Training for Cultural Competence

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Training for Cultural CompetenceCharmaine C. Williams PhD aa the University of Toronto, Faculty of Social Work, Toronto, CanadaPublished online: 03 Oct 2008.

To cite this article: Charmaine C. Williams PhD (2005): Training for Cultural Competence, Journal of Ethnic And CulturalDiversity in Social Work, 14:1-2, 111-143

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Training for Cultural Competence:Individual and Group Processes

Charmaine C. Williams

ABSTRACT. This paper reviews the experience of evaluating a culturalcompetence workshop series for social workers practicing in a mentalhealth care setting. The study used a pretest-posttest nonequivalent com-parison group design, and evaluation was based on both quantitative andqualitative data collections. Between subjects analyses suggested thatthere were no differences between the intervention and comparisongroup after the intervention was completed, but within-subjects analysesrevealed that the intervention group had made superior gains in theirscores on the Awareness subscale of the Multicultural Counseling In-ventory. Qualitative data contributed additional information about im-portant individual and group processes that affected the experience oftraining and contributed to self-reported outcomes from training. Thestudy suggests that evaluating process and outcomes of training at boththe individual and group levels may be particularly important to under-standing how cultural competence develops for social work practitionersin interdisciplinary settings.

Charmaine C. Williams, PhD, is Assistant Professor in the University of TorontoFaculty of Social Work, Toronto, Canada (Email: [email protected]).

Address correspondence to: Charmaine C. Williams, University of Toronto, 246Bloor Street West, Room 432, Toronto, Ontario, Canada M5S 1A1.

The author gratefully acknowledges the support and encouragement that shereceived from Drs. A. K. Tat Tsang, Marilyn Laiken, Marion Bogo and Usha Georgeof the University of Toronto during the process of this research. She is also gratefulto the Akwatu Khenti and the social workers who participated in this project for theirsupport.

Journal of Ethnic & Cultural Diversity in Social Work, Vol. 14(1/2) 2005Available online at http://www.haworthpress.com/web/ECDSW

2005 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J051v14n01_06 111

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[Article copies available for a fee from The Haworth Document Delivery Ser-vice: 1-800-HAWORTH. E-mail address: <[email protected]>Website: <http://www.HaworthPress.com> © 2005 by The Haworth Press, Inc.All rights reserved.]

KEYWORDS. Cultural competence, workshops, mental health care,interdisciplinary settings, racial and ethnic diversity

INTRODUCTION

Clients that are categorized as racial and/or ethnic minorities facesignificant challenges in their attempts to seek and make use of mentalhealth care. A substantial research literature documents that racial andethnic minority people have difficulty accessing services, and oftenencounter services and service providers that are culturally insensitive,disrespectful, and discriminatory (Beiser, Gill, & Edwards, 1993; Bhuiet al., 2003; Boerstler & de Figueiredo, 2003; Williams, 2002). NorthAmerican professional bodies associated with mental health care haveattempted to address these problems by defining expectations for pro-fessional cultural competence. The emphasis on competence, ratherthan cultural sensitivity or cultural awareness, communicates the expec-tation that developing this capacity will enable practitioners to functionmore effectively and adequately for racial and ethnic minority clients(NASW National Committee on Racial and Ethnic Diversity, 2001) Al-though there is some ambivalence attached to designating competenciesfor multicultural practice (Dean, 2001), the efforts to define culturalcompetence have helped to establish standards by which accessibility ofservices for racial and ethnic minorities can be evaluated (Bonder, Mar-tin, & Miracle, 2001; Galambos, 2003). These standards are the founda-tion for an increasing number of cultural competence training programsfor social workers and other mental health professionals (Garcia & VanSoest, 2000; Ridley, Espelage, & Rubinstein, 1997; Ronnau, 1994).Yet, we still have relatively little empirical literature to guide us in un-derstanding how best to train for cultural competence, or how to bestevaluate the outcomes of educational interventions (Boyle & Springer,2001; Ridley, Mendoza, & Kanitz, 1994; Tsang & Bogo, 1997).

This paper reviews the experience of evaluating a cultural compe-tence workshop series for practicing social workers. The study wasdesigned to explore how training outcomes could be evaluated mean-ingfully in an interdisciplinary practice context. The existing empirical

112 JOURNAL OF ETHNIC & CULTURAL DIVERSITY IN SOCIAL WORK

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literature that informs cultural competence training has gaps that limitits applicability to social workers in such environments. These gapsneed to be addressed if mental health care services are to become moreaccessible to increasingly diverse populations.

LITERATURE REVIEW

Evaluating Outcomes in Cultural Competence Training

A significant portion of the literature on cultural competence trainingbases evaluation on post-training reactive measures that evaluate learn-ers’ perceptions of learning and their satisfaction with the experience,but provide little or no information that can confirm learning has takenplace. Therefore, the evidence base for cultural competence training isrelatively small. Researchers, primarily in the counseling psychologyfield, have attempted to develop more sophisticated ways of measuringoutcomes through the development of reliable measures of what theyterm “multicultural competence” (D’Andrea, Daniels, & Heck, 1991;LaFromboise, Coleman, & Hernandez, 1991; Ponteretto et al., 1996;Sodowsky, Taffe, Gutkin, & Wise, 1994). In this research literature,training programs have been evaluated using single group pretest-posttest designs (Byington, Fischer, Walker, & Freedman, 1997; DiazLazaro & Cohen, 2001; Sodowsky, 1996), comparison group designs(Barnes, 1998; M. D’Andrea, Daniels, & Heck, 1991; Edwards, 1997;Gompertz, 1997), and experimental designs (Barise, 2000; Smith, 1998).For the most part, investigations have reported positive effects fromtraining and, in the studies using comparison group and experimentaldesigns, researchers attribute positive change in learning groups to thedelivered educational interventions. Group-based training strategies,for example, case discussions and interviewing exercises, are mostcommonly named as contributing to more positive effects than are seenwith either no training, general counseling training, or more dyadiclearning strategies (Barise, 2000; Michael D’Andrea & Daniels, 1997;Ridley et al., 1994; Sodowsky, Kuo-Jackson, & Loya, 1997). Yet, thesestudies have usually investigated outcomes from interventions designedby the same people who designed the outcomes scales; therefore, thepositive findings may partially reflect substantial overlap betweencourse content and scale content. In addition, most of this research hasbeen conducted in university settings with college students. The length

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of the interventions and the level of practice experience in the learninggroups for these studies were all very specific to a university setting,and, therefore, findings from the studies cannot be generalized toprofessional learner groups.

The literature on cultural competence training for health professionalshas generated some evidence applicable to practicing professionals inhealth care settings and is also relevant, because the interventions stud-ied are usually conducted in workshop format, a common format forcontinuing professional education. Unfortunately, recent reviews of thisliterature reveal problems similar to those identified in the counselingpsychology literature. There are few studies with sufficient method-ological rigor to support conclusions about effectiveness of training andstudies that are designed appropriately tend to use outcome measuresthat focus on immediate improved performance on standardized mea-sures of cultural competence, rather than evaluation of any practicecompetence (Beach et al., 2005; Price et al., 2005). Although the avail-able research suggests cultural competence training with an emphasison case discussion and interviewing skills is effective in improvingknowledge, attitudes, and skills of health professionals, there is verylittle it reveals about how those improvements may be translating intoimproved practice.

The bulk of the literature in both fields evaluates group outcomesfrom training, as is conventional in experimental or quasi-experimentaldesigns, that seek to demonstrate that a group receiving an interventionwill show effects of the intervention after it is completed. However, thismodel presents some problems for the evaluation of cultural compe-tence as it has been understood in social work, and it is particularlyproblematic for evaluating training outcomes for practicing socialworkers. Social work has placed less emphasis on static measurementof cultural competence and more emphasis on facilitating progressalong continua of cultural competence (Cross, Bazron, Dennis, & Isaacs,1989; Fong, 2001; Lum, 2003; Manoleas, 1994). The measurement ofcultural competence presumes that competence can be defined in astandardized manner, and deficiencies in competence can be reliablyexposed through scores on a standardized instrument. However, thedescription of continua of cultural competence assumes that individualsstart at different places in their development of competence and arrive atdifferent places on the continuum after exposure to an educational expe-rience. This assumption is supported by literature demonstrating thatindividual scores on self-report cultural competence scales are associ-ated with individual attributes and experiences, for example, minority


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racial/ethnic identity (Ladany, Inman, Constantine, & Hofheinz, 1997;Ottavi, Pope-Davis, & Dings, 1994), immigrant status (Shergill, 1998),experience with culturally different clients (Holcomb-McCoy & Myers,1999; Pope-Davis, Reynolds, Dings, & Nielson, 1995), previous train-ing in multicultural practice (Constantine, Juby, & Liang, 2001; Ottaviet al., 1994; Pope-Davis & Nielson, 1996), and number of years ofprofessional practice (Carlson, Brack, Laygo, Cohen, & Kirkscey,1998). These investigations have provided cross-sectional data linkingindividual attributes to measured cultural competence and, therefore, donot reveal the relevance of individual attributes to the development ofcultural competence. Yet, the association of individual attributes withlevels of cultural competence raises an important issue. It is possiblethat an individual’s constellation of traits and experiences may havesuch an important influence on the development of cultural competencethat it is inappropriate to obscure the effects of individual attributes byanalyzing group progress alone. This is especially true with regard totraining for practicing social workers in interdisciplinary health caresettings. Within any group that participates in training, individualscome from a variety of environments where they function in differentroles and their work is integrated with different configurations of healthprofessionals (Dixon, 1978). Therefore, knowledge of group outcomesdoes not tell us enough about how cultural competence is penetratingclinical care; it is likely that, in interdisciplinary settings, social workersmust apply what they have learned without the support of other socialworkers.

The body of literature that is available to explore processes andoutcomes of cultural competence training for social work professionalsis limited methodologically and often not applicable to the experienceof practicing social workers; however, it does provide some tools forattempting to explore these issues as they apply to social workers in thefield. The pilot study described in this paper built on that literature toexplore methods for evaluating cultural competence training for prac-ticing social workers in interdisciplinary settings. The study evaluatedthe outcome of a workshop-based intervention delivered in a mentalhealth care setting, as continuing education workshops are commonmodes for professional development of practicing social workers. Thestudy was designed so that both individual and group processes couldbe explored by combining qualitative and quantitative data collectionsand within and between subjects data analyses.


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DESCRIPTION OF THE EDUCATIONAL INTERVENTION

The educational intervention focused on developing skills that wouldbe relevant to interactions with clients (assessment and intervention plan-ning) and interactions with colleagues (supervision and organizationaldevelopment). Objectives and instructional strategies were further refinedusing needs assessment data; the curriculum is presented in Figure 1.The intervention was designed to be delivered in four 3-hour sessions overfour weeks. This method of delivery was chosen to enhance the devel-opment of competence by reinforcing information at intervals (El-Guebaly,Toews, Lockyer, Armstrong, & Hodgins, 2000). Course content focusedon working with multicultural concepts including: definitions of culture,race, ethnicity; acculturation theory; understandings of the influence ofworldviews; racial/ethnic identity development; intersectionality; cul-tural transference and countertransference; power and privilege in thehelping relationship; and the cultural context of various health beliefs.The intervention used an “idiographic” approach (Ridley et al., 1994);training learners to use approaches and constructs that could be trans-ferred across ethnocultural groups. There was emphasis on making useof adult education principles and evidence-based clinical training prac-tices, for example: building on existing knowledge (Queeney, 2000);peer-supported learning (Sandelands, 1998); activity-based learning(Cummings, 1992); reinforcement of newly presented information (Ford,Smith, Weissbein, Gully, & Salas, 1998); and linking training to job re-quirements (Berman, 1994; Corrigan & McCracken, 1998). The instruc-tor also supported learning by responding to participant requests forspecific information, bringing in additional resources and designingcase studies to address participant-identified learning needs. Resourcesfor each session were provided in booklets that included summaries ofinformation, case studies, and suggested sources for locating additionalinformation.

Participants in the comparison group had access to “standard diversityactivities.” The organization was in the process of initiatives to increasesensitivity to diversity. Standard activities included clinical seminars, ex-posure to print and poster materials, diversity training, and participationin service development activities relevant to diversity. Participation in allof these activities was voluntary with the exception of mandatory orienta-tion sessions for new employees. The standard diversity programmingwas directed at increasing sensitivity to all types of diversity. In contrast,the educational intervention focused on developing clinical skills foraddressing racial/ethnic diversity and diversity within those categories.


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METHODS

Sample

All social workers employed at a mental health care service pro-vider in Toronto, Canada were eligible for participation in the study.This group was estimated to contain 100 people with a wide range of


FIGURE 1. Curriculum Outline

Module Learning Objectives Activities

Module one • Explore connections betweenculture and social work

• Learn multicultural constructs/frameworks

• Apply social work and culturalcompetence knowledge, values,skills and self-awareness topractice situations

• Reflection on personaldevelopment in culturalcompetence

• Dyadic discussions of definitionsin pairs

• Lecture and large groupdiscussion

• Case studies in small groups• Discussion and negotiation of

learning goals

Module two • Integrate and apply social workand cultural competenceknowledge

• Learn guidelines for culturallycompetent assessment ofindividuals, families andcommunities

• Practice interview techniques forintegrating cultural informationinto problem formulation

• Dyadic discussions of identityand cultural transference andcountertransference


• Case studies in small groups• Video analysis

Module three • Integrate and apply social workand cultural competenceknowledge

• Explore guidelines for negotiatingintervention in cross-culturalsituations

• Review and practice interviewtechniques for integrating culturalcompetence skills in assessmentand intervention

• Large group discussion/reviewof previously learned material


• Case studies in small groups• Role-playing interviews

Module four • Integrate race/ethnicity analysiswith analysis of other identities

• Apply cultural competence skillsto professional and organizationalissues

• Explore specific goals for buildingcultural competence


• Analysis of videotaped newsstory applying multiculturalconstructs

• Case studies in small groups• Small group sharing and

reflection

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experience and some variation in educational background. The work-shop and research study were publicized through the clinical servicesnetwork (email, newsletters, and meetings). The only criterion for in-clusion in the study was that the participants be in positions designatedas “social worker” within the organization.

All participants in the study were volunteers. It was not possible toemploy random assignment of participants to the comparison or experi-mental group because of organizational policies. Instead, participantswere asked to participate in the comparison group if they were unable toattend the scheduled sessions of the program and were agreeable to join-ing a waiting list. The educational intervention was conducted twice(two training periods, each including four 3-hour sessions over fourweeks). Class size was limited to 25 students to maintain an environ-ment conducive to participation in large group discussions and smallgroup work. Each workshop series included learners who were not par-ticipants in the research study. Comparison group data were collectedduring both training periods. Data were collected from 47 social work-ers over a period of 2.5 months; 29 individuals in the intervention groupand 18 individuals in the comparison group. Characteristics of thesample are presented in Table 1. As already discussed, previous re-search assessing cultural competence has identified associations be-tween self-reported competence and racial identity, experience withculturally different clients, previous multicultural training, and extentof general practice experience. Statistical analyses confirmed that par-ticipants in the intervention and comparison groups were not significantlydifferent on these demographic and professional variables (Table 1).Statistical tests also established that there were no significant differencesbetween the participants in the first and second sessions; therefore, thedata analysis merged the groups into one intervention group and onecomparison group.1

The investigation was confined to one study site to diminish barriersthat commonly prevent the implementation of professional develop-ment evaluation studies, for example, heterogeneity of focus of healthcare settings, discrepancies in procedures in different locations, and dif-ficulty of following up with learners to assess post-intervention learningoutcomes (Dixon, 1978).

Instrumentation

The Information Form. A questionnaire was used to gather informa-tion about the participants in the following categories:


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Demographics. Respondents provided information about their age,gender, and self-defined ethnic origin. The ethnic origin data wereclassified to identify racial minority and non-racial minority individu-als. Racial minority people were identified by matching self-identifica-tion categories to Statistics Canada designated categories for “visibleminorities.”2

Professional background. Each participant provided informationabout his or her professional degree, number of years of professionalpractice, self-assessed level of experience working with a culturally


TABLE 1. Study Participant Characteristics

Variables InterventionGroup (n = 29)

# or mean

ComparisonGroup (n = 18)

# or mean

Tests for significantdifference betweengroups

Age20-3435-4445-5455-64

88

121

8721

Pearson X2

(3, n = 47) = 4.90,p =.18, Cramer’s V = .32

GenderMaleFemale

326

315

Pearson X2

(1, n = 47) = 0.40, p =.53, Cramer’s V = .09

# Years professionalexperience

10.69 ± 8.56 9.44 ± 6.18 t(45) = .535, p = .60

Ethnicity*Racial MinorityNon-Racial Minority

425

513

Pearson X2

(1, n = 47) = 1.40, p =.24, Cramer’s V = .17

Highest Professional DegreeBSWMSW

425

018

Pearson X2

(1, n = 47) = 3.47, p =.06, Cramer’s V = .27

Self-assessed level ofexperience working withculturally diverse client group

SomeA great deal

209

135

*Pearson X2

(1, n = 47) = 0.06, p =.81, Cramer’s V = .03

Highest level of previoustraining in ethnic/culturaldiversity

NoneSeminarsWorkshopsConcentrated Education

07

1111

2367

Pearson X2

(3, n = 47) = 3.58, p =.31, Cramer’s V = .28

*Computed as a 2 x 2 table because there were zeros in the “none” cells for both groups.

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diverse client group (1 = none, 2 = some, 3 = a great deal), and highestlevel of previous education (prior to this study) in the areas of racialand ethnic diversity (1 = no education, 2 = seminars, 3 = professionaldevelopment workshops and 4 = concentrated education as part of pro-fessional training).

The Multicultural Counseling Inventory (MCI). The MCI is a self-report measure developed by a team led by Sodowsky (Sodowsky,Taffe, Gutkin, & Wise, 1994) to measure competencies in four do-mains: multicultural awareness, multicultural knowledge, multicul-tural skills, and multicultural relationship. The scale has 40 items withfour-point response categories (1 = very inaccurate to 4 = very accu-rate). Each competence domain is represented in a subscale. The aware-ness subscale assesses experience and commitment to working withethnic minorities (10 items). The knowledge subscale assesses knowl-edge of cultural information and relevant practice research (11 items).The skills subscale assesses ability to retain ethnic minority clients andto modify practice to address cultural diversity (11 items). The relation-ship subscale assesses interpersonal contributions to multicultural prac-tice including comfort level, use of stereotype-based information, andparticipation in activities to redress inequities faced by racial and ethnicminority people. The MCI was developed empirically using exploratoryand confirmatory factor analysis of data provided by training and prac-ticing counselors. Its construct, concurrent, and criterion validity havebeen assessed extensively (Ponteretto et al., 1996; Pope-Davis & Dings,1995; Sodowsky et al., 1994). An overview of several investigationsusing the MCI has reported that it yields an average Cronbach’s alpha of.87 (Ladany et al., 1997). In this study, the Cronbach’s alpha was .89.The agreement for the procedural use of the MCI prohibits the repro-duction or sharing of individual items and/or subscales.

Multicultural Case Conceptualization (MCC). A team led by Ladany(Ladany et al., 1997) developed an evaluation of the ability to constructa multicultural case conceptualization. A multicultural case conceptual-ization involves identifying salient racial/ethnic factors in a clinicalexample and integrating them into a case formulation. The ability to dothis is evaluated by presenting a case vignette and asking respondents toprovide one written statement (2-3 sentences) of their clinical opinionsregarding the etiology of the client’s described problem, and one writ-ten statement of their clinical opinions of the appropriate interventionfor the problem. Each respondent receives two scores for each case; onefor the conceptualization of etiology, and another for the conceptualiza-tion of appropriate intervention. Responses are scored on an ordinal


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scale ranging from 0 = no indication of race or ethnicity issues to 5 =three mentions of race or ethnicity with three integrations of thematerial into interpretation of the case. The scoring system reflects theinfluence of learning taxonomies (Biggs & Collis, 1982; Bloom &Krathwohl, 1956) that suggest the capacity to identify issues relevant toa topic is an indication of learning, but at a less advanced level than thatdemonstrated by the capacity to integrate those issues into newly syn-thesized material. The MCC task has been demonstrated to be reliable,valid, and less susceptible to social desirability bias than the conven-tional multicultural competence measures (Constantine & Ladany,2000).

The Course Evaluation Forms

The education and training program at the organization had a qualityimprovement program in place that included standardized evaluations ofall educational events. This standard form was modified and adminis-tered to all course participants. The form generated both quantitative andqualitative data. The qualitative data reported in this study was generatedfrom open-ended questions in the instrument that raised questions aboutperceptions of the training experience, key learning experiences, and ap-plications of learning to current and future practice. “Feedback” formsthat had open-ended questions asking what was useful or problematic inthe first, second, and third sessions provided further evaluation data.

The Follow-up Interview

A semi-structured follow-up interview was developed to generate nar-ratives that would enrich the evaluation of the program. The interviewused open-ended questions to gather information about the experience ofthe educational intervention, its impact on practice, and the learners’ im-pressions of how it affected their personal and professional approaches tocultural diversity. The questions included the following: How relevant iscultural competence to your practice; How did you find the program fitwith your professional needs; What elements of the program made themost significant impressions on you as a practioner (probes: content, pro-cess, materials, facilitator, etc.); Do you believe that experiences from theworkshop series have proven relevant to any practice/professional situa-tions you have encountered recently (examples).


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Procedures

Pretesting of the Instruments. A pretesting phase of the study wasused to complete three tasks: (1) testing of the study procedure, (2) testingand evaluation of the MCC vignettes, and (3) training of the investigatorand the second rater for rating of the responses to the case vignettes. Theevaluation package was circulated to four colleagues who completedthe forms and provided feedback on the process. The investigator thendeveloped three alternate vignettes that could potentially be used in fol-low-up evaluations. These vignettes were first assessed for face validityby a panel including three professors of social work and two PhD candi-date social workers, and then they were pretested by ten MSW level so-cial workers outside of the organization. Respondent scores weresubjected to correlational analysis to select an alternate vignette evok-ing responses most equivalent to those evoked by the index vignette.Based on this analysis, a second vignette was selected for the follow-upevaluations. Interrater agreement was .922 (80% agreement) for the rat-ings of etiology responses and .971 (90% agreement) for ratings of in-tervention responses.

The Experiment. The instruments (information form, MCI, MCC vi-gnette) were mailed to individuals in both the intervention and compari-son groups with a request to return the completed forms prior to thebeginning of the educational intervention. At the end of the educationalintervention, the course participants were given a package with a sec-ond vignette, the MCI and a course evaluation form. The comparisongroup received a similar package, without the course evaluation form.Interviews with randomly selected volunteers from the interventiongroup were conducted six to eight weeks after the workshop was com-pleted. Follow-up interviews were conducted by a research assistant sixto eight weeks after the intervention was completed.

Comparison group participants were asked about their participationin diversity activities available at the organization. Two participants re-ported they had attended educational seminars during the study period;no other activities were disclosed.

Data Analysis

The data set was explored to ensure it met requirements for theunderlying assumptions of each planned statistical analysis. Individualchanges on MCI scores were explored using a univariate repeated


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measures analysis of variance. Wilcoxon tests were used to test forwithin subjects differences on the MCC task. Group differences wereassessed by applying independent sample t-tests to the MCI data andMann- Whitney U tests to the MCC data.

Linear regression analyses using dummy coding was used to test forassociations between MCI total scores and the following demographic/professional variables: middle age category (ages 45-54); female gen-der; racial minority status; MSW degree; a great deal of experienceworking with a culturally diverse client group; and concentrated educa-tion in ethnic/cultural diversity. The same dummy variables were usedto test for associations between demographic/professional variables andMCC ratings using two-way contingency table analyses.

This information was supplemented by analysis of the qualitativedata from the information form, the course evaluation forms, the end-of-session feedback forms, and the follow-up interviews. Text and in-terview data were analyzed using the template approach to text analysis(Crabtree & Miller, 1992). Text data were coded by hand; codes wereadded to an electronic data file, and text segments were sorted andreassembled using the QSR-N5® software program. A second coder re-viewed coding and discrepancies were resolved through discussion toconsensus. If there were discrepancies in coding, the research team fol-lowed this procedure: (1) review of codes and coding definitions;(2) re-examination of text sequence in question; (3a) re-assignment ofcode(s) agreeable to both raters or (3b) discarding of code(s) for whichthere was no agreement.

FINDINGS

This section will report on data relevant to individual and group pro-cesses in the learning intervention. There is quantitative data availablefor both the intervention and comparison groups, but the qualitativedata presented here will only be from intervention group participants.

Individual Processes–Quantitative Results

The progress of individuals within the groups was examined throughrepeated measures analyses. Univariate repeated-measures ANOVAsconducted on the MCI data set using group as a between-subjects factorrevealed that individuals in both the comparison and intervention groupimproved scores on the scale between time 1 and time 2. There was a


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main time effect for the MCI total score (Wilks’ Λ = .820, F(1,46) =10.092, p = .003, partial eta-squared = .180), the Awareness subscale(Wilks’ Λ = .787, F(1,40) = 10.818, p = .002, partial eta-squared = .213),the Knowledge subscale (Wilks’ Λ = .911, F(1,41) = 4.019, p = .05, par-tial eta-squared = .089), the Skills subscale (Wilks’ Λ = .907, F(1,41) =4.185, p = .047), but not the Relationship subscale. An interaction effectbetween subject and group membership was found for the Awarenesssubscale only (Wilks’ Λ = .821, F(1,40) = 8.740, p = .005, partial etasquared = .179). The significant time effects indicated that there werechanges from time 1 to time 2 regardless of group. The test of the interac-tion indicated that the groups changed differentially on the Awarenesssubscale.

Separate Wilcoxon tests were conducted for the intervention and com-parison group (using a split file) to assess within subjects differences inperformance between time 1 and time 2. The numbers of individuals ineach group that improved their ratings, decreased their ratings, and hadthe same ratings at time 1 and time 2 are presented in Table 2. There wasno significant difference between time 1 and time 2 performance for the


TABLE 2. Mean Ranks for Within-Subject Differences on the MulticulturalCase Conceptualization Ability Task

Result Frequency Mean Rank

Intervention Group (n = 29)

Time 2 etiology score worse than Time 1 etiology score 8 7.31

Time 2 etiology score better than Time 1 etiology score 9 10.5

Time 2 etiology score equal to Time 1 etiology score 12

Time 2 intervention score worse than Time 1 intervention score 4 7.00

Time 2 intervention score better than Time 1 intervention score 21 14.14

Time 2 intervention score equal to Time 1 intervention score* 4

Comparison Group (n = 18)

Time 2 etiology score worse than Time 1 etiology score 9 8.94

Time 2 etiology score better than Time 1 etiology score 6 6.58

Time 2 etiology score equal to Time 1 etiology score 3

Time 2 intervention score worse than Time 1 intervention score 3 8.17

Time 2 intervention score better than Time 1 intervention score 12 7.96

Time 2 intervention score equal to Time 1 intervention score* 3

*The Wilcoxon test does not calculate mean ranks for tied scores.

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etiology tasks in either the intervention or comparison group. On the con-ceptualization of interventions, however, the results indicated a signifi-cant difference in both the comparison group (z = �2.113, p = .035) andthe intervention group (z = �3.696, p < .001). Individuals in both groupsdemonstrated improved performance on their conceptualizations of inter-vention.

Linear regression analyses revealed two significant associationsbetween demographic/professional variables and scores on the MCI,but neither explained large proportions of the variance. There was asignificant positive association between racial minority status and totalscore on the MCI at time 1 (F(1,46) = 4.268, p = .04, adjusted R2 = .07,Standardized beta coefficient = .291, t(46) = 2.066). There was also asignificant positive association between MSW level of education andMCI score at time 1 (F(1,46) = 4.706, p = .04, adjusted R2 = .07, stan-dardized beta coefficient = .305, t(46) = 2.169). Two-way contingencytable analyses testing for associations between the professional/demo-graphic variables and ratings on the MCC task only revealed two signifi-cant associations. Racial minority status was associated with higherratings on the conceptualization of intervention at both time 1 (Pearsonχ2 (4,47) = 11.380, p = .02, Cramer’s V = .49) and time 2 (Pearson χ2

(4,47) = 11.908, p = .02, Cramer’s V = .50).

Individual Processes–Qualitative Results

Qualitative data from the intervention group revealed that someexperiences of the workshop series were affected by individual attrib-utes and experiences. For example, one person described her previousexperience of learning about cultural diversity as positively affectingher experience in the intervention: “It addressed my needs because, itwas, in a way, a refresher. Because I did my undergraduate studies at(name of school), which really does take into account diversity, racialand ethnic backgrounds and their implications in practice . . . I thought(the facilitator) went beyond some of what I had already done and putsome frameworks around it that I was very happy to see.”

Seventeen of the 29 workshop participants (59%) referred to theintervention as building positively on previous learning experiencesand providing a “refresher” or “booster” session for earlier education.One participant echoed several of her colleagues in the comment “Youdo need that again and again and again. I think for myself anyway, it’sgood for me to have that reminder.”


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It seemed that professional experience also was relevant to whatlearning experiences were valued by individuals (mentioned by 20 of29 learners; 69% of the intervention group). For example, one partici-pant said, “We’re trained in social work to do assessments, but I justpicked up more . . . the basics were there–what we always used in as-sessment and intervention, but this was richer, more detailed in thecultural area, than my basic knowledge.” Similarly, another learner in-dicated “I think that in the assessment and engagement process, I’vealways used those sorts of questions and I think its just because I waswell trained that way. But in terms of linking people up to service, Ithink that was something I benefited from learning more about.” Yet,it seems that professional experience could also be the foundation ofbarriers to learning in this particular educational experience. Onelearner noted that her professional experience and expectations lim-ited the usefulness of some of the training: “Exploring cultural/ethnicissues as part of therapy is different than in more instrumental inter-ventions. Therefore, it would be more useful for me to have this typeof workshop just for psychotherapists.” However, this was the only in-tervention participant who expressed this sentiment, perhaps reflect-ing that most volunteers for the program had professional roles thatwere reflected in the course content. There were other comments (12of 29 written/oral narratives and mentioned in several of the anony-mous “feedback” forms) noting the positive contribution of the coursecontent, particularly the case studies; for example: “The case studieswere things that we deal with on a daily basis in our own practice. Itwas energizing!” In addition, intervention participants expressed thebelief that the training would be useful to other social workers andpeople in other disciplines. Seven participants (24% of learner group)commented on applicability of the training to the work of profession-als in other disciplines. All noted that interdisciplinary training wouldbe valuable for increasing the overall competence of the organizationand would be useful as people of different disciplines are often doingvery similar work in a mental health care setting. For example, oneparticipant commented: “Different people with different trainingoften do the same jobs so, I think it’s less important what the disciplineis and more important what the job is.” Evidently, learners believedthat professional experience, including specifics of current job re-sponsibilities, had an impact on how beneficial the workshop serieswould be.

Finally, one woman’s discussion of issues relevant to her racialidentity suggested that this, too could affect the experience of the training.


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Referring to the Afro-Caribbean ethnicity of the facilitator, she noted:

I didn’t feel like she brought her own personal experience as awoman of color to the workshop. But she talked a lot about herpersonal experience as a clinician working with clients and howclients have related to her in her professional role, which was help-ful because clients do react to me.

In addition to this woman, ten of the intervention participants (34%)spoke or wrote about personal characteristics that they believed affectedtheir approach to cultural competence and their experience of the inter-vention. One participant’s ethnic minority status made her conclude “Iguess I’ve always had awareness.” Another person indicated that beingan immigrant “. . . has raised issues of cultural diversity for me.” Yet,personal identity was not only relevant to people who identified as eth-nic minorities. One woman wrote about her experience as a White so-cial worker in Africa and her feelings about establishing credibility incross-cultural work. Those experiences made it meaningful for her tolearn about “how to address clients and the perception of the clinicianbeing elitist or oppressive.” Therefore, the qualitative data suggest thatthere were individual identity and professional attributes that affectedthe experience individuals had in the educational intervention and thespecific gains they perceived making in cultural competence.

Group Processes–Quantitative Results

As already presented, repeated measures analyses detected a groupdifference in improvements on the MCI Awareness subscale; the inter-vention group demonstrated significantly greater improvements thanthe comparison group in scores on the Awareness subscale betweentime 1 and time 2. Independent sample t-tests conducted to evaluatedifferences between time 2 MCI total score and subscale scores in theintervention and comparison groups revealed no significant differences.The mean scores for both groups at time 1 and time 2 are presented inTable 4. Mann-Whitney U tests conducted to test for group differencesin ratings on the MCC task revealed no significant group differences inmedian scores for the conceptualizations of etiology or intervention attime 2. The mean ranks and test statistics for both groups at time 1 andtime 2 are presented in Table 5. Therefore, group analyses suggestedthere were no differences between the intervention and comparisongroups after the intervention was completed.


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Group Processes–Qualitative Results

The qualitative data provided some insight into group processes inthe intervention group. Written and oral narratives suggested that otherparticipants in the group contributed significantly to individual learningexperiences, particularly by facilitating a social bond and safety in thelearning environment. The opportunity to have a learning experienceexclusively with other social workers was named as a positive part ofthe intervention by 9 of the 29 learners (31%). Although other com-ments had alluded to the value of interdisciplinary learning, commentssuggested that these learners perceived benefits from learning withoutother disciplines. For example, one participant noted, “It was nice withjust social workers. We did not come there to do battle.” Another sug-gested that having only social workers made it possible to begin with ashared perspective:


TABLE 3. Mean MCI Scores for the Intervention and Comparison Groups (withStandard Deviations)

Intervention Group (n = 29) Comparison Group (n = 18)

Pre Post Pre Post

MCI Total 108.27 ± 22.92 118 ± 22.82 114.5 ± 20.25 118 ± 18.29

MCI- awareness 26.89 ± 5.56 29.35 ± 5.68 29.31 ± 5.17 29.44 ± 4.72

MCI- relationship 23.81 ± 2.72 24.1 ± 3.09 22.89 ± 3.72 23.29 ± 3.70

MCI- knowledge 33.04 ± 4 35.24 ± 4.28 34.44 ± 4.99 34.53 ± 5.77

MCI- skills 36.21 ± 3.85 37.81 ± 3.66 37 ± 4.07 37.22 ± 4.31

TABLE 4. Between-Group Differences on Ratings for the Multicultural CaseConceptualization Task

Intervention GroupMean Ranks (n = 29)

Comparison GroupMean Ranks (n = 18)

Test Statistic

Etiology time 1 21.34 28.28 z = �1.74, p = .08

Intervention time 1 23.22 25.25 z = �.51, p = .61

Etiology time 2 24.36 23.42 z = �.235, p = .82

Intervention time 2 25.45 21.67 z = .98, p = .33

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It had been a long time for me since I’d been in an environmentlearning, especially with other social workers. It was wonderful. Itwas like we had the same background of knowledge and skills sowe can start at a level that is good for us. That was wonderful.

This view was echoed by another participant that noted “It wasgeared specifically to social workers because there is a common knowl-edge and value base for social work.” According to another participant,the perception that there were common values in the learning groupcontributed to a positive experience that extended beyond the learningexperience: “How impressed I am by my colleagues’ understanding andcommitment to these issues. I feel supported by others.” One participantalso mentioned that it was helpful to know that other social workerswere dealing with similar issues.

The group process also was named as being relevant to creatingsafety in the learning experience (20 of 29 participants; 69%). As therewere no questions about safety on either the written forms or the inter-view schedule, the appearance of it in so many narratives was notewor-thy. Clearly, there was some anticipation that there could be tensions inthe learning experience, as suggested in the comment, “I was afraid ofwhat I would think and feel at first, because of the content and due to mypast experiences in classes where I was chastised for asking a question.”Qualitative data indicated that tensions were also experienced in theworkshop series by at least one participant: “(There were) situationsthat were a bit murky or made people feel uncomfortable. I think there’ssome anxiety about what does this all mean.” This participant attributedthe successful management of such situations to the work of the facilita-tor: “She asked good questions to draw out what we thought was goingon.” Ten of the participants who raised the issue of safety also attributedthe creation of safety in the learning to the style and manner of thefacilitator, for example:

I guess one of the things that stood out most about (the facilitator)was that it felt very safe. And I think that comes from the facilitator. . . I think being able to create safety in a learning experience is im-portant. To encourage participation, encourage discussion of issues.

However, the all of the participants described safety in the learningexperience as part of the group process, for example, indicating the pos-itive experience of “the openness of discussion, the level of tolerance,acceptance and openness of my social work colleagues.” All of the


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intervention participants mentioned the sharing and discussion in groupsas a positive aspect of the learning experience.

Self-Reported Outcomes

None of the evaluations of the educational intervention involvedobservations of post-intervention practice; information about practiceoutcomes was provided exclusively through self-report from the courseevaluation forms and follow-up interviews. Nevertheless, it is notablethat 19 of 29 learners reported new practices that they had applied as a re-sult of the training, and 25 of 29 learners reported new anticipated prac-tices that they would attribute to the learning experience. Reported newpractices included: increased exploration of the cultural context of clients(n = 10, 34% of intervention group); use of specific resources and referralnetworks presented during the workshop series (n = 5, 17%); sharinginformation with colleagues (n = 6, 21%); integration of culture-relevantinformation into program procedures (n = 6, 21%); and increased self-reflection about cultural issues (n = 11, 38%). Anticipated practicesincluded initiation of discussion of cultural issues (n = 12, 41%); in-creased comfort and confidence in using culture-relevant practices (n =14, 48%); and participating more actively in organizational developmentactivities (n = 5, 17%). Many participants reported that they believed animportant outcome of the learning intervention was increased comfortand confidence in addressing cultural issues (n = 14, 48%). The only newor anticipated practice that was described as a potential group activity wasthe possible initiation of a discussion group with others that had partici-pated in the workshop series.

Participants provided stories about how they were able to applylearning from the workshop series in practice. Although it was notpossible to observe people in practice or meet with their clients or col-leagues to confirm the applications, their narratives were valuable forproviding information about the areas of practice in which learnersbelieved they had been able to demonstrate increased cultural compe-tence. Examples included:

In my intakes that I’m doing, I’m making a different section oncultural issues and pulling it in as part of my psychosocial assess-ments. I did before, but I’m doing a little bit more in-depth than Idid before, especially by mentioning any outside resources thathave been used successfully or unsuccessfully and why. (follow-upinterview)


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I have become increasingly proficient in including culturallyrelevant information in assessment and treatment of clients. I haveincreased advocacy efforts in my position that will support per-sonal and organizational cultural competence. (course evaluationform)

We have revised our intake form to be a bit more sensitive, con-scious of diversity issues . . . You know the course was helpful.I was sort of mindful of diversity issues in developing that form.(follow-up interview)

I took action immediately in redirecting a racist patient and alertingthe team to the fact that racist comments constitute inappropriatebehavior. (course evaluation form)

Well, it helped quite specifically. I had a referral a couple of weeksafter the course of someone from a country where he had escapedfrom atrocities, lost his parents; they probably were dead. And hesort of landed here in Toronto, or thereabout. . . His expressed feel-ing was that he needed to connect with people from his own back-ground who would understand without him having to explain. AndI don’t think I would have been as clear on how to proceed at tryingto figure out. . . I wouldn’t have thought in the same way and Iprobably wouldn’t have thought of who to call in the same way. Ithink I would have been sort of vague and thought that this isn’treadily accessible. (follow-up interview)

Apparently, respondents perceived benefits from the educationalintervention that could be applied in their practice.

LIMITATIONS

There are limitations of this study that must be taken into account in theinterpretation of its results. As has already been discussed, it was notpossible to employ random assignment of participants to the interventionand comparison groups. Although the statistical analyses indicated therewere no differences between the intervention and comparison groups, orthe participants in the two sessions, it is possible that there was insuffi-cient power to detect differences due to the small sample. Small samplesize could have similarly obscured differences between the outcomes forthe intervention and comparison groups. A small sample size limits the


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generalizability of the results and generalizability is also limited becausethe study was carried out in a single organizational context. Moreover, allparticipants in the research study were volunteers; therefore, they cannotbe assumed to be completely representative of social workers working inmental health care settings. Finally, the study design could not accommo-date observations of post-intervention practice by the participants and theonly source of data on post-intervention applications of learning wasself-report accounts. These accounts, together with the results from theMCI scale and the evaluations of performance on the MCC task, pro-vided insight into levels of knowledge, comprehension, and analysisthat had been achieved in the intervention group, but fell short ofproviding information about client outcomes and effects on services.For all these reasons, this study is best interpreted as a pilot study thathas the potential to contribute to an increased understanding of culturalcompetence in social work, and how it could be evaluated in interdisci-plinary contexts. The results of the study will be discussed first with re-gard to their relevance to existing literature on outcomes from training,and second with regard to their implications for evaluation of trainingoutcomes.

DISCUSSION

A workshop-based educational intervention for cultural competencewas delivered to social workers practicing in an interdisciplinary mentalhealth care setting while another group of practitioners participated in“standard diversity activities” available in the organization. Post-inter-vention analyses showed little difference between the two groups. Bothgroups improved performance on the MCI, a standardized measure ofcultural competence, and the MCC assessment, a performance task forevaluating cultural competence. The similarities in group experiencewere revealed by both within and between-group analyses, but within-subject analyses detected a significant difference; the interventiongroup demonstrated superior gains on the Awareness subscale of theMCI. Further quantitative analyses indicated that racial minority iden-tity and MSW level education were indicated with higher scores on theMCI at time 1. Qualitative data collected from the intervention groupduring and after the intervention revealed that learners perceived bene-fit from the educational intervention and identified both individual andgroup elements that influenced their perception of benefit. Immediatelyafter the intervention and six to eight weeks later, participants in the


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intervention were able to identify several new and anticipated practicesthat they attributed to the learning experience.

There may have been design and statistical limitations that may havemade it difficult to detect differences between outcomes for the inter-vention and comparison groups. Use of within-subject analyses made itpossible to detect one difference by integrating individual differencesinto the analyses. Yet, it is necessary to consider reasons why theintervention may not have been more effective in increasing culturalcompetence than the standard diversity activities available in theorganizational setting. The observation of similar positive changes inthe two groups suggests that exposure to the organization’s diversityinitiative had a positive impact on participants in the comparisongroup. Although exposure to information is not recognized as an espe-cially effective intervention for improving multicultural practice, it isrecognized as contributing to gains in knowledge, skills, and attitudesrelevant to practice (Barise, 2000; Beach et al., 2005; Edwards, 1997).Perhaps the standard diversity activities in the organization were aseffective as the intervention in improving peoples’ abilities to answerquestions on the MCI and compose conceptualizations on the MCCtask. The superior effect that the intervention had on awareness as mea-sured by the MCI may reflect the specific effect of course content thataddressed commitment to multicultural practice, for example, informa-tion about service barriers, health disparities, etc. The counseling psy-chology literature demonstrates that educational interventions can oftencontribute to gains in specific areas of cultural competence without pro-moting change in other areas (Sodowsky, Kuo-Jackson, Richardson, &Corey, 1998). Perhaps the intervention would have been more effectivein more areas if it had more specifically targeted learning needs. Al-though only one participant expressed discontent about the inapplica-bility of the intervention to her work, that comment addresses animportant aspect of professional training. Learning interventions thatare targeted to address specific learning needs and job responsibilitiesare more likely to contribute to changes in practice (Fenwick, 2000;Giffort, 1998). Although the qualitative data suggested most learnersperceived considerable overlap between the course content and situa-tions they encountered in their professional roles, it is possible that theprogram content was still not specific enough to contribute to learningthat was substantially better than that stimulated by the non-specificeducational programming of the organization.

Attention to specific learning needs and specific job responsibilitiescompels those that design educational interventions to address the


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individual differences that people bring to their experience of developingcultural competence. The associations between racial minority status andhigher MCI scores may speak to the important role that personal experi-ence plays in developing an understanding of cultural competence. Thisfinding, the finding of a positive association between MSW level educa-tion and MCI scores, and other studies that reveal positive associationsbetween minority racial/ethnic identity, professional/educational experi-ence, and cultural competence remind us that individuals start at differentplaces in their development of competence in this area. The continua ofcompetence that have been developed in social work (Cross et al., 1989;Manoleas, 1994) are probably useful for engaging practitioners in view-ing cultural competence as a capacity that is continually developing basedon personal, professional, and educational experiences.

Participants in the intervention group perceived benefit from the in-tervention and reported transferring learning to the practice setting. Thequalitative data describing the experiences they had in the interventionprovided information about how individual and group processes mayhave been instrumental in contributing to improved practice. As indi-viduals, participants in the intervention apparently made choices aboutwhat areas of course content and experience were most useful tothem. Based on their personal and professional experiences, they madedecisions about what learning needs they desired to meet through the in-tervention, and this was reflected in the wide range of comments aboutkey learning experiences in the intervention. This selection purpose wasfurther demonstrated by the wide range of new and anticipated practicesthat learners identified as emerging from their participation in the inter-vention. Clearly, the intervention had not served to create a consoli-dated definition of cultural competence and its applications in practice.Instead, learners emerged with a variety of ideas about culturally com-petent practice, and they used those ideas to develop a range of methodsfor integrating cultural competence into their professional roles. Thisfinding is consistent with literature that suggests health professionals ininterdisciplinary settings apply practice learning in a myriad of ways,depending on their roles, their practice contexts, and their personal ca-pacities (Dixon, 1978). These type of learning outcomes would be verydifficult to capture on standardized measures or through comparison ofgroup outcomes. Evidently, learners individualize their learning experi-ences depending on their needs and in preparation for applying theirlearning as individual practitioners in the organization. Accordingly,understanding the factors that promote the competence of individualpractitioners is very important.


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Yet, there were important group processes that contributed to thelearning of individuals. Being trained with other social workers wasperceived as a positive experience that contributed to social bondingand safety in the learning experience. As unmanaged tension in learn-ing experiences greatly diminishes the capacity to learn (Laiken, 1992);creating an experience where learners were with social workers exclu-sively likely diminished some of the anxiety that may have been antici-pated in the learning experience. Learners feel safer and more able totrust in situations that they perceive as socially homogeneous (Kanter,1977). This may be particularly important for social workers in inter-disciplinary settings as they are increasingly isolated from each other incontemporary management structures (Globerman, Davies, & Walsh,1996). Training for diversity, anti-racism, or cultural competence can,unfortunately, be a setting for cross-cultural misunderstanding, anger, andlong-term damage (Garcia & Van Soest, 2000; Poole, 1998; Srivistava,1993). Management of the process is an important responsibility of thefacilitator (Cain, 1996; Korda & Pancrazio, 1989), and as the partici-pants indicated, the facilitator contributed positively to dissipatingtensions and making the environment safe. However, positive socialconnection between group members are also crucial to promoting safety(Rittner, Nakanishi, Nackerud, & Hammons, 1999). In this learning ex-perience, the social connections were created by the organizational con-text and the learners’ positive orientations to people in their discipline.As some learners indicated, learning with other disciplines may havealso been beneficial, and in that case, social bonding could still havebeen facilitated by the organizational connection and/or the connectionswithin interdisciplinary teams. Positive group learning experiences canbe an investment toward ongoing cultural competence in the organiza-tion. Group activities in educational interventions can be a precursor topeer supervision activities to support cultural competence (for example,the discussion group suggested by one participant). Peer supervisionis becoming increasingly important because of the diminishing avail-ability of discipline-specific supervision in contemporary health caresettings (Hekelman, Flynn, Glover, Galazka, & Phillips, 1994). There-fore, group process in cultural competence learning experiences may behighly relevant to aiding the development of cultural competence inservice systems.

Learning cultural competence may be facilitated by positive, sup-portive group processes; yet when it comes to evaluating outcomesof learning, individuals may be a more appropriate unit of analysisthan groups. Tracking individuals allows incorporation of individual


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experiences and goals into an evaluation of their progress through thecontinua of cultural competence. Moreover, encouraging social work-ers in interdisciplinary settings to individualize their goals for culturalcompetence education may be particularly appropriate, as they oftenimplement culturally competent practices in isolation from other socialworkers.

IMPLICATIONS

Evaluating this workshop series raised some important issues aboutthe evaluation of cultural competence training programs in interdisci-plinary practice settings. Standardized measures of cultural competenceconfine definitions of competence to predetermined categories that can-not apply in all contexts. For example, the MCI addressed issues thatwere relevant to agency-based counseling practice, but did not addressmany other aspects of mental health care that were relevant to the socialworkers in this study (e.g., discharge planning, family support, psycho-social rehabilitation). The case-study-based evaluation of the MCCcould be made more applicable. It was a standardized evaluation thatcould be customized for the practice setting by designing appropriatecase examples, and could also be individualized by using a codingscheme that classified respondent’s unstructured responses.3 Evalua-tions that can be used flexibly are compatible with encouraging prog-ress through continua of cultural competence, because they permitindividuals to identify aspects of competence that are relevant to effec-tive practice in their areas without the constraint of predetermined defi-nitions on a standardized scale. As this study and others suggest thatcultural competence is affected by individual attributes and experi-ences, it seems there are important reasons to retain an interest incontinua of competence that create space for individualized definitionsof cultural competencies. There will still be a need, however, for somestandardized understanding of what level of skills and knowledge repre-sent competence. Future research in this area can look at how to evalu-ate training outcomes in ways that will begin to address these issues.Some possible strategies to pursue are already identified in the literatureand awaiting further validation in research, for example, use of role playassessments (Shergill, 1998), analysis of taped interviews (MorrisonVan Vooris, 1998), and review of practice portfolios (Coleman, 1996).Each method presents challenges for achieving standardization thatwould be appropriate for evaluation purposes, but these methods bring


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us closer to being able to answer important questions about how trainingis contributing to effective work with clients. In the meantime, the infor-mation that this study provides about learners’ reports of increasedculturally competent practices and anticipated practices indicate impor-tant things about increased feelings of self-efficacy for multiculturalpractice. Professionals must feel empowered and confident in usingnew learning before they are able to commit to changing procedures inservice settings (Guterman & Bargal, 1996; Pearlsmutter, 1998). Thismay be especially true if they must apply cultural competence in inter-disciplinary settings where they have little support from other socialworkers.

There are large numbers of practicing social workers in NorthAmerican mental health care settings. Therefore, they are positioned tohave a significant impact on the cultural competence of those servicesand to provide leadership in increasing access for racial and ethnicminority clients. It is important to know more about how to support on-going development of cultural competence in practitioners, and how toevaluate this development using methods that are relevant to improvingclient outcomes. This study contributes to that effort by demonstratingsome of the contributions of using standardized instruments, standard-ized case-study-based evaluations, and semi-structured qualitativeevaluations. The study also supports the feasibility of using workshop-based interventions for social workers in interdisciplinary settings.Future research should explore workshop-based interventions furtheras they are a primary method of continuing education for post-degreesocial workers (Postle, Edwards, Moon, Rumsey, & Thomas, 2002).However, there is almost no empirical literature addressing the use ofworkshop-based interventions for cultural competence education. Fu-ture research should also take into account that evaluating individualprogress in cultural competence may be more important than assessinggroup outcomes. This work is integral to advancing the very importantagenda of assuring that all citizens, regardless of racial or ethnic origin,are able to access appropriate mental health care when they need it.

NOTES

1. A series of two-way contingency table analyses were conducted to evaluatewhether there was homogeneity of proportions between the intervention groups at time1 and time 2, and the comparison groups at time 1 and time 2. Variables entered into theanalyses were: age, gender, ethnicity, highest professional degree, level of experience


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working with a culturally diverse client group and highest level of previous training inethnic/cultural diversity. The proportion of participants in each category not signifi-cantly different between the time 1 and time 2 intervention groups, or the time 1 andtime 2 comparison groups. The results of the tests are presented in the table above. Thetable also presents results of independent t-tests testing for differences in years of so-cial work experience between sessions 1 and 2.

2. The term “visible minority” is used in Canadian government institutions to referto people who are identified as of non-Caucasian race or non-White color. This desig-nation excludes Aboriginal groups because they are considered a distinct citizen group.

3. Another study (Oles, Black, & Cramer, 1999) used a case vignette response taskto evaluate changes in college students’ endorsements of anticipated professionalbehaviors for work with gay and lesbian clients, but the instrument provided multiplechoice response categories that restricted potential answers and potentially cuedrespondents to socially desirable answers.

REFERENCES

Barise, A. (2000). The effectiveness of case-based instruction vs. the lecture-discussion method in multicultural social work. Dissertation Abstracts Interna-tional Section A: Humanities & Social Sciences, 61(6-A), 2181.

Barnes, N. D. (1998). Evaluation of an educational intervention to improve cross- culturalcommunication in the medical interview. Unpublished PhD, University of Kansas.


Variable Intervention Group 1 vs.Intervention Group 2

Comparison Group 1 vs.Comparison Group 2

Age Pearson X2 (3, n = 29) = 1.75,p = .63, Cramer’s V = .25

Pearson X2 (3, n = 18) = 7.07,p = .07, Cramer’s V = .63

Gender Pearson X2 (1, n = 29) = .03,p = .86, Cramer’s V = .03

Pearson X2 (1, n = 18) = .40,p = .53, Cramer’s V = .15

Ethnicity Pearson X2 (1, n = 29) = 0.29,p = .59, Cramer’s V = .10


Highest professionaldegree


No statistic calculated be-cause highest professionaldegree was a constant

Experience/culturallydiverse client group



Previous educationin ethnic/culturaldiversity



# Years of professionalexperience

Session one mean = 11.31years (SD = 9.32); session twomean = 9.68 years (SD = 7.46).No significant difference - t(27)= .489, p = .63

Session one group mean =9.56 years (SD = 8.05); ses-sion two group mean = 9.33years (SD = 4.03). No signifi-cant difference - t(16) = .074,p = .94

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Documents

Training for Cultural Competence