Chu, W., Wippold, G., & Becker, K. D. (2022).
Professional psychology,
research and practice, 53(4), 362–371.
Abstract
We conducted a systematic review to characterize features and evaluate outcomes of cultural competence trainings delivered to mental health providers. We reviewed 37 training curricula described in 40 articles published between 1984–2019 and extracted information about curricular content (e.g., cultural identities), as well as training features (e.g., duration), methods (e.g., instructional strategies), and outcomes (i.e., attitudes, knowledge, skills). Training participants included graduate students and practicing professionals from a range of disciplines. Few studies (7.1%) employed a randomized-controlled trial design, instead favoring single-group (61.9%) or quasi-experimental (31.0%) designs. Many curricula focused on race/ethnicity (64.9%), followed by sexual orientation (45.9%) and general multicultural identity (43.2%). Few curricula included other cultural categorizations such as religion (16.2%), immigration status (13.5%), or socioeconomic status (13.5%). Most curricula included topics of sociocultural information (89.2%) and identity (78.4%), but fewer included topics such as discrimination and prejudice (54.1%). Lectures (89.2%) and discussions (86.5%) were common instructional strategies, whereas opportunities for application of material were less common (e.g., clinical experience: 16.2%; modeling: 13.5%). Cultural attitudes were the most frequently assessed training outcome (89.2%), followed by knowledge (81.1%) and skills (67.6%). To advance the science and practice of cultural competence trainings, we recommend that future studies include control groups, pre- and post-training assessment, and multiple methods for measuring multiple training outcomes. We also recommend consideration of cultural categories that are less frequently represented, how curricula might develop culturally competent providers beyond any single cultural category, and how best to leverage active learning strategies to maximize the impact of trainings.
Here are some thoughts:
This systematic review by Chu and colleagues provides a comprehensive examination of cultural competence trainings for mental health providers, synthesizing findings from 37 unique curricula published over a 35-year period. A key insight is the uneven distribution of focus across cultural identities: while race/ethnicity, sexual orientation, and general multiculturalism are frequently addressed, other critical identities—such as religion, immigration status, and socioeconomic status—are significantly underrepresented. This raises important ethical and practical concerns, as mental health providers may be inadequately prepared to serve clients from these less-represented backgrounds. Furthermore, the authors note that discrimination and prejudice are the least commonly covered topics, a troubling omission given the high prevalence of microaggressions in therapy and their negative impact on therapeutic alliance and client outcomes.
The review also highlights methodological and pedagogical patterns in training design. Most studies relied on single-group pre-post designs, with only a small fraction employing randomized controlled trials, limiting causal inferences. Didactic methods like lectures and discussions dominate, while active learning strategies—such as role-playing, modeling, and feedback—are underutilized, despite evidence supporting their effectiveness in skill acquisition and adult learning. Interestingly, while self-assessment was the primary outcome measure, its susceptibility to social desirability bias suggests a need for more objective or multi-informant evaluations, such as behavioral observations or client-reported measures. The authors also point out that most trainees were graduate students, underscoring the need for ongoing cultural competence training among practicing professionals to ensure lifelong development.
For psychologists, this review serves as both a validation and a call to action. It affirms that cultural competence trainings are generally effective in improving attitudes, knowledge, and skills, but it also identifies clear gaps in content, methodology, and evaluation. The authors propose several forward-looking recommendations, including the incorporation of active learning strategies, expansion of cultural identity coverage, integration of discrimination-related content, and use of more rigorous research designs. By addressing these areas, psychologists can enhance the relevance, impact, and sustainability of cultural competence trainings, ultimately improving mental health care for culturally underserved communities.
