Developing Cultural Competence in Disater Mental Health ... · PDF fileand Human Services Guide, ... Developing Cultural Competence in 5 ... Giger and Davidhizar’s “transcultural

Editor’s Note: This Chapter is comprised ofexcerpts from the US Department of Healthand Human Services Guide, “DevelopingCultural Competence in Disaster MentalHealth Programs” (DHHS Pub. No. SMA3828) 1. For the full guide and much moredetail, please visit www.samhsa.gov.

Disasters—earthquakes, hurricanes,chemical explosions, wars, school shootings,mass casualty accidents, and acts ofterrorism—can strike anyone, regardless ofculture, ethnicity, or race. No one whoexperiences or witnesses a disaster isuntouched by it.

Peoples’ reactions to disaster and theircoping skills, as well as their receptivity tocrisis counseling, differ significantly because

of their individual beliefs, culturaltraditions, and economic and social statusin the community. For this reason, workersin our Nation’s public health and humanservices systems increasingly recognize theimportance of cultural competence in thedevelopment, planning, and delivery ofeffective disaster mental health services.

The increased focus on cultural competencealso stems from the desire to better serve aU.S. population that is rapidly becomingmore ethnically and culturally diverse. Torespond effectively to the mental healthneeds of all disaster survivors, crisiscounseling programs must be sensitive tothe unique experiences, beliefs, norms,values, traditions, customs, and language ofeach individual, regardless of his or herracial, ethnic, or cultural background.Disaster mental health services must beprovided in a manner that recognizes,respects, and builds on the strengths andresources of survivors and theircommunities.

The Crisis Counseling Assistance andTraining Program (CCP) is one of theFederal Government’s major efforts toprovide mental health services to peopleaffected by disasters. Created in 1974, thisprogram is currently administered by theCenter for Mental Health Services(CMHS), Substance Abuse and MentalHealth Services Administration(SAMHSA), and the Federal EmergencyManagement Agency (FEMA). TheProgram provides supplemental funding toStates for short-term crisis counselingservices to survivors of federally declared

Developing Cultural Competency 54

5Developing Cultural Competence in

Disater Mental Health ProgramsU.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES (SAMHSA)

Disaster mental

health services

must be provided in

a manner that

recognizes,

respects, and builds

on the strengths

and resources of

survivors and their

communities.

© Copyright 2007 – New York Disaster Interfaith Services (NYDIS)

visit www.samhsa.gov

disasters. Crisis counseling services providedthrough the Program include outreach,education, community networking andconsultation, public information andreferral, and individual and groupcounseling. The CCP emphasizesspecialized interventions and strategies thatmeet the needs of special populations suchas racial and ethnic minority groups.

The purpose of this guide is to assist Statesand communities in planning, designing,and implementing culturally competentdisaster mental health services for survivorsof natural and human-caused disasters of allscales. It complements informationpreviously published by FEMA and CMHSon disaster mental health response andrecovery. FEMA provided the funding forthis guide as part of the agencies’ ongoingeffort to address the needs of specialpopulations in disaster mental healthresponse and recovery. “DevelopingCultural Competence in Disaster MentalHealth Programs: Guiding Principles andRecommendations” is part of a series ofpublications developed by CMHS.2

BACKGROUND ANDOVERVIEW

Disasters affect hundreds of thousands ofpeople in the United States annually.Between 1993 and 1998, the American RedCross responded to more than 322,000disaster incidents in the United States andprovided financial assistance to more than600,000 families (American Red Cross,2000). In 1997 alone, the FederalEmergency Management Agency (FEMA)responded to 43 major disasters in 27 Statesand three western Pacific Island territories(FEMA, 2000). In recent years, human-caused disasters have been a majorchallenge. Such events include the 1992civil unrest in Los Angeles, the 1995bombing of the Alfred P. Murrah FederalBuilding in Oklahoma City, and theSeptember 2001 terrorist attacks on theWorld Trade Center in New York and thePentagon in Arlington.

Disaster crisis counseling is a specializedservice that involves rapid assignment andtemporary deployment of staff who mustmeet multiple demands and work inmarginal conditions and in unfamiliarsettings such as shelters, recovery servicecenters, and mass care facilities. The majorobjective of disaster mental healthoperations is to mobilize staff to disastersites so that they can attend to theemotional needs of survivors. In the past,these responses tended to be generic; littleor no effort was made to tailor resources tothe characteristics of a specific population.With time and experience, however, serviceproviders and funding organizations havebecome increasingly aware that race,ethnicity, and culture may have a profoundeffect on the way in which an individualresponds to and copes with disaster. Today,those in the field of disaster mental healthrecognize that sensitivity to culturaldifferences is essential in providing mentalhealth services to disaster survivors.

Integrating cultural competence in thetemporary structure and high-intensitywork environment of a disaster reliefoperation is a challenge. Increasing culturalcompetence, not a one-time activity, is along-term process that requiresfundamental changes at the institutionallevel. Because both culture and the natureof disasters are dynamic, these changes mustbe followed by ongoing efforts to ensurethat the needs of those affected by disasterare met.3


The major objective

of disaster mental

health operations is

to mobilize staff to

disaster sites so

that they can attend

to the emotional

needs of survivors.


UNDERSTANDINGCULTURE

Culture influences many aspects of ourlives—from how we communicate andcelebrate to how we perceive the worldaround us. Culture involves sharedcustoms, values, social rules of behavior,rituals and traditions, and perceptions ofhuman nature and natural events. Elementsof culture are learned from others and maybe passed down from generation togeneration.

Many people equate race and ethnicity withculture; however, the terms “race” and“ethnicity” do not fully define the scopeand breadth of culture. Race and ethnicityare indeed prominent elements of culture,but there are important distinctionsbetween these terms. For example, manypeople think of “race” as a biologicalcategory and associate it with visiblephysical characteristics such as hair and skincolor.

Physical features, however, do not reliablydifferentiate people of different races(DHHS, 2001). For this reason, race iswidely used as a social category. Differentcultures classify people into racial groups onthe basis of a set of characteristics that aresocially important (DHHS, 2001). Often,members of certain social or racial groupsare treated as inferior or superior or givenunequal access to power and other resources(DHHS, 2001).

“Ethnicity” refers to a common heritage ofa particular group. Elements of this sharedheritage include history, language, rituals,and preferences for music and foods.Ethnicity may overlap with race when raceis defined as a social category. For example,because Hispanics are an ethnicity, not arace, ethnic subgroups such as Cubans andPeruvians include people of different races(DHHS, 2001).

“Culture” refers to the shared attributes of agroup of people. It is broadly defined as acommon heritage or learned set of beliefs,norms, and values (DHHS, 2001). Culture

is as applicable to groups of whites, such asIrish Americans or German Americans, as itis to racial and ethnic minorities (DHHS,2001). People can share a culture, regardlessof their race or ethnicity. For example,people who work for a particularorganization, people who have a particularphysical or mental limitation, or youth in aparticular social group may share culturalattributes.

A culture can be defined by characteristicssuch as:• National origin;• Customs and traditions;• Length of residency in the United States;• Language;• Age;• Generation;• Gender;• Religious beliefs;• Political beliefs;• Sexual orientation;• Perceptions of family and community;• Perceptions of health, well-being, and

disability;• Physical ability or limitations;• Socioeconomic status;• Education level;• Geographic location; and• Family and household composition.


Elements of culture

are learned from

others and may be

passed down from

generation to

generation.



Important Considerations When Interacting with

People of Other Cultures

Giger and Davidhizar’s “transcultural assessment and intervention model” was developed to assist in the provision oftranscultural nursing care. It is currently used by several other health and human services professions. The modelidentifies five issues that can affect the interactions of providers and service recipients. These issues, adapted below toapply to disaster crisis counseling, illustrate the importance of acknowledging culture and of respecting diversity. Acomplete description of the model can be found in Transcultural Nursing: Assessment and Intervention (Giger andDavidhizar, 1999).

Communication: Both verbal and nonverbal communication can be barriers to providing effective disaster crisis

counseling when survivors and workers are from different cultures. Culture influences how people express their

feelings, as well as what feelings are appropriate to express, in a given situation. The inability to communicate can

make both parties feel alienated and helpless.

Personal Space: “Personal space” is the area that immediately surrounds a person, including the objects within that

space. Although spatial requirements may vary from person to person, they tend to be similar among people in a given

cultural group (Watson, 1980). A person from one subculture might touch or move closer to another as a friendly gesture,

whereas someone from a different culture might consider such behavior invasive. Disaster crisis counselors must look

for clues to a survivor’s need for space. Such clues may include, for example, moving the chair back or stepping closer.

Social Organization: Beliefs, values, and attitudes are learned and reinforced through social organizations, such as

family, kinships, tribes, and political, economic, and religious groups. Understanding these influences will enable the

disaster crisis counselor to more accurately assess a survivor’s reaction to disaster. A survivor’s answers to seemingly

trivial questions about hobbies and social activities can lead to insight into his or her life before the disaster.

Time: An understanding of how people from different cultures view time can help avoid misunderstandings and miscom-

munication. In addition to having different interpretations of the overall concept of time, members of different cultures

view “clock time”—that is, intervals and specific durations—differently. Social time may be measured in terms of

“dinner time,” “worship time,” and “harvest time.” Time perceptions may be altered during a disaster. Crisis counselors

acting with a sense of urgency may be tempted to set timeframes that are not meaningful or realistic to a survivor. The

result may be frustration for both parties.

Environmental Control: A belief that events occur because of some external factor—luck, chance, fate, will of God, or

the control of others—may affect the way in which a survivor responds to disaster and the types of assistance needed.

Survivors who feel that events and recovery are out of their control may be pessimistic regarding counseling efforts. In

contrast, individuals who perceive that their own behavior can affect events may be more willing to act (Rotter, 1966).

Disaster crisis counselors need to understand beliefs related to environmental control because such beliefs will affect

survivors’ behavior.

TABLE 2-2 4

Culture changes continuously. For example, immigrants to the United States bring with them their own beliefs, norms, andvalues, but through the process of acculturation gradually learn and adopt selected elements of the dominant culture. Animmigrant group may develop its own culture while becoming acculturated. At the same time, the dominant culture maychange as a result of its interaction with the immigrant group (DHHS, 2001).


DIVERSITY AMONG ANDWITHIN RACIAL ANDETHNIC MINORITYGROUPS

Four racial and ethnic minority groups—African Americans, American Indians andAlaska Natives, Asian Americans and PacificIslanders, and Hispanic Americans—accounted for approximately 30 percent ofthe U.S. population in the year 2000 andare expected to account for nearly 40percent of the U.S. population by 2025(DHHS, 2001). Although there areimportant differences among these fourgroups, there also is broad diversity withineach group. In other words, people whofind themselves in the same racial or ethnicgroup—either by census category orthrough self identification— do not alwayshave the same culture. Examples follow:

• American Indians and Alaska Natives maybelong to more than 500 tribes, each ofwhich has a different cultural tradition,language, and ancestry (DHHS, 2001).

• Asian Americans and Pacific Islanders mayidentify with any of 43 subgroups andspeak any of 100 languages and dialects(DHHS, 2001).

• Hispanics may be of Mexican, PuertoRican, Cuban, Central and SouthAmerican, or other heritage (DHHS, 2001).

Furthermore, the broad category labels areimprecise (DHHS, 2001). For example,people who are indigenous to the Americasmay be called Hispanic if they are fromMexico or American Indian if they are fromthe United States (DHHS, 2001). Inaddition, many people in a particular racialor ethnic minority group may identify moreclosely with other social groups than withthe group to which they are assigned bydefinition (DHHS, 2001). Finally, manypeople identify with multiple cultures thatmay be associated with factors such as race,ethnicity, country of origin, primarylanguage, immigration status, age, religion,sexual orientation, employment status,disability, geographic location, orsocioeconomic status.

Recognizing the limitations of thetraditional broad groupings, the U.S.Census Bureau revised the categories usedto report race and ethnicity in the 2000Census. For the first time, individuals couldidentify with more than one group (U.S.Office of Management and Budget, 2000).The U.S. Census Bureau anticipated thatthis change would result in approximately63 categories of racial and ethnic identifica-tions (DHHS, 2001).

Appendix C lists additional resourcesoffering statistical and demographic data onracial and ethnic populations andsubpopulations.

CULTURALCOMPETENCE: SCOPEAND TERMINOLOGY

We use many terms to refer to conceptsassociated with cultural competence andwith interactions between and amongpeople of different cultures, including“cultural diversity, cultural awareness,cultural sensitivity, multiculturalism, andtranscultural services.” Although thedifferences in the meanings of these termsmay be subtle, they are extremelyimportant. For example, the term “culturalawareness” suggests that it may be sufficientfor one to be cognizant, observant, andconscious of similarities and differencesamong cultural groups (Goode et al.,2001).

“Cultural sensitivity,” on the other hand,connotes the ability to empathize with andunderstand the needs and emotions ofpersons of one’s own culture, as well asthose of others, and to identify withemotional expressions and the problems,struggles, and joys of someone fromanother culture (Hernandez and Isaacs,1998).


...People who find

themselves in the

same racial or

ethnic group—

either by census

category or through

self identification...


The term “cultural competence” suggests abroader concept than “cultural sensitivity”implies. As previously defined in thissection, the word “culture” refers to theshared attributes—including beliefs, norms,and values—of a group of people (DHHS,2001). The word “competence” implies thecapacity to function effectively, both at theindividual and organizational levels.“Competence” is associated with “culture”to emphasize that being aware of orsensitive to the differences between culturesis not sufficient. Instead, service providersmust have the knowledge, skills, attitudes,policies, and structures needed to offersupport and care that is responsive andtailored to the needs of culturally diversepopulation groups.

Many people and organizations havedeveloped definitions of culturalcompetence. The following definitionblends elements of definitions used bySAMHSA (DHHS, 2001), the HealthResources and Services Administration(DHHS), the Office of Minority Health(DHHS, 2000a), and definitions found inthe literature (Bazron and Scallet, 1998;Cross et al., 1989; Denboba, 1993; Evans,1995; Roberts et a al.,1990; Taylor et al.,1998):

Cultural competence is a set of values,behaviors, attitudes, and practices within asystem, organization, program, or amongindividuals that enables people to workeffectively across cultures. It refers to theability to honor and respect the beliefs,language, interpersonal styles, and behaviorsof individuals and families receiving services,as well as staff who are providing suchservices. Cultural competence is a dynamic,ongoing, developmental process that requires along-term commitment and is achieved overtime.

Cross and colleagues (1989) note thatculturally competent organizations andindividuals:

• Value diversity;• Have the capacity for cultural assessment;• Are aware of cross-cultural dynamics;• Develop cultural knowledge; and• Adapt service delivery to reflect an

understanding of cultural diversity.

At the individual level, cultural competencerequires an understanding of one’s ownculture and worldview as well as those ofothers. It involves an examination of one’sattitudes, values, and beliefs, and the abilityto demonstrate values, knowledge, skills,and attributes needed to work sensitivelyand effectively in cross-cultural situations(Goode et al., 2001).

At the organizational and programmaticlevels, cultural competence requires acomprehensive, coordinated plan that cutsacross policymaking, infrastructurebuilding, program administration andevaluation, and service delivery. Culturallycompetent organizations and programsacknowledge and incorporate theimportance of culture, assess cross-culturalrelations, are aware of dynamics that canresult from cultural differences andethnocentric attitudes, expand culturalknowledge, and adopt services that meetunique cultural needs (DHHS, 2000d).


Cultural

competence is a

dynamic, ongoing,

developmental

process that

requires a long-

term commitment

and is achieved

over time.


THE CULTURALCOMPETENCECONTINUUM

Cultural competence is not a matter ofbeing politically correct or of assigning oneperson to handle diversity issues, nor does itmean simply translating materials intoother languages. Rather, it is an ongoingprocess of organizational and individualdevelopment that includes learning moreabout our own and other cultures; alteringour thinking about culture on the basis ofwhat we learn; and changing the ways inwhich we interact with others to reflect anawareness and sensitivity to diverse cultures.

The Cultural Competence Continuum wasdeveloped by Cross et al. (1989) for mentalhealth professionals. Today, many otherpublic health practitioners and community-based service providers also find it a usefultool. The continuum assumes that culturalcompetence is a dynamic process withmultiple levels of achievement. It can beused to assess an organization’s orindividual’s level of cultural competence, toestablish benchmarks, and to measureprogress.

The negative end of the continuum ischaracterized by Cultural Destructiveness.Organizations or individuals in this stageview cultural differences as a problem andparticipate in activities that purposelyattempt to destroy a culture. Examples ofdestructive actions include denying peopleof color access to their natural helpers orhealers, removing children of color fromtheir families on the basis of race, andrisking the wellbeing of minorityindividuals by involving them in social ormedical experiments without theirknowledge or consent. Organizations andindividuals at this extreme operate on theassumption that one race is superior andthat it should eradicate “lesser” cultures.

Organizations and individuals in theCultural Incapacity stage lack the abilityto help cultures from diverse communities.Although they do not intentionally seek tocause harm, they believe in the superiorityof their own racial or ethnic group andassume a paternalistic posture toward“lesser” groups. They may act as agents ofoppression by enforcing racist policies andmaintaining stereotypes. Employmentpractices of organizations in this stage ofthe continuum are discriminatory.

Cultural Blindness is the midpoint of thecontinuum. Organizations and individualsat this stage believe that color or culturemakes no difference and that all people arethe same. Individuals at this stage may viewthemselves as unbiased and believe that theyaddress cultural needs. In fact, people whoare culturally blind do not perceive, andtherefore cannot benefit from, the valuabledifferences among diverse groups. Servicesor programs created by organizations at thisstage are virtually useless to address theneeds of diverse groups.

Culturally pre-competent organizationsand individuals begin to move toward thepositive end of the continuum. They realizeweaknesses in their attempts to servevarious cultures and make some efforts toimprove the services offered to diversepopulations. Pre-competent organizationshire staff from the cultures they serve,involve people of different cultures on theirboards of directors or advisory committees,and provide at least rudimentary training incultural differences. However, organizationsat this stage run the risk of becomingcomplacent, especially when membersbelieve that the accomplishment of one goalor activity fulfills the obligation to thecommunity. Tokenism is another danger.Organizations sometimes hire one or moreworkers from a racial or ethnic group andfeel that they have done all that is necessary.


...Cultural

competence is a

dynamic process

with multiple levels

of achievement.


Culturally Competent organizations andindividuals accept and respect differences,and they participate in continuing self-assessment regarding culture. Suchorganizations continuously expand theircultural knowledge and resources and adoptservice models that better meet the needs ofminority populations. In addition, theystrive to hire unbiased employees, and seekadvice and consultation from representa-tives of the cultures served. They alsosupport their staff members’ comfort levelswhen working in cross-cultural situationsand in understanding the interplay betweenpolicy and practice.

Culturally Proficient organizations holddiversity of culture in high esteem. Theyseek to add to the knowledge base ofculturally competent practice by conductingresearch, developing new therapeuticapproaches based on culture, andpublishing and disseminating the results ofdemonstration projects. Culturallyproficient organizations hire staff memberswho are specialists in culturally competentpractice. Achieving cultural competenceand progressing along the continuum donot happen by chance. Policies andprocedures, hiring practices, servicedelivery, and community outreach must allinclude the principles of culturalcompetence. For these reasons, acommitment to cultural competence mustpermeate an organization before a disasterstrikes. If the concepts of culturalcompetence and proficiency have beenintegrated into the philosophy, policies, andday-to-day practices of the mental healthprovider agency, they will be much easier toincorporate into disaster recovery efforts.

CULTURAL COMPETENCEAND DISASTER MENTALHEALTH SERVICES

Culture as a source of knowledge,information, and support providescontinuity and a process for healing duringtimes of tragedy (DeVries, 1996). Survivorsreact to and recover from disaster withinthe context of their individual racial andethnic backgrounds, cultural viewpoints,life experiences, and values. Culture offers aprotective system that is comfortable andreassuring. It defines appropriate behaviorand furnishes social support, identity, and ashared vision for recovery. For example,stories, rituals, and legends that are part ofa culture’s fabric help people adjust tocatastrophic losses by highlighting themastery of communal trauma andexplaining the relationship of individuals tothe spiritual. Despite the strengths thatculture can provide, responses to disasteralso fall on a continuum. Persons fromdisadvantaged racial and ethniccommunities may be more vulnerable toproblems associated with preparing for andrecovering from disaster than persons ofhigher socioeconomic status (Fothergill etal., 1999).

Because of the strong role that culture playsin disaster response, disaster mental healthservices are most effective when survivorsreceive assistance that is in accord with theircultural beliefs and consistent with theirneeds (Hernandez and Isaacs, 1998). Asdisaster mental health service providers seekto become more culturally competent, theymust recognize three important social andhistorical influences that can affect thesuccess of their efforts. These threeinfluences are the importance ofcommunity, racism and discrimination, andsocial and economic inequality.


Achieving cultural

competence and

progressing along

the continuum do

not happen by

chance.


The Importance of Community

Disasters affect both individuals andcommunities. Following a disaster, there maybe individual trauma, characterized as “ablow to the psyche that breaks through one’sdefenses so suddenly and with such brutalforce that one cannot react to it effectively”(DHHS, Rev. ed. in press). There also maybe collective trauma—“a blow to the basictissues of social life that damages the bondsattaching people together and impairs theprevailing sense of community” (DHHS,Rev. ed. in press). Cultural andsocioeconomic factors contribute to bothindividual and community responses to thetrauma caused by disaster.

The culture of the community provides thelens through which its members view andinterpret the disaster, and the community’sdegree of cohesion helps determine the levelof social support available to survivors. Inother words, a community that is disruptedand fragmented will be able to provide lesssupport than a cohesive community.

A classic example is presented by sociologistKai Erikson, who studied the impact of thedevastating 1972 flood in Buffalo Creek,West Virginia (Erikson, 1976). The floodled to relocation of the entire community.Erikson describes a “loss of community,” inwhich people lost not only their sense ofconnection with the locale but also thesupport of people and institutions. Resultsof this community’s fragmentation includedfear, anger, anxiety, and depression.

Other studies have emphasized positiveeffects that can result from disasterexperiences in communities that perform aprotective role and cushion the stress of thedisaster (Dynes et al., 1994). Comparedwith nondisaster-related suffering, which isisolating and private, the suffering ofdisaster survivors can be collective andpublic (Dynes et al., 1994). However,devastating disasters can have positiveoutcomes. They can bring a communitycloser or reorient its members to newpriorities or values (Ursano, Fullerton et al.,1994). Individuals may exhibit courage,

selflessness, gratitude, and hope that theymay not have shown or felt before thedisaster.

Community often is extremely importantfor racial and ethnic minority groups, and itmay dramatically affect their ability torecover from disaster. For example, a racialor ethnic minority community may provideespecially strong social support functionsfor its members, particularly when it issurrounded by a hostile society. However,its smaller size may render it more fragileand more subject to dispersion anddestruction after a disaster. Members ofsome racial and ethnic minority groups,such as refugees, previously haveexperienced destruction of their socialsupport systems, and the destruction of asecond support system may be particularlydifficult (Beiser, 1990; Van der Veer, 1995).

Racism and Discrimination

Many racial and ethnic minority groups,including African Americans, AmericanIndians, and Chinese and JapaneseAmericans, have experienced racism,discrimination, or persecution for manyyears. Both legally sanctioned and moresubtle forms of discrimination and racismare an undeniable part of our Nation’shistorical fabric. Despite improvements inrecent decades, evidence exists that racialdiscrimination persists in housing rentalsand sales, hiring practices, and medical care.Racism also takes the form of demeaningcomments, hate crimes, and other violenceby institutions or individuals, eitherintentionally or unintentionally (DHHS,2001).

As a result of past or present experienceswith racism and discrimination, racial andethnic minority groups may distrust offers ofoutside assistance at any time, even followinga disaster. They may not be accustomed toreceiving support and assistance frompersons outside of their own group innondisaster circumstances. Therefore, theymay be unfamiliar with the social andcultural mechanisms of receiving assistanceand remain outside the network of aid.


Community often is

extremely important

for racial and ethnic

minority groups,

and it may

dramatically affect

their ability to

recover from

disaster.


Particularly during the “disillusionmentphase” of the disaster, when intragrouptensions are typically high, racial and ethnicminority groups can face the brunt of angerand even blame from members of the largerculture. Such psychological assaults andexperiences with racism and discriminationcan result in increased stress for individualsand groups.

Social and Economic Inequality

Poverty disproportionately affects racial andethnic minority groups. For example, in1999, 8 percent of whites, 11 percent ofAsian Americans and Pacific Islanders, 23percent of Hispanic Americans, 24 percentof African Americans, and 26 percent ofAmerican Indians and Alaska Natives livedin poverty (DHHS, 2001). Significantsocioeconomic differences also exist withinracial and ethnic minority groups. Forexample, although some subgroups of AsianAmericans have prospered, others remain atlow socioeconomic levels (O’Hare and Felt,1991).

Social and economic inequality also leads toreduced access to resources, includingemployment; financial credit; legal rights;and education, health, and mental healthservices (Blaikie et al., 1994). Poorneighborhoods also have high rates ofhomelessness, substance abuse, and crime(DHHS, 2001).

Poverty makes people more susceptible thanothers to harm from disaster and less able toaccess help (Bolin and Stanford, 1998). Low-income individuals and families typically losea much larger part of their material assetsand suffer more lasting negative effects fromdisaster than do those with higher incomes(Wisner, 1993). Often, disadvantagedpersons live in the least desirable and mosthazardous areas of a community, and theirhomes may be older and not as sound asthose in higher income areas. For example,many low-income people live in apartmentbuildings that contain unreinforced masonry,which is susceptible to damage in a disaster(Bolton et al., 1993).

Although disaster relief activities can helpameliorate some of the damage rendered bya disaster, some groups cannot readily accesssuch services. Negative perceptions derivedfrom pre-disaster experiences may serve as abarrier to seeking care. Lack of familiaritywith sources of community support or lackof transportation are common barriers formany immigrants and unwillingness todisclose their immigration status is a majorbarrier.

Middle-class disaster survivors are morelikely than lower-income people—includingthose from other cultures—to know how tocomplete forms, communicate adequately,talk to the “right” people, or otherwisemaneuver within the system. Thus, theymay be more likely to receive aid thansurvivors with fewer means or those fromdifferent cultures (Aptekar, 1990). On theother hand, affluent groups may find itdifficult to accept assistance from mentalhealth and social service agencies. They mayfear a loss of control and find it humiliatingto accept emergency assistance such asclothing, food, loans, and emotionalsupport from disaster workers.

In some instances, people of lowersocioeconomic status exhibit strong copingskills in disaster situations because theyhave seen difficult times before and havesurvived. In other instances, the loss ofwhat little one had may leave an individualfeeling completely hopeless.


Poverty makes

people more

susceptible than

others to harm from

disaster and less

able to access help.


CULTURAL COMPETENCEAND DISASTER MENTALHEALTH PLANNING

Providing culturally competent mentalhealth services to survivors requires actionbefore, during, and after a disaster. Thedisaster mental health plan, which shouldbe part of a State or community emergencymanagement plan, can help ensure anefficient, coordinated response to themental health needs of the affectedpopulation (DHHS, Rev. ed., in press).These plans specify roles, responsibilities,and relationships among agencies andorganizations in responding to acommunity’s mental health needs followinga disaster (DHHS, Rev. ed., in press).

Well-designed disaster mental health plansenhance coordination and minimize chaos,thereby helping to ensure that survivorsreceive assistance in a timely, helpful, andculturally sensitive manner should a disasteroccur. Disaster mental health plans thatidentify and address diverse needs within acommunity can save valuable time andavert many problems. In the absence ofsuch planning, disaster relief isdisorganized, especially in the immediateaftermath. Confusion and inefficiency canprevail when survivors attempt to gainaccess to services.

Successful program planners recognize thatcreating culturally competent environmentsrequires more than recruiting bilingual andbicultural mental health workers,sponsoring a single diversity managementclass, sending a few employees to a culturalcompetence workshop, or hiring a “token”racial or ethnic minority grouprepresentative. Rather, cultural competencemust be a part of the program values;included in the program’s missionstatement; and encouraged in attitudes,policies, and practices at every level.

To develop a culturally competent disastermental health plan, planners must:

• Assess and understand the community’scomposition;

• Identify culture-related needs of thecommunity;

• Be knowledgeable about formal andinformal community institutions that canhelp meet diverse mental health needs;

• Gather information from and establishworking relationships with trustedorganizations, service providers, andcultural group leaders and gatekeepers;and

• Anticipate and identify solutions tocultural problems that may arise in theevent of a disaster.

Table 1-4 presents questions that should beaddressed in the mental health plan. Forfurther information about disaster mentalhealth planning, refer to Disaster Responseand Recovery: A Strategic Guide (DHHS,Rev. ed., in press).5


Disaster mental

health plans that

identify and address

diverse needs

within a community

can save valuable

time and avert

many problems.



Community demographic characteristics

Who are the most vulnerable personsin the community? Where do theylive?

What is the range of familycomposition (i.e., single-parenthouseholds)?

How could individuals be identifiedand reached in a disaster?

Are policies and procedures in placeto collect, maintain, and reviewcurrent demographic data for anyarea that might be affected by adisaster

Mental health resources

What mental health service

providers serve the community?

What skills and services does eachprovider offer?

What gaps, including lack of culturalcompetence, might affect disasterservices?

How could the community’s mentalhealth resources be used in responseto different types of disasters?

Nongovernmental organizations’roles in disaster

What are the roles of the AmericanRed Cross, interfaith organizations,and other disaster relieforganizations?

What resources do non-governmentagencies offer, and how can localmental health services be integratedinto their efforts?

What mutual aid agreements exist? nHow can mental health providerscollaborate with private disaster reliefefforts?

TABLE 1-4

Questions to Address in a Disaster Mental Health Plan6

Cultural groups

What cultural groups (ethnic, racial,and religious) live in the community?

Where do they live, and what are theirspecial needs?

What are their values, beliefs, andprimary languages?

Who are the cultural brokers in thecommunity?

Socioeconomic factors

Does the community have any specialeconomic considerations that mightaffect people’s vulnerability todisaster?

Are there recognizable socio-economic groups with special needs?

How many live in rental property?

How many own their own homes?

Government roles and responsibilities in disaster

What are the Federal, State, and localroles in disaster response?

How do Federal, State, and localagencies relate to one another?

Who would lead the response

during different phases of a disaster?

How can mental health services beintegrated into the governmentagencies’ disaster response?

What mutual aid agreements exist?

Do any subgroups in the communityharbor any historical or politicalconcerns that affect their trust ofgovernment?

Community partnerships

What resources and supports wouldcommunity and cultural/ethnic groupsprovide during or following adisaster?

Do the groups hold pre-existingmutual aid agreements with any Stateor county agencies?

Who are the key informants/gatekeepers of the impactedcommunity?

Has a directory of cultural resourcegroups, natural helpers, andcommunity informants who haveknowledge about diverse groups beendeveloped?

Are the community partners involvedin all phases of disasterpreparedness, response, and recoveryoperations?


GUIDING PRINCIPLES AND RECOMMENDATIONS 7

This SAMHSA Guide goes on to discuss each of nine guiding principles for cultural competence in disaster mental healthprograms and suggests ways to integrate them into disaster mental health planning and crisis counseling programs.

Editor’s Note: The nine guiding principles are included here to identify them for you. For a fuller description of these principles andadditional material, please consult the full SAMHSA document as referenced at the beginning of this chapter.

The guiding principles, in many ways, overlay the Key Concepts of Disaster Mental Health (DHHS, 2000e), presented inTable 2-1. The Cultural Competence Checklist for Disaster Crisis Counseling Programs, presented in Appendix F,summarizes key content in a convenient form for use in program planning.

GUIDING PRINCIPLES FOR CULTURAL COMPETENCE IN DISASTERMENTAL HEALTH PROGRAMS

Principle 1: Recognize the importance of culture and respect diversity.

Principle 2: Maintain a current profile of the cultural composition of the community.

Principle 3: Recruit disaster workers who are representative of the community or service area.

Principle 4: Provide ongoing cultural competence training to disaster mental health staff.

Principle 5: Ensure that services are accessible, appropriate, and equitable.

Principle 6: Recognize the role of help-seeking behaviors, customs and traditions, and

natural support networks.

Principle 7: Involve as “cultural brokers” community leaders and organizations representing

diverse cultural groups.

Principle 8: Ensure that services and information are culturally and linguistically competent.

Principle 9: Assess and evaluate the program’s level of cultural competence.


This Chapter has the following Appendices:

Appendix A: Cultural Competence Resources and Tools

Appendix B: Disaster Mental Health Resources from the Center of Mental Health Services

Appendix C: Sources of Demographic and Statistical Information

Appendix D: Sources of Assistance and Information


American Psychological Association (1990).APA Guidelines for Providers of Psychological Services toEthnic, Linguistic, and Culturally Diverse Populations.Washington, DC: American Psychological Association.Offers recommendations on working with ethnic andculturally diverse populations to providers ofpsychological services.

Child Welfare League of America (1993).Cultural Competence Self-assessment Instrument.Washington, DC: Child Welfare League of America.A tool designed to help organizations providing familyservices identify, improve, and enhance culturalcompetence in staff relations and client service functions.The instrument, which has been field-tested, provides apractical, easy-to-use approach to addressing the majorissues associated with delivering culturally competentservices.

Cohen, R. (1992).Training mental health professionals to work withfamilies in diverse cultural contexts. Responding toDisaster: A Guide for Mental Health Professionals.Washington, DC: American Psychiatric Press, Inc.Explores cultural considerations for mental healthworkers and disaster survivors in the immediate andlonger-term aftermath of a disaster. Examines issues ofloss, mourning, separation, coping, and adaptation asthey relate to disaster survivors from various cultures.

Cross, T. L. (1989). Towards a Culturally Competent System of Care.Vol. I: AMonograph of Effective Services for Minority Children whoare Severely Emotionally Disturbed. Washington, DC:CASSP Technical Assistance Center, GeorgetownUniversity Child Development Center.One of the first documents to provide practicalinformation on operationalizing cultural competence.Provides definitions for competence, introduces theconcept of a cultural competence continuum, andprovides information that can be used at individual andorganizational levels.

Giger, J., and Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. St.Louis, MO: Mosby, Inc.Provides tools that can be used to evaluate cultures’perceptions and needs related to communication, space,social organization, time, environmental control, andbiological variations. Giger and Davidhizar were amongthe first to develop the concept of cultural competence in

the nursing profession. Now in its third printing, thepublication is used by a number of other disciplines.

Goode, T. D. (1999). Getting Started: Planning, Implementing and EvaluatingCulturally Competent Service Delivery Systems in PrimaryHealth Care Settings, Implications for Policy Makers andAdministrators. Washington, DC: Georgetown University,National Center for Cultural Competence.A checklist that can assist programs and organizations ininitiating strategic development of policies, structures,procedures, and practices that support cultural andlinguistic competence.

Health Resources and Services Administration (1998).Health Care Rx: Access for All.Washington, DC: HealthResources and Services Administration.A chart book that provides a picture of the health ofracial and ethnic minority Americans and the cascade offactors that limit access to health care, hamper workforcediversity, and limit culturally competent services.

Hernandez, M., and Isaacs, M. (1998). Promoting Cultural Competence in Children’s Mental HealthServices. Baltimore, MD: Paul H. Brookes Publishing. Provides an excellent framework for developing aculturally competent mental health system. Focuses onthe need to develop organizational infrastructures thatsupport and further cultural competence and the need toensure that programs are meaningful at the communityand neighborhood levels. Also addresses special issuesrelated to serving culturally diverse populations. Designedfor planners, program managers, policy makers,practitioners, parents, teachers, researchers, and otherswho are interested in improving mental health servicesfor families.

Hicks, Noboa-Rios (1998). Cultural Competence in Mental Health: A Study of NineMental Health Programs in Ohio. Columbus, OH:Outcomes Management Group, Ltd. Provides an assessment of nine culturally competentprograms that were funded to encourage the provision ofcultural sensitivity training to the mental healthcommunity and to develop nontraditional, culturallysensitive methods of delivering services to persons ofcolor. Prepared for the Multi-Ethnic BehavioralConsortium of the Ohio Department of Mental Health.


Appendix A: Cultural Competence Resources and Tools DHHS Pub. No. SMA 3828, pp.46-47.


Appendix A: Cultural Competence Resources and Tools DHHS Pub. No. SMA 3828, pp.46-47.

Nader, K., Dubrow, N., and Stamm, H. (1999).Honoring Differences: Cultural Issues in the Treatment ofTrauma and Loss. Ann Arbor, MI: Brunner/Mazel.Discusses the treatment of trauma and loss whilerecognizing the importance of understanding the culturalcontext in which the mental health professional providesassistance.

Perkins, J., Simon, H., Cheng, F., et al. (1998). Ensuring Linguistic Access in Health Care Settings: LegalRights and Responsibilities. Los Angeles, CA: NationalHealth Law Program. An informative discussion on linguistic issues that canimpede effective service delivery. Covers the importanceof language access, use of community volunteers,limitations of interpretation, linguistic barriers in mentalhealth, and effective use of written materials.

Substance Abuse and Mental Health ServicesAdministration (2000). Cultural Competence Standards in Managed Mental HealthCare for Underserved/Under-represented Racial/EthnicGroups Washington, DC: Western Interstate Commissionfor Higher Education and Center for Mental HealthServices, Substance Abuse and Mental Health Services Administration, U.S. Department ofHealth and Human Services.Provides information on cultural competence guidelines,performance indicators, and potential outcomes in theareas of triage and assessment, care planning, treatmentplans, treatment services, communication styles, andcross-cultural linguistic and communication support.

Substance Abuse and Mental Health ServicesAdministration (2000). Cultural strengths and challenges in implementing asystem of care model in American Indian communities.Systems of Care: Promising Practices in Children’s MentalHealth (2000 Series, Vol. 1). Washington, DC: Centerfor Effective Collaboration and Practice, AmericanInstitutes for Research.Examines promising practices of five American Indianchildren’s mental health projects that integrate traditionalAmerican Indian helping and healing methods with thesystems of care model.

U.S. Department of Health and Human Services (1992-1999). Cultural Competence Series. Monograph series sponsoredby Bureau of Primary Health Care, Health Resources andServices Administration; Center for Substance AbusePrevention, Substance Abuse and Mental Health Services

Administration; and Office ofMinority Health.

Van der Veer, G. (1995). Psychotherapeutic Work with Refugees. New York: Plenum Press.Suggests that the trauma that a refugee experiences in adisaster may not be an isolated incident, but part of aseries of ongoing traumatic events. Stresses thatovercoming cultural difference is essential in workingwith traumatized refugees and that such work requirescreatively adjusting a variety of existing techniques.



Appendix B: Disaster Mental Health Resources from the Center for Mental Health Services(CMHS), DHHS Pub. No. SMA 3828, p. 48.


PUBLICATIONS

ADM 86-1070R Psychosocial Issues for Children andAdolescents in Disasters

ADM 90-538 Training Manual for Mental Health andHuman Service Workers in Major Disasters, Second Edition

SMA 94-3010R Disaster Mental Health Response andRecovery: A Strategic Guide (May not be available; revisededition in press)

SMA 95-3022 Psychosocial Issues for Children andFamilies: A Guide for the Primary Care Physician

SMA 96-3077 Responding to the Needs of People withSerious and Persistent Mental Illness in Times of MajorDisaster

SMA 99-3323 Psychosocial Issues for Older Adults inDisasters

SMA 99-3378 Crisis Counseling Programsfor the Rural Community

VIDEOS

ESDRB-2 Children and Trauma:The School’s Response

OM 00-4070 Voices of Wisdom:Seniors Cope with Disaster

OM 00-4070S Voices of Wisdom:Seniors Cope with Disaster(Spanish Version)

OM 00-4071 Hurricane Andrew:The Fellowship House Experience

GENERAL MATERIALS

CMHS Program Guidance Series

The following publications and videos on disaster response and recovery planning for special populations were developed by theEmergency Mental Health and Traumatic Stress Services Branch of CMHS. To download these documents or order copies,please visit the Substance Abuse and Mental Health Services Administration (SAMHSA) Web site at www.samhsa.gov



Appendix C: Sources of Demographic and Statistical Information DHHS Pub. No. SMA 3828, p. 49.

The following World Wide Web resources offer demographic and statistical information useful for developing disaster mentalhealth community profiles:

STATISTICS ABOUT IMMIGRATION PATTERNS

Immigration and Naturalization Service,U.S. Department of Justice:http://uscis.gov/graphics/shared/aboutus/statistics/index.htm

NATIONAL, STATE, AND COUNTY STATISTICS AND DEMOGRAPHICDATA BY AGE, RACIAL, ETHNIC, AND LINGUISTIC SUBGROUPS

U.S. Bureau of the Census:www.census.gov/population/www/index.html

UNEMPLOYMENT INFORMATION BY GENDER, RACE, AND AGE

Bureau of Labor Statistics:http://stats.bls.gov/

DEMOGRAPHIC INFORMATION BY ZIP CODE

PeopleSpot:http://peoplespot.com/statistics/demographics.htm

GENERAL INFORMATION

Government Information Sharing Project,Oregon State University:http://govinfo.kerr.orst.edu/index.html

National Center for Health Statistics,Centers for Disease Control and Prevention:www.cdc.gov/nchs/

Federal Healthfinder ®:www.healthfinder.gov/


www.healthfinder.gov/

www.cdc.gov/nchs

http://govinfo.kerr.orst.edu/index.html

http://peoplespot.com/statistics/demographics.htm

http://stats.bls.gov/

www.census.gov/population/www/index.html

http://uscis.gov/graphics/shared/aboutus/statistics/index.htm


Appendix D: Sources of Assistance and Information DHHS Pub. No. SMA 3828, pp. 50-53.

FEDERAL GOVERNMENT ORGANIZATIONS ANDRESOURCES

Federal Emergency Management Agency (FEMA)FEMA coordinates with other State and Federal agenciesto respond to presidentially declared disasters. It providesdisaster assis-tance for individuals, businesses (throughthe Small Business Administration), and communities(through the Robert T. Stafford Disaster Relief andEmergency Assistance Act).

Federal Emergency Management AgencyHuman Services Division500 C Street, SWWashington, DC 20472Phone: 202.566.1600www.fema.gov

Center for Mental Health Services (CMHS),Substance Abuse and Mental Health ServicesAdministration (SAMHSA)Through an interagency agreement with FEMA, CMHSprovides consultation and technical assistance for theCrisis Counse-ling Assistance and Training Program.Publications and videotapes on disaster human responseare available through SAMHSA’s National Mental HealthInformation Center.

Center for Mental Health Services Emergency MentalHealth and Traumatic Stress Services Branch5600 Fishers Lane, Room 17C-20Rockville, MD 20857Phone: 301.443.4735Fax: 301.443.8040www.samhsa.gov

SAMHSA’s National Mental Health Information Center P.O. Box 42557Washington, DC 20015Phone: 1.800.789.2647Fax: 301.984.8796TDD: 1.866.889.2647www.mentalhealth.samhsa.gov/

Federal Communications Commission (FCC)445 12th Street, SWWashington, DC 20554Phone: 202.418.1771 or 1.888.225.5322TTY: 202.418.2520 or 1.888.835.5322Fax: 202.418.0710 or 1.866.418.0232www.fcc.gov

Health Resources and Services Administration(HRSA)Office of Minority Health5600 Fishers LaneRoom 14-48Rockville, MD 20857Phone: 301.443.3376 or 1.888.275.4772www.hrsa.gov

Indian Health Service (IHS)Office of Public HealthThe Reyes Building801 Thompson AvenueSuite 400Rockville, MD 20852-1627Phone: 301.443.3024www.ihs.gov

National Institute on Deafness andOther Communication Disorders (NIDCD)31 Center DriveMSC 2320Bethesda, MD 20892Phone: 301.496.7243www.nidcd.nih.gov

NIDCD Information Clearinghouse1 Communication AvenueBethesda, MD 20892Phone: 1.800.241.1044TTY: 1.800.241.1055www.nidcd.nih.gov

Office for Civil RightsU.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509FHubert H. Humphrey BuildingWashington, DC 20201Phone: 202.619.0257 or 1.877.696.6775www.hhs.gov/ocr

Office of Public Health and ScienceU.S. Office of Minority Health Resource CenterU.S. Department of Health and Human ServicesP.O. Box 37337Washington, DC 20013-7337Phone: 301.443.5084 or 1.800.444.6472Fax: 301.251.2160www.omhrc.gov


www.omhrc.gov

www.hhs.gov/ocr

www.nidcd.nih.gov

www.nidcd.nih.gov

www.ihs.gov

www.hrsa.gov

www.fcc.gov

www.mentalhealth.samhsa.gov/

www.samhsa.gov

www.fema.gov


Rural Information Center Health ServiceNational Agricultural Library10301 Baltimore AvenueRoom 304Beltsville, MD 20705-2351Phone: 301.504.5547 or 1.800.633.7701Fax: 301.504.5181TDD/TTY: 301.504.6856www.nal.usda.gov/ric

NATIONAL ORGANIZATIONS

American Red Cross (ARC)ARC has chapters in most large cities and a State chapterin each capital city. Every local Red Cross chapter ischarged with readiness and response responsibilities incollaboration with its disaster partners. Disaster servicesinclude preparedness training, community education,mitigation, and response. ARC chapters help familieswith immediate basic needs (food, clothing, and shelter)and provide supportive services and longer-terminterventions. Contact the local chapter for assistance orthe chapter in your State capital.

American Red Cross National Headquarters2025 E Street, NWWashington, DC 20006Phone: 202.737.8300 General InformationPhone: 202.303.4498 Public InquiryPhone: 703.206.7460 Disaster Serviceswww.redcross.org

PROFESSIONAL PRIVATE SECTOR ORGANIZATIONS ANDRESOURCES

African American Mental Health Research CenterInstitute for Social ResearchUniversity of Michigan426 Thompson, Room 5118Ann Arbor, MI 48106Phone: 734.763.0045Fax: 734.763.0044http://rcgd.isr.umich.edu/prba

American Psychological Association750 First Street, NEWashington, DC 20002-4242Phone: 202.336.5510 or 1.800.374.2721TDD/TTY: 202.336.6123www.apa.org

Cross Cultural Health Care Program270 S. Hanford StreetSuite 100Seattle, WA 98134Phone: 206.860.0329Fax: 206.860.0334www.xculture.org

National Alliance for Hispanic Health1501 16th Street, NWWashington, DC 20036Phone: 202.387.5000www.hispanichealth.org

National Asian American and Pacific Islander MentalHealth Association1215 19th StreetSuite ADenver, CO 80202Phone: 303.298.7910Fax: 303.298.8180www.naapimha.org

National Association for Rural Mental Health3700 W. Division StreetSuite 105St. Cloud, MN 56301Phone: 320.202.1820Fax: 320.202.1833www.narmh.org

National Association of Social Workers750 First Street, NESuite 700Washington, DC 20002-4241Phone: 202.408.8600 or 1.800.638.8799www.naswdc.org



www.naswdc.org

www.narmh.org

www.naapimha.org

www.hispanichealth.org

www.xculture.org

www.apa.org

http://rcgd.isr.umich.edu/prba

www.redcross.org

www.nal.usda.gov/ric


National Center for American Indian and AlaskaNative Mental Health ResearchUniversity of Colorado Health Sciences CenterDepartment of Psychiatry, North Pavilion4455 E. 12th AvenueCampus Box A011-13Denver, CO 80220Phone: 303.724.1414Fax: 303.724.1474www.uchsc.edu/sm/ncaianmhr

National Center for Cultural CompetenceGeorgetown University Center forChild and Human Development3307 M Street, NWSuite 401Washington, DC 20007-3935Phone: 202.687.8635 or 1.800.788.2066Fax: 202.687.8899TTY: 202.687.5503http://gucchd.georgetown.edu

National Indian Health Board101 Constitution Avenue, NWSuite 8-B09Washington, DC 20001Phone: 202.742.4262Fax: 202.742.4285www.nihb.org

National MultiCultural Institute3000 Connecticut Avenue, NWSuite 438Washington, DC 20008-2556Phone: 202.483.0700Fax: 202.483.5233www.nmci.org

National Rural Health AssociationOne West Armour BoulevardSuite 203Kansas City, MO 64111-2087Phone: 816.756.3140www.nrharural.org

STATE AND LOCAL GOVERNMENT AGENCIES

Departments of Mental HealthContact the State agency responsible for mental healthservices. A State disaster mental health coordinator maybe designated to manage the Crisis Counseling Program.The main office will be located in your State’s capitalcity.

Emergency ServicesThe emergency services agency is the lead agencydelegated by the State’s governor to carry out day-to-dayemergency management responsibilities. Contact theOffice of Emergency Services in your capital city.

UNIVERSITY AND MEDICAL UNIVERSITIES

Academic practitioners with general training in stress,coping, and counseling often express interest in offeringassistance to communities that have experienced adisaster. Undergraduate and graduate students are usuallyvery interested in serving as crisis counselors. Caution isadvised to ensure that survivors are treated appropriatelyand not enlisted into research studies or given treatmentsdesigned for traditional psychiatric disorders. Contactyour local university’s departments of psychiatry,psychology, or social work.

RELIGIOUS ORGANIZATIONS

Churches, synagogues, other faith-basedorganizations, and interfaith organizations are valuableresources for identifying and serving disaster survivors.Often, they are the most productive and rapid respondersfor immediate basic needs. Most denominations havesome kind of disaster relief program. Contact the districtoffice for major denominations in your area.

MEDIA

Television, radio, and newspapers can provide a list ofresources and supports in major disasters.



www.nrharural.org

www.nmci.org

www.nihb.org

http://gucchd.georgetown.edu

www.uchsc.edu/sm/ncaianmhr


VOLUNTARY ORGANIZATIONS

The National Voluntary Organizations Active inDisasters (NVOAD) has made disaster response apriority. Member organizations provide effective servicesand avoid service duplication by coordinating responseefforts. Member organizations include:Adventist Community Services (ACS)American Red Cross (ARC)American Relay League, Inc. (ARL)AMURT (Ananda Marga Universal Relief Team)Catholic Charities USA (CC)Christian Disaster Response, AECCGCChristian Reformed World Relief CommitteeCRWRC)Church of the Brethren (CB)Church World Service (CWS)The Episcopal Church (EC)Friends Disaster Service (FDS)Inter-Lutheran Disaster Response (ILDR)Mennonite Disaster Service (MDS)Nazarene Disaster Response (NDR)The Phoenix Society (PS)The Points of Light Foundation (PLF)Presbyterian Church, USA (PC)REACT International, Inc. (REACT)The Salvation Army (SA)Second Harvest National Network of Food Banks(SHNNFB)Society of St. Vincent de Paul (SSVP)Southern Baptist Convention (SBC)United Methodist Church Committee of Relief(UMCOR)Volunteers of America (VOA)World Vision (WV)

ADDITIONAL RESOURCES

Building Cultural Competence:A Blueprint for ActionWashington State Department of HealthMaternal and Child Health Communityand Family HealthNew Market Industrial Campus, Building #7P.O. Box 47880Olympia, WA 98504-7880Phone: 360.236.3504 or 206.389.3052Fax: 360.586.7868

The Diversity JournalHarvard Pilgrim Health CareOffice of DiversityBrookline, MA 02146-7229Phone: 617.730.7710Fax: 617.730.4695

A Practical Guide for the Assessment of CulturalCompetence in Children’s Mental HealthOrganizationsThe Technical Assistance Center for theEvaluation of Children’s Mental Health System Judge Baker Children’s Center295 Longwood AvenueBoston, MA 02115Phone: 617.232.8390Fax: 617.232.4125


1 U.S. Department of Health and Human Services. Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles andRecommendations. DHHS Pub. No. SMA 3828. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health ServicesAdministration, 2003.

2DHHS Pub. No. SMA 3828. Rockville, MD, pp. 1-2.

3Ibid, p4-5.

4Ibid., p. 25.

5Ibid., pp. 8-20.

6Ibid., p. 21.

7 Ibid., p. 22.


Documents

Developing Cultural Competence in Disater Mental Health ... · PDF fileand Human Services Guide, ... Developing Cultural Competence in 5 ... Giger and Davidhizar’s “transcultural