Client and provider experiences of multicultural competence in community mental health

A major problem in the United States is the existence of inferior mental healthcare outcomes for racial and ethnic minorities compared with their European American counterparts. The federal government has documented the existence of mental health disparities for racial and ethnic minorities, and has called for more culturally sound healthcare practices at the provider level. Sue et al.'s (1982, 1998) widely accepted theory of cultural competence in counseling highlights the importance of certain provider qualities, including being aware of their biases about human behavior, appreciative of the diverse worldviews of their clients, and skilled in working with culturally diverse clients. However, it remains unclear if clients are able to observe and measure to what extent providers are considerate of their sociocultural context and needs. Further, the relationship between provider and client experiences of provider multicultural competence has not been sufficiently addressed in the literature. The current study used hierarchical linear modeling to examine how providers' self-reported multicultural competence, based on multiple measures, impacted client perceptions of multicultural competence in the community mental health setting. A unique aspect of the study was that it examined differences in ratings of clients who had the same provider. The study also examined how ethnic identity development, and majority or minority status match of race and ethnicity self-label affected the relationship between provider behaviors and client perceived multicultural competence. Results indicated that clients tend to view some providers as being more multiculturally competent than others. The aspect of self-reported multicultural competence that explained a significant amount of variance in client ratings was the sensitivity of providers to client needs. Ethnic identity development was not found to explain differences in perceived multicultural competence of providers. Match of client and provider based on reported racial and ethnic majority or minority status had a positive, significant impact on how clients rated their providers' multicultural competence. The current study offers a launching base for the implementation of culturally competent practices at the provider level. It is an important addition to the field of counseling psychology to find that clients and providers in community mental health settings differentially measure and interpret multicultural competence.