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Qualitative research for education: An introduction to theories and methods

Cultural competence (CC) was introduced to reduce substance use treatment (SUT) disparities among migrants and ethnic minorities. However, outcome reviews report limited evidence for its effectiveness in reducing SUT disparities. This paper applies Bacchi’s “What’s the problem represented to be?” approach and an ecosocial perspective in a narrative review (2007–2017) of CC in SUT. This review qualitatively identifies (1) the origin and (2) nature of CC and derivatives in SUT, (3) the presuppositions, (4) how the concepts are questioned and (5) what is left unquestioned. The literature search yielded 41 studies. (1) CC originated in the USA whereas derived concepts are more common in other continents. (2) Components of CC and derivatives are mostly located at the micro (client–provider) level. (3) The most prevalent presuppositions are situated at the micro service user (language, trauma, shame) and the macro level and to a lesser extent at the provider level (ethical requirements, discomfort) and client–provider interaction (distrust, confidentiality, countertransference, worldviews). (4) The authors of the reviewed papers question whether CC is sufficient, how it relates to generalist treatment approaches and whether CC is sufficiently evidence based. (5) Unquestioned issues concern defining culture, formal treatment access, the ‘prevalence presupposition’ and a lack of macro outcome indicators.

Cultural competence and derivatives in substance use treatment for migrants and ethnic minorities: what’s the problem represented to be?

Post-secondary education is a time that shapes identity. Emerging adulthood is also a life stage during which mental illness often emerges. Although increasing attention is being given to mental health support for transitional age youth, the role of culture and cultural identity is often not considered, considered abstractly, or considered only in relation to ethnicity. Who you are and who you become is shaped by where you come from and what you experience; therefore, it is important to understand how cultural identity impacts mental health and acculturation associated with post-secondary environments. Culture must be seen as a broad concept that extends beyond race, gender, and ethnicity. Culture is about patterns and power, and both contribute to (or threaten) belonging, resilience, inclusion, and exclusion. This paper takes a broad view of culture and argues that understanding and supporting cultural identity is critical for effectively supporting post-secondary youth mental health.

Impact of Cultural Identity on Mental Health in Post-secondary Students

Emerging adulthood and post-secondary education is a life stage during which mental health challenges often emerge or are recognized. In this chapter we present the argument that inclusivity and cultural competence are key enablers of success in supporting post-secondary youth mental health. We begin with an examination of the mental health challenges for post-secondary transitional aged youth and the associated need to target resources toward them. This is followed by a discussion of culture as a notable determinant of mental health. We take a broad view of culture that extends beyond race, gender, and ethnicity, and recognize that culture is about patterns as well as power. Barriers to youth mental wellness are explored through a lens of culture and cultural identity, given that they both can impact mental health positively and negatively. Finally, we identify strategies to promote inclusivity and support youth mental health at the level of individuals (clinicians, staff, faculty, and student leaders) and of the institution itself through its associated goals, programs, and initiatives. Overall, the chapter highlights the urgent need for the creation of inclusive campus environments through culturally competent practices.

Supporting Post-secondary Youth Mental Health Through Inclusive Practices Attuned to Culture

Cultural Competence in Mental Health Services: Learning from Client Experiences

People served by mental health providers represent diverse cultural groups. In-depth qualitative interviews were used to collect data to examine: “How do people, diagnosed with a mental illness, perceive their experience in a partial care mental health program from the perspective of their cultural context?” Four participants described cultural identities that included ethnic, health status, and sexual orientation identities. The participants' way of participating in the world was often in conflict with cultural values and expectations of the family and counselors. Cultural competence must include understanding how complex, multiple cultural contexts interact and influence a person's participation in the therapeutic process.

Stephanie Salomone

Papers

Cultural Lens on Mental Illness: Four Clients Share Their Perspectives