Cultural Competency for Mental Health Professionals

An Athealth Interview with Dr. Patti R. Rose

September 2014

Dr Patti Rose

Dr. Patti R. Rose

Dr. Patti Rose acquired her Master’s Degree from Yale University followed by her Doctorate (Ed.D) from Columbia University, Teachers College. She received her Bachelor’s Degree from LeMoyne College in Syracuse, New York where she majored in Biology.

She was recently a full-time Lecturer for the Department of Anthropology at the University of Miami (UM) where she has served, with various teaching titles, since 2005. She teaches courses for Africana, American and Women and Gender Studies.

Dr. Rose has significant academic experience which has included serving as Lecturer for the Yale University School of Public Health, Lecturer for the University of Miami Executive MBA Program in Health Services Administration and as an Adjunct Professor at Springfield College and Worcester State College, Adjunct Professor for Barry University and Lecturer for the University of Miami School of Education, where she taught Ph.D. students and the School of Business. Her full-time academic positions, beyond her current role at the University of Miami, were as Associate Professor at Nova Southeastern University (NSU) in Fort Lauderdale, FL and Assistant Professor at Florida International University in Miami, FL. In recent years, she has developed new courses for the University of Miami entitled Contemporary Issues in America, Black Women in Medicine and Healing, Psychosocial Health and Healing and Women (on-line course), Race and Healthcare in America, Contemporary Issues in African American History, Culture, Race and Diversity Issues in the United States, Mass Incarceration and the Impact on the Black Community and Black Women in Medicine and Healing and Culture, Race and Diversity. She also developed and taught on-line courses while an Associate Professor at NSU including a course on Maternal and Child Health.

Dr. Patti Rose has given keynote addresses, conference presentations and workshops, based on invitations and abstract acceptances in Nairobi Kenya, Barcelona, Spain, Paris, France, Aruba, N.A., St. Thomas, V.I., Puerto Rico, U.S. and many national college, university, community and other settings.

Dr. Rose’s passion is to travel the globe to understand the world and to share her knowledge of various cultures, history, globalism and diversity through lectures, writing, teaching and speaking engagements. She has traveled to Puerto Rico, Mexico, Fiji, Africa (South Africa, Kenya, Senegal and the Cape Verde Islands), Sri Lanka, Japan, Europe (Spain, Italy, France, Portugal and the Netherlands), the Caribbean (Jamaica, Tortola, St. Thomas, Barbados) Haiti, Aruba, N.A, Latin and Central America (Cuba, Honduras, Nicaragua, Costa Rica, Panama, the Dominican Republic) and Asia including, China (Guangzhou, Shanghai, Xian, Suzhou, Nanjing and Beijing), Singapore City, Singapore and Bali (Ubud, Denpasar). At the end of July of 2014 she will also travel to Thailand (Bangkok and Phuket).

Administratively, she has served as Chief Executive Officer (CEO) of her own firm, Rose Consulting, Inc. followed by President and CEO of Plainfield Health Center in Plainfield, NJ. Prior to that, she served as Vice President of Behavioral Health Services at The Jessie Trice Center for Community Health, formerly known as Economic Opportunity Family Health Center (EOFHC), Inc., one of the largest community health centers in the nation, located in Miami, FL and Consultant for that organization and other entities.

She is the author of several books, including, Cultural Competency for Health Administration and Public Health, published by Jones and Bartlett Learning in 2011, and Cultural Competency for the Health Professional, published in 2012 by the same publisher. She also has published articles including a piece in the Harvard Journal of Minority Public Health, which focused on Teenage Pregnancy in the Black community. She also is the Administrator and sole writer for her Blog, entitled Natural Is Cool Enough (N.I.C.E.), which has a national and international following, and N.I.C.E. has culminated into a significant student activity group, facilitated by Dr. Rose, at the University of Miami. She also developed a DVD entitled “Cultural Competency: A Public Health Imperative” through her consultation for a project directed through the Alumni Office of the Yale University School of Public Health, where she also received the Public Health Service Award (2004), for her commitment to Public Health Service.

In the summer of 2013, she taught Chinese college students at Jiatong University in Shanghai, China for 6 weeks in the NGE International Summer Program and during the summer of 2014 she is doing the same for five weeks in Guangzhou, China, for the Jinan International Summer Program at Jinan University.

She is currently working on assembling documentary photographs and relevant cultural and historical information from her most recent experiences with the indigenous Kuna Yana people of the San Blas Islands in Panama, where she recently visited, along with images compiled/to be compiled on various locations in Asia (China, Singapore, Bali and Thailand) for her next book.

Dr. Rose has studied and has language skills in both Spanish and Mandarin Chinese based on her travels and intense study and speaking practice in both languages.

ATHEALTH: Thank you for taking time for this interview. During most of the interview we will focus on your recent book, Cultural Competence for the Health Professional, but please feel free to add to the discussion with any new and/or interesting ideas you have acquired since the book was published in 2013.

If you agree, I would like to begin the interview with a more general discussion of cultural competency and finish with a focus on the disparities minorities experience with mental health care.

First, tell us how you became interested in cultural competence. What drew you to the subject?
DR. ROSE: I was working as an Associate Professor for the Graduate Public Health Program at Nova Southeastern University. They needed their medical students to receive instruction on how to deal with diverse populations that they would encounter upon entering the field as practitioners. I was asked to do so, given my interest and knowledge in terms of culture and diversity. I was given an appointment in the medical school to focus on this topic, which also led to the development of further research on my end and ultimately, my books regarding the subject matter and a consulting firm. My travel throughout the world has been the training for this knowledge and experiential insight, but more importantly, a commitment to cultural competency has inspired continued academic/scholarly interest.

ATHEALTH: Address, briefly, the difference between “Race” and “Ethnicity.”
DR. ROSE: For my work, I use the guidelines provided by the Office of Management and Budget (OMB) of the U.S. government. Although I am merely the messenger, in terms of these terms, I believe they are the clearest guidelines available. I do not agree with them wholeheartedly. So the races are Black/African American, White, Native American, Asian and Pacific Islander. The only ethnicity would be Hispanic. An example of my disagreement with these terms is that Egypt is listed under the category of White, in terms of the people, although it is in Africa. Currently, it is populated by Arab people, but going back to antiquity, it is clear that the people were Black. This kind of distortion of information is problematic to say the least and is evident within the varying categories. Hispanic is listed as THE ethnic category given the common language of the people, namely Spanish. Although Spaniards in America also speak Spanish, they are placed in the category of White due to their European heritage. This is all explained in great detail in both of my books.

ATHEALTH: In your book, you focus on four (4) racial and one (1) ethnic group(s). Please describe each of these for our readers.
DR. ROSE: Truly the 4 racial categories, as indicated above, are from the Office of Management and Budget as this entity establishes the racial and ethnic categories for the United States. My recommendation, for accuracy and the most up-to-date information on this categorization is for the reader to visit and explore racial and ethnic categories.

ATHEALTH: Do you believe any one of these groups is especially vulnerable to healthcare disparities? Or, do you see all of them as about equally vulnerable?
DR. ROSE: The African American/Black groups are particularly vulnerable to health care disparities. Unfortunately, it is not just a matter of my belief but a painful reality. It is not due to race but socioeconomic status. Black Hispanic and African American people have suffered from economic disparity throughout the history of the United States. The result, from a health vantage point, is vulnerability, moreso than any other groups. It is a matter of race discrimination as well, so the impact, for Black Hispanic people, in terms of poor health outcomes, is worse than for White Hispanic people. Lower income impacts education, employment opportunities, housing options, diet and beyond. Every aspect of one’s life is impacted, so consequently, individuals with higher incomes, which is mainly the current majority population, have better health outcomes. Native Americans also suffer greatly, and one needs to only explore their history in this country and how they were treated to understand why their health status has been gravely impacted. In general, reviewing the history of the various groups who are vulnerable to healthcare disparities will serve to be very informative.

ATHEALTH: You use the term ‘emerging minorities’ and write that it is replacing the term ‘minorities.’ Would you please explain why this is occurring?
DR. ROSE: The term emerging majorities is the replacement term for minorities because the so-called minority groups, combined, will become the majority in the United States. It has already happened in some cities in the United States, and the projection, at the time of publication of my books, is that by 2050, and now new data indicates by 2042, current minority groups will, in fact, be the majority, hence the term emerging majority. This further validates, the need for cultural competence by all health care practitioners and administrators.

 ATHEALTH: As a follow-up, draw a picture for us of how you see the demographics in the United States in 10-15 years.
DR. ROSE: It’s quite a simple picture. The racial groups-Black/African Americans, Native Americans, Asians and the ethnic group, Hispanics, combined, will be the majority group in the United States, and the White population will be the minority group.

ATHEALTH: Where will the changing demographics impact the healthcare system the most?
DR. ROSE: Every aspect of the health care system is and will be impacted by these changing demographics. There is and will continue to be a need to understand the cultural nuances and overall culture of the varying groups. Linguistically, health care organizations will need to determine ways to communicate with the groups served by their organizations. Cultural competency, a skill set that is and will continue to be imperative, is and will continue to be necessary to serve the emerging majority populations effectively and to ensure that malpractice cases do not surge, based on lack of understanding of the patients served and miscommunication/maltreatment due to cultural incompetency. Health care organizations that are not prepared to serve their patients, based on their needs, will lose those patients who will seek care from those entities that will be able to serve them optimally. Health care organizations run the risk of decreasing their market share if they are not prepared.

ATHEALTH: Some people use the terms “interpretation” and “translation” interchangeably. Explain how we should use each of these terms in the healthcare world.
DR. ROSE: Interpretation is for the spoken word. Translation is for the written word.

ATHEALTH: You state that providing trained interpreters and language line services is “difficult” and “quite costly for health care,” but you believe these services are “imperative.”

First, what are the biggest obstacles to implementing these services?
DR. ROSE: Due to cost, the biggest obstacle to implementing such services is the financial burden. Administrators must understand the need for it and include said services in the line item budgets for their health care facilities. It must become as imperative as any other service/equipment/facility that is necessary for health care organizations to function optimally.

ATHEALTH: Second, on average, how much does it cost to add these services to an emergency department visit?
DR. ROSE: This cannot be answered as a specific number, per se. It depends on the linguistic needs of the organization, the size, the diversity, whether or not there are interpreters on staff and beyond. For example, if there are limited numbers of trained interpreters on staff, then perhaps supplemental language lines may be needed, or perhaps the service can be used on an as-needed basis. The health care organization should therefore approach the matter contractually and acquire the best rate possible for the organization.

ATHEALTH: Third, how should these services be paid for?
DR. ROSE: The service should be paid for from the revenue stream of the organization. It should be considered as part of the provision of services of the organization like any other service. Therefore, it should be included in the budget of the organization.

ATHEALTH: How could small to medium (1-10 clinicians) mental health practices add translation and/or interpreting services to their practices? Are these services covered by insurance?
DR. ROSE: Similar to any other health care organization, for mental health practices, the provision of culturally competent care should be inherent in the mission of the entity. Culturally competent care should not be viewed as an additional service but as part of the process of serving patients optimally. Insurance does not and should not cover it because it is not a billable item. For example, as a mental health professional is trained to treat a patient, he/she should also be trained to do so from a culturally competent vantage point. Mental health practitioners that are hired should be diverse, have some language training, have taken required courses regarding cultural competence, should understand the changing demographics in the United States, have an understanding of the primary groups served by his/her organization, etc. In my book, written specifically for health professionals, I think all found within is applicable to mental health practitioners.

ATHEALTH: Tell us how you differentiate ‘political correctness’ and ‘cultural competence.’
DR. ROSE: Cultural competence is a skill set necessary to provide optimal care. To refer to such a skill set in the same category of political correctness is to demean the concept and perhaps would be tantamount to reducing it to what is appropriate at a given time based on societal views rather than a requirement based on an true understanding, valuing and appreciating the cultures of people who are living in the United States and are part of the nation, not contingent to it.

ATHEALTH: You criticize Dr. Sally Satel for being “extremely short-sighted and prejudicial” for some of her beliefs in her book, PC. M.D. How Political Correctness is Corrupting Medicine. Tell our readers what you find objectionable about Dr. Satel’s writing and how often you find health professionals with similar views to hers.
DR. ROSE: I find it counterproductive to spend too much time exploring the views of an individual’s perspective that differs from my own. What I will say is that we are a global society with people living in the United States who are culturally and linguistically diverse. As health care professionals, the question is how to serve all individuals optimally by valuing (not just tolerating) all. It is not about political correctness but the provision of services based on mutual understanding and respect for the diversity that all groups bring to the table. No group is better than another but often times there are differences, culturally, that matter. The goal is to communicate optimally with individuals, and when mistakes are made, due to miscommunication or misunderstanding, culturally, correction is necessary by the health care provider. As with any other aspect of the provision of service and in business, in general, “the customer is always right.” In terms of healthcare, the customer is the patient.

ATHEALTH: Do you see provisions within the Affordable Care Act (ACA) that facilitate healthcare professional cultural competency? Do you have concerns that the ACA could widen healthcare disparities for emerging minorities?
DR. ROSE: ACA is political. My goal, with the exception of my interview with Dr. Shalala in my second book and my new Kindle book, entitled The New Health Care Reform Law: A Non-Political, Simplified Explanation, is not to get into the muck and mire of the politics surrounding ACA. To my knowledge, there is no provision in ACA to addressing cultural competency specifically. The law does increase access to care, but it is up to health care organizations to ensure that the provision of care is offered from a culturally competent vantage point.

ATHEALTH: If I understood correctly, in your interview with Dr. Donna Shalala, former Secretary of the US Department of Health and Human Services (DHHS), she believes that as more emerging minorities are covered by health insurance, more healthcare professionals will strive to be culturally competent or culturally proficient in order to stay competitive and prosper in business. Do you agree with her?
DR. ROSE: I am hopeful that Dr. Donna Shalala is correct based on her perspective regarding this matter. It would seem to be the prudent way to go for health care organizations from a competitive/business vantage point and, of course, because it is the right thing to do, in the best interest of all patients (the latter being the priority).

ATHEALTH: You write about ‘visual affirmation’ being an important part of cultural competency. Would you describe a healthcare facility that is a model for using art and waiting room reading materials to meet the needs of emerging minorities in their community?
DR. ROSE: Rather than naming a specific organization, as I have seen some and helped to get others there through consultation, I will describe what would be optimal. For example, you have health care facilities in which the majority of your patients are Black people. You have a waiting room. In it, you have artwork or images on the wall that positively reflect Black people. You have magazines/materials available that are reflective of their current culture. Not all Black people are from the same group, so if your patients are largely of American descent, then go with American images. If they are Haitian people, as an example, then your images should be of Haitian people with magazines and other information in English and Creole. It is a concept that is easy; it works and it is the right thing to do. Know the demographics of your patients and create a space for them where they feel welcome, comfortable, affirmed, and appreciated.

ATHEALTH: Diversifying the workforce is such an important aspect of cultural competency. Many of our readers work in small to medium sized offices. What advice can you give to those who, even though the staff is not diversified, want their emerging minority clients to feel comfortable and valued?
DR. ROSE: From my vantage point, diversity and cultural competence are too completely different concepts. The staff should be diversified. One of the skill sets held by all staff, diverse or not, is cultural competence. All staff should have the necessary cultural competency skill set, before hired, and if hired without such skills, they should be immediately trained. Think of it as a nurse being hired without knowing how to take a person’s blood pressure. That would be a serious shortcoming that may preclude his/her hire or require immediate training if she/he was excellent in every other way. The same would be necessary for the skills associated with cultural competence. Patients should be treated as one expects to be treated and should always be comfortable and valued. If the staff is not diversified or the staff is diversified and does not know how to ensure that their patients are comforted and valued, at all times, then my advice to patients is to seek care elsewhere as that facility is not ready to provide optimal care. My advice is to get your organization ready, if it is not, to provide optimal care, in a culturally competent manner, to all clients.

ATHEALTH: Trusting one’s healthcare provider is paramount for all of us. Your writing helps us understand how difficult it might be for an emerging minority patient to trust a provider from the “outside.” For our readers who strive for good treatment outcomes, will you address how research demonstrates that distrust negatively impacts treatment outcomes?
DR. ROSE: Historically, there is evidence of maltreatment of various emerging majority groups by healthcare practitioners. Harriet Washington’s text entitled Medical Apartheid is a great book to begin to explore many of these atrocities. The research conducted and funded by the United States Public Health Service, for 40 years, entitled the Tuskegee Syphilis Study, is one of the most notable events in which Black men who were infected with syphilis were researched by physicians, to follow the impact of the disease on these men, if untreated. They were not treated, even when medicine became available to cure them, during the course of their illness. The research was conducted until most of the men died. Using this as an example, one gets an idea as to why there is distrust of health care providers by some emerging majority groups because the knowledge of this atrocity, and many others, may be in the recesses of their minds when they seek treatment from health care providers who have a different racial/ethnic/historical background from them.

ATHEALTH: Prevention is such an important aspect of quality healthcare. Routine screening is built-in to prevention. In many cases cultural views need to be altered in order for emerging minorities to accept modern screening. Share with us an example of a group benefiting from an organization’s cultural proficiency applied to health screening.
DR. ROSE: As my work does not focus on the results of the impact of western medicine on the outcomes of health care for individuals but rather on improvement of skill sets for the practitioner, in terms of cultural competence, this is a question that is out of my purview of discussion.

ATHEALTH: Much of the cultural competency writing seems to address the issue from a ‘top down’ approach. It certainly makes sense that leaders and healthcare professionals understand and support diversity and competency. However, a ‘bottom up’ approach can have lasting value when a group embraces change. What efforts are being made to tackle cultural competency from within an emerging minority itself? How is that working?
DR. ROSE: The responsibility for the provision of service in an optimal and culturally competent manner does not belong to those who are receiving the service but to the providers.

ATHEALTH: From your writing, improved health literacy seems to parallel better health care. Do studies show a return on investment (ROI) from programs aimed at improving health literacy among emerging minorities?
DR. ROSE: I am unaware of programs designed to improve the health literacy of emerging minorities. The problem, per my book, exists at a more systemic level. The educational system in the United States is inequitable. People who are poor are exposed to inferior schools with lack of resources and lowered expectations. Consequently, necessary educational skills are often lacking including lower literacy levels. This leads to health literacy issues. When the inequities of the educational system are addressed in the country as a whole, health literacy will be a consequence of such efforts.

ATHEALTH: It seems logical that learning to speak English would improve a minority’s health literacy. Is it possible that we might be doing emerging minorities a disfavor by diluting English as the United States’ “official” language?
DR. ROSE: Technically, the United States does not have an “official” language. The problem is that most Americans are monolingual, which is very unfortunate. When traveling around the world, I find that most individuals that I encounter, no matter their socioeconomic status, have the ability to speak more than one language. To have a multilingual focus will not dilute the “official” language but ensure that individuals in the United States are in a better position to serve others by embracing their language as well. I personally have taken the time to learn Spanish (which is an ongoing process) and Mandarin (which is also ongoing). I am at the intermediate level in terms of Spanish and at the beginning level for Mandarin. When you speak a person’s language, it is a way of valuing and affirming their culture.

ATHEALTH: Define the Cultural Competency Continuum and give us some ‘real world,’ clinical examples of the continuum from cultural destructiveness to cultural proficiency.
DR. ROSE: The cultural competency continuum is explained in both of my cultural competency books with references. It is my suggestion that the reader take a look at my books to review the continuum thoroughly. Each of my books also has case studies with “real world” scenarios that are applicable to the continuum.

ATHEALTH: Discuss why a diverse staff alone does not meet criterion for cultural proficiency or, even, competency.
DR. ROSE: It is possible for a staff to be diverse, but also culturally incompetent. Perhaps the diverse staff does not understand that a person who is from the Dominican Republic does not have the same cultural experiences as a person who is from Honduras even though both individuals speak Spanish. Latin American people are from different nations and, therefore, their cultural experiences are different, and there are variations in terms of the use of certain words in the Spanish language. Of course, this is a mere example but nevertheless, it helps to explain that diversity alone is not sufficient. Cultural competence is a skill set. It is not simply a matter of hiring people that are from different races/cultures/ethnicities but ensuring that all staff, at every level, who will be serving patients have the skill set, culturally speaking, to do so.

ATHEALTH: Do you have an example(s) of a culturally proficient healthcare facility?
DR. ROSE: I think it would not be appropriate to single out one particular facility as there are many that have achieved varying degrees of cultural competency to proficiency. I believe that organizations where I have provided consultation, who have followed my recommendations, have achieved such. I have seen the results and overall, I have been impressed as these efforts usually begin with the Board of Directors and Executive Administration, followed by all levels of staff as well as ensuring visual affirmation, signage, translation, interpretation and beyond, throughout the facility.

ATHEALTH: The internet can be such a valuable source for education and training. Do you know of any web-based technologies focused on cultural competency? Any mobile apps?
DR. ROSE: In the back of my second book, Cultural Competency for the Health Professional, I have listed useful websites. Also, that book has an interactive technological component of which each purchaser receives a code, enabling an interactive process. I am not familiar with any mobile apps.

ATHEALTH: The educational model LEARN, Listen, Explain, Acknowledge, Recommend and Negotiate, seems to contain elements that fit well with mental health practices. What is your opinion of that model and what are the best resource(s) for LEARN training?
DR. ROSE: Although this appears to be a strong model, it is not my own, hence, I think it would be best to get feedback from the developers in of its applicability and resources associated with it.

ATHEALTH: Our readers are especially concerned about the psychosocial impact of culturally incompetent care. Would you describe the importance of providers’ awareness of ‘microaggressions, microassaults, microinsults and microinvalidation’ in the clinical setting?
DR. ROSE: The terms mentioned here were outlined in my book, Cultural Competency for the Health Professional, in a chapter written by Omari Keeles. I will defer to him for an analysis of this detail. Perhaps he can be contacted by you for an interview as he was a contributing author for my work.

ATHEALTH: Your writing clearly describes the negative impact of prejudice, discrimination and racism. Would you grade the United States in each of these areas for improvements made since the 1960s. What are some of the major challenges that still lie ahead?
DR. ROSE: The challenges are grave and numerous although there are improvements. The health disparity that exists in the U.S. indicates that efforts have not been substantial enough to close the gap. The concerns, challenges and issues are too numerous to list here and, in fact, would lend to another book. The short answer is that prejudice, discrimination and racism must be absolutely minimalized or cease to exist followed by efforts to improve the socioeconomic status of emerging majorities from a “systems” rather than individual vantage point.

ATHEALTH: Do you believe marketplace competition for emerging minority patients will positively impact cultural competence? Or, as some believe, might the scarcity of certain specialists cause them to flee to practices catering to the more health literate populations? For instance, ‘concierge practices’ seem to be gaining popularity in primary care.
DR. ROSE: This question makes the assumption that health literacy is the key issue at hand. Although health literacy is an important aspect of this dialogue, it should not be used as “code words” to justify why clinicians may opt out of caring for patients who are from emerging minority groups. Emerging MAJORITY patients will positively impact cultural competence based on sheer numbers. Patients will go to facilities where they are valued and respected and as demographics continue to change in favor of higher numbers of emerging majority patients, health care organization will “lose” in the competition if cultural competency skill sets are not ramped up to meet their healthcare needs.

ATHEALTH: Dr. Donna Shalala describes how the University of Miami is a model for incorporating cultural competency into their medical school curriculum. How have they done that? Are there other healthcare professional schools that cause you to feel optimistic about training programs, generally?
DR. ROSE: My knowledge of healthcare professional schools and how this matter is handled is limited to the information provided through varying accrediting bodies. I would recommend reading Chapter 10 of my book entitled Cultural Competency for the Health Professional to view Dr. Donna Shalala’s perspective regarding the University of Miami as a model for incorporating cultural competency into their medical school curriculum. Her response, per my interview with her on this matter, was detailed and comprehensive.

ATHEALTH: As a follow-up, do you know of a specific mental health training program for psychologists, social workers, etc. that embedded cultural competency into their curriculum?
DR. ROSE: As a cultural competency consultant, I offer such training for healthcare organizations/health professionals, utilizing my books as resource materials for the process.

ATHEALTH: Let me setup a scenario for you. Speak to our readers who work in practices in a suburban area. This clinician might be a solo clinician or share office space with less than 5 colleagues. The majority of their patients are non-Hispanic White with only an occasional patient from an emerging minority. What are the top three or four priorities you recommend for them to become culturally competent or proficient for that occasional patient?
DR. ROSE: Let me set up a scenario for you. A customer comes into a store that sells mainly clothes but has a small section in the back, which sells shoes. It is rare that a customer will request shoes. Should the customer who requests the shoes be treated differently from the person who walks in to buy clothing? The answer is no. Therefore, in your scenario, the goal of the clinician, from a culturally competent vantage point, is to meet the needs of the patient, optimally by ensuring that the customer is visually affirmed, that efforts are made to ascertain key aspects of the patients culture that may impact care by asking him/her key questions in an appropriate manner, by determining if there is a need for language assistance and by valuing the individual and his/her culture and not just tolerating it. The latter may entail understanding that there may be treatment protocols that may have to take culture into consideration, e.g. is traditional healing a factor, and if so, respecting that and making determinations about Western Medicine offerings without judgment and avoiding the possibility of synergistic effects.

ATHEALTH: Sylvia Atdjian, MD and William Vega, PhD, wrote about disparities in mental health treatment in Psychiatric Services in 2005. Their article focused on disparities in both access to and quality of mental health care for racial and ethnic minority groups. In addition to other issues, they reported on the underutilization of psychiatric services, problems in treatment engagement, over diagnosis of schizophrenia among African Americans and depression among Latinos. In addition to other obstacles, the authors highlighted the lack of treatment engagement and cultural mistrust in mental health care. Have you seen any significant progress in these mental health areas since 2005?
DR. ROSE: My work is not specific to mental health so I would be unable to respond to this question in terms of progress, since 2005.

ATHEALTH: Several years ago, the American Psychiatric Association (APA) formed a work group to address health disparities and cultural competency. Could you comment on the impact the APA has had on its memberships’ cultural competency? Are there any other mental health professional organizations that have developed meaningful cultural competency training for their members?
DR. ROSE: I am not familiar with the efforts of the APA in terms of cultural competency.

ATHEALTH: Your writing makes it clear that health disparities in emerging minority groups could be positively addressed by training more minority healthcare professionals. Do you know if the percentage of minority mental health professionals, psychiatrists, psychologists, social workers, etc. in training is increasing?
DR. ROSE: Although training more minority healthcare professionals will be helpful and useful, it is not the solution to the problem.

ATHEALTH: Some research shows that, although quality of health care in the United States is improving, access and disparities are not improving. What might be causing that discrepancy?
DR. ROSE: Socioeconomic status. When economic disparity exists, health disparity exists. One cannot be addressed without the other. So the discrepancy continues and unfortunately, will remain.

ATHEALTH: What advice do you have for our mental health professional readers who want to make to become culturally proficient?
DR. ROSE: My recommendation would be to read my second book, Cultural Competency for the Health Professional. I believe this would be an excellent place to start. The next step would be to request, from their health care facility, cultural competence training to ensure that they will be in a position to serve their patients optimally.

ATHEALTH: You are in China now and will be in Thailand next month. Tell us about your work in Asia. How do you assess the state of cultural competency in countries other than the United States? Are there countries that you look to as a model of cultural proficiency?
DR. ROSE: Homogeneity often lends to cultural competence so in homogeneous nations, it is often more obvious. However, the categorization of race, as it is handled in the U.S. is different from other nations. The history of nations must also be taken into consideration such as slavery in the Americas and Colonization in Africa. This impacts how the dominant group may treat others in their nation. Because there is so much variation, I would say that there is not one “model” that I would identify. What I would say is that the model is to find it in our hearts and minds, no matter where we are in the world, to value and appreciate all people, and when providing services do so with effectiveness and efficiency and appreciation of all of humanity. The fact that we have to have a discussion about why we must be culturally competent is the problem. Why should any service be provided in an incompetent manner?

ATHEALTH: Are you more or less optimistic about the United States, health professionals’ cultural competency than you were a decade ago?
DR. ROSE: I am more optimistic. As emerging majorities continue to flourish in the U.S. health professionals must strive to meet the needs of all, if they want their organizations to thrive and succeed.

ATHEALTH: Thank you so much, Dr. Rose. I know that your passion and your expertise will positively impact our readers who want to become more skilled as they care for all of their patients.

Dr. Rose offers Cultural Competency consultation on an individual/employee/administrative and organization-wide basis which includes workshops, individual/employee/administration and organization assessments, strategic planning,  program development, visual affirmation and signage walk-throughs, individual/employee preparation for interaction with culturally diverse groups, interpretation and translation guidance, patient and employee demographic analyses, development of training modules, cultural competency for accreditation preparation and beyond. Consultation will be tailored to meet the needs of the individual(s)/employee(s)/organization.

If you would like to contact Dr. Rose, please email her at or

Her books may be purchased by clicking the links below:
Cultural Competency for Health Administration and Public Health
Cultural Competency for the Health Professional
The New Health Care Reform Law: A Non-Political, Simplified Explanation (Kindle Edition)