enhanced through effective outreach and involvement of students, parents and the community. Access and usability of services are also important to reach intended audiences, and involve attention to logistical issues such as:

Depending on cultural, historical or ethnic background, some parents may be resistant to services. Explaining the nature and benefits of services to parents in terms that are acceptable, understandable and amenable to them can help overcome resistance.

Relationships with competent community providers: Another way to ensure that programs and interventions have utility for students and their families is to enlist clinicians and other providers who have the capacity to provide culturally and linguistically competent services. A policy statement may serve to support the expectation that services provided will be uniformly culturally and linguistically competent and of high quality. This means that the services are effective, respectful and compatible with the stakeholders’ cultural beliefs and language preference. However, changing the make up of staff at an agency can be difficult or politically challenging to achieve, and may take years even with the best intentions.

Evaluation: Finally, a regular review of evaluation data can help identify whether services are being utilized at expected rates and whether they are culturally and linguistically effective. If not, they may be adjusted according to need.