Cultural Competence Standards in Managed Care Mental Health Services for Asian and Pacific Islander Americans

Knowledge and Understanding, Skills, and Attitudes



The following areas of knowledge and understanding, skills, and attitudes shall be essential components of core continuing education to ensure APIA cultural competence among clinical staff, and promote effective response to the mental health needs of APIA consumers.

Knowledge and Understanding of:

Consumer Populations’ Background

  1. Factors which define cultural differences between and among different APIA populations, including differences related to history, traditions, values, belief systems, acculturation and migration patterns, reasons for immigration/migration, and dialect and language fluency.
  2. Particular psychosocial stressors and traumas relevant for APIA consumers. These include war, trauma, migration, unique aspects of cultural survival and maintenance, socioeconomic status, political unrest, racism, discrimination, and violence related to racism and discrimination.
  3. APIA consumers as members of broadly defined family networks, and informal social networks within their community.
  4. How class, social status, and racism influence behavior, attitudes, values, belief systems, and mental health of APIA consumers.


Clinical Issues

  1. Differences in symptom expression, symptom language, and symptomatic patterns of APIA consumers with mental illness/emotional disturbance.
  2. Culture-bound syndromes associated with APIA populations and subcultures.
  3. Differences in thresholds of symptomotology and psychiatric distress in APIA consumers.
  4. The role of verbal and nonverbal language, speech patterns, and communication styles among APIA consumers and the expression of symptomotology and psychiatric distress.
  5. Dynamics of language use and conceptual frameworks among monolingual and bilingual APIA consumers and how these affect the expression of symptomotology and psychiatric distress among APIA consumers.
  6. Differences in the attribution of mental illness (religious, supernatural, etc.) and issues of stigma specific to the different APIA cultures.
  7. Differences between "culturally acceptable" behavior and or psychopathology of the different APIA populations.
  8. Help seeking behaviors of APIA individuals.
  9. Role and manifestation of spiritual, tradition, values, and practice beliefs, and their integration into treatment for APIA consumers.
  10. APIA consumers within a family life cycle and intergenerational conceptual framework in addition to individual identity development framework.
  11. The different effects of acculturation process and ethnic/racial identity on APIA individuals.
  12. The different effects of commonly used medications on APIA individuals.
  13. Assessment tools, and their uses and limitations for the different APIA subgroups.
  14. The impact of psychosocial stressors vs. intrapsychic dynamics in APIA consumers.

How to Provide Appropriate Treatment

  1. Differences in the acceptability and effectiveness of different treatment modalities for APIA individuals.
  2. Use of trained skilled and qualified language and culturally informed interpreters for monolingual APIA consumers.
  3. Use of APIA culturally informed individuals, including family members when appropriate, by clinicians serving APIA consumers.
  4. Public administrative issues in developing, implementing and evaluating programs for APIA consumers.
  5. Use natural community supports and other community resources for APIA consumers.
  6. Indigenous healing practices and the role of belief systems (religion and spirituality) in the treatment of APIA consumers.

Agency/Provider Role

  1. How one’s own culture and prejudices may bias assessment, care planning and treatment planning, as well as influence the therapeutic alliance in the delivery of services to APIA consumers and other families.
  2. The role and types of power relationships within the community, agency, or institution and their impact on APIA consumers.
  3. Ways that mainstream professional values may conflict with, or be responsible to, the needs of APIA consumers.
  4. Effects of institutional racism and historical barriers on social service policies for APIA individuals, and knowledge of how to reduce barriers through utilization of and participation in systems change efforts.
  5. How resources (agencies, persons, informal helping networks, research) shall be utilized on behalf of APIA consumers and their communities.
Skills to:

Provide Appropriate Treatment

Skills to Communicate Effectively Across Cultures

  1. Communicate and listen effectively across cultures and across all levels of care. Communicate accurate information on behalf of APIA and their communities.
  2. Engage and establish rapport with APIA consumers and their families using socially/culturally appropriate conventions.

Skills to Communicate Effectively Across Cultures

  1. Conduct APIA culturally competent intake assessments which take into account the psychological, social, biological, physiological, cultural, political, spiritual, and environmental aspects of the APIA consumer’s experience.
  2. Assess APIA consumers with an understanding of cultural differences in symptom expression, thresholds of psychiatric distress, and culture-bound syndromes.
  3. Appropriately refer for assessment and use assessment tools, recognizing the limitations of psychological tests and testing procedures when used with APIA consumers.
  4. Appropriately interpret testing results of APIA consumers.

Skills to Formulate and Implement Quality Care and Treatment Plans

  1. Formulate culturally competent service plans (case management and treatment) that are appropriate for the APIA consumers client and the family’s concepts of mental illness.
  2. Create and implement multidimensional service plans (case management and treatment) for APIA consumers including culture, family, and community.
  3. Utilize APIA culturally appropriate community resources (i.e. family, clans, societies, church, community members and other groups).
  4. Provide psychopharmacological interventions, with an understanding of different biological/physiological responses to medications.

Skills to Conduct Quality Research

  1. Implement culturally appropriate research design and methodology, and interpret research findings taking into account cultural and social issues relevant to APIAs.
  2. Conduct ethical research and research with integrity.

Skills to Communicate Effectively Across Cultures

  1. Provide efficacious treatment to APIA consumers.
  2. Provide psychoeducational interventions which promote APIA consumer and family voice and ownership in shaping the service delivery system.
  3. Work effectively with families of APIA consumers.
  4. Empower and advocate for APIA consumers, families, and communities.

Skills to Use Consumer’s Preferred Language in Treatment

  1. Use APIA consumer’s preferred language/dialect to elicit the range and nuances of emotions, feelings, dynamics, etc..
  2. Understand and interpret a broad series of culturally specific verbal and non-verbal responses by APIA consumers and their families.
  3. Refer to providers who shall use APIA consumer’s preferred language/dialect.

Skills to Appropriately Address Race/Ethnicity Issues in Treatment

  1. Know when and how to use trained interpreters, recognizing the limitations of using interpreters in the treatment of APIAs.
  2. Appropriately address racial/ethnic issues in the treatment of APIA consumers when indicated.

Use One’s Self and Knowledge in the Treatment Process.

  1. Recognize one’s own limitations and know when and where to refer APIA consumers.
  2. Evaluate applications of new techniques, exemplary practices, research, and knowledge as to their validity and applicability in working with APIA populations.
  1. Demonstrate attitudes that indicate a respect for the APIA consumer’s immigration, migration, colonization, and acculturation experiences.
  2. Demonstrate attitudes that indicate a respect for diverse heritages, cultures, and experiences of APIA consumers.
  3. Demonstrate attitudes that indicate a willingness to work with culturally, ethnically, and racially diverse populations, including APIAs.
  4. Demonstrate an understanding and respect for how one’s self as provider/therapist (especially one’s cultural/ethnic/racial/gender match to the APIA consumer) may influence the therapeutic relationship. Recognize the need to process this dynamic, and in some cases refer the APIA consumer for his/her benefit.


Recommended Performance Indicators

  1. Ongoing program planning and implementation of behavioral health services which meet the needs of APIA consumers and their communities.
  2. Human Resource Development Plan inclusive of recruitment, retention and development of staff at all levels to enhance and ensure quality culturally competent services to APIA consumers and their communities.

Recommended Outcomes

  1. Provider shall demonstrate ongoing assessment of behavioral health needs of APIA consumers and their communities.
    Benchmark: Documented annual assessment and service planning process
  2. Provider services and programs that reflect the needs of APIA consumers and their communities.
    Benchmark: Implementation of services and programs which are commensurate with the (changing) needs of the APIA consumer and community using consumer and community assessment data.
  3. Human Resource Development Plan to enhance culturally competent mental health services for APIAs is established and implemented.
    Benchmark: Documented participation of all provider staff in annual training sessions.