Clinicians Corner: Providing Culturally Appropriate Services

A new tool helps behavioral health providers improve their practice.

Posted Jun 29, 2019

Image via Shutterstock
Source: Image via Shutterstock

Decades of research have identified barriers to seeking among diverse racial and ethnic minority (REM) groups. Models of seeking mental health treatment have identified several factors that influence individuals’ decisions to seek therapy such as attitudes towards professional help-seeking, awareness of when treatment seeking is appropriate, mental health stigma, and financial barriers (Turner, 2019). One way to improve care with diverse individuals is to utilize culturally and linguistically appropriate services.

Why is Understanding Culture Important?

Culturally and linguistically appropriate services (CLAS) “is a way to improve the quality of services provided to all individuals, which will ultimately help reduce health disparities and achieve health equity.” Studies consistently show that clients from ethnic and racial backgrounds have a higher rate of dropout than non-Hispanic Whites. One limitation with most of the research is the lack of diversity in the studies. In a recent study by Kilmer et al. (2019), 70% of participants identified as White. Despite the sample characteristics, the results were consistent with earlier studies they found that REM clients were more likely than non-REM clients to terminate after one session. One factor related to dropout may be the lack of cultural sensitivity.

According to the Model of Treatment Initiation (Turner, 2019) four major areas influence treatment seeking among ethnic minority groups: accessibility factors (structural variables that may influence an individual’s ability to access treatment), availability factors (examines access to culturally competent services), appropriateness factors (examines how individuals view mental health problems as requiring treatment), and acceptability factors (captures variables such as stigma and cultural mistrust). Culturally adapted treatments are increasingly available but they are of little use if the client does not remain in treatment after the first session (Kilmer et al., 2019).

Tools for Enhancing Your Cultural Competence

Attention to training and diversity are important components of accreditation requirements for doctoral level psychologists to help foster a competent workforce to serve an increasingly diverse population (Kilmer et al., 2019). In 2017, the American Psychological Association published guidelines for multicultural competency. The 2017 APA Multicultural Guidelines, provide information to help providers and psychologists with engaging in a better understanding of diversity and its considerations within practice, research, consultation and education (including supervision). Kilmer and colleagues (2019) note that studies on early termination by REM clients have persisted across several decades despite accreditation guidelines, principles, standards, and implementing regulations suggesting that more improvements in diversity training is needed.

A new e-learning program from the Department of Health and Human Services ( seeks to offer a tool to behavioral health providers to enhance their skills. The goal of this e-learning program is to help behavioral health professionals increase their cultural and linguistic competency. By tailoring services to an individual's culture and language preferences, health professionals can help bring about positive health outcomes for diverse populations.

The course includes four modules that discuss:

  • An introduction to cultural and linguistic competency
  • Your cultural identity and how it affects your work with clients
  • Increasing awareness of your client's cultural identity
  • How to build stronger therapeutic relationships with clients from diverse backgrounds

You can visit the Office of Minority Health’s Think Cultural Health website to learn more about the program.

Copyright 2019 Erlanger A. Turner, Ph.D.


American Psychological Association. 2017. Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. Retrieved from:

Kilmer, E. D., Villarreal, C., Janis, B. M., Callahan, J. L., Ruggero, C. J., Kilmer, J. N., ... & Cox, R. J. (2019). Differential early termination is tied to client race/ethnicity status. Practice Innovations, 4(2), 88-98.

Turner, E.A. (2019). Mental Health Among African Americans: Innovations in Research and Practice. Lanham, MD: Lexington.