Problems in professional and ethical standards and guidelines regarding culturally competent practice with racial, ethnic, linguistic, and culturally diverse groups

Abstract

Historically, disadvantaged racial and ethnic groups (Institute of Medicine, Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington, DC, 2002) and sexual minorities (Avery et al, Am J Public Health 91(6):990, 2001) have been problematically served by mental health interventions. This problem is even more complex because an additional aspect is that there are often more barriers for members of minority groups for accessing behavioral health services (Benuto and O’Donohue, Enhancing behavioral health in Latino populations. Springer International Publishing, Cham, 2016). To adapt mental health services to better serve individuals from minority groups, there has been a movement to incorporate cultural considerations into professional guidelines and ethical standards in a variety of disciplines within the fields of behavioral health (e.g., Griner and Smith Psychother Theory Res Pract Train, 43(4):531-548, 2006; Betancourt et al, Public Health Rep, 2016). However, despite these efforts over a number of years, the wide variety of standards and guidelines developed related to these activities have both strengths and also limitations and flaws, including unclear function and scope, conflict with other important values, a lack of empirical evidence related to the extent to which these documents actually have any effect in producing desired competence outcomes, inconsistent restrictions on professionals to judge and thus target potentially maladaptive behaviors and values in minority cultures, a problematic assumption of homogeneity within each minority culture, and the assumption that an understanding of universal values will not suffice to improve these services. This chapter will examine each of these issues with respect to some of the major documents in the behavioral health field, provide specific examples of how these problems exist within current documents and standards, as well as provide suggestions for future development of more sound standards.