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Home > The Importance of Fathers in the Healthy Development of Children > Appendix D - Cultural Competence Self-Assessment Questionnaire, Service Provider Version

The Importance of Fathers in the Healthy Development of Children
User Manual Series (2006)
Author(s):  Office on Child Abuse and Neglect
Rosenberg, Wilcox
Year Published:  2006
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Appendix D - Cultural Competence Self-Assessment Questionnaire, Service Provider Version1

This questionnaire is designed to assess the cultural competence training needs of mental health and human service professionals. The self-assessment process is used to develop agency-specific training interventions that address cross-cultural weaknesses and build upon cross-cultural strengths of the staff, generally, and the organization, specifically. Cultural competence is a development process; therefore, the goal is to promote positive movement along the cultural competence continuum. Thus, the assessment should be viewed as an indication of areas in which the agency and staff can enhance attitudes, practices, policies, and structures concerning service delivery to culturally diverse populations.

Instructions: Please circle or otherwise mark the response that most accurately reflects your perceptions. If you have trouble understanding a question, answer to the best of your ability. Feel free to expand your responses or note concerns on the backs of the pages. Inapplicable questions will be eliminated from the analysis. Please keep in mind that there is no way to perform poorly. The higher the score, the more culturally competent your agency and staff are.

Knowledge of Communities

1. How well are you able to describe the communities of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

2. Please list the cultural group(s) of color who reside in your service area and how much of the overall population this represents:

Group Percent of Population
in Service Area		 Percent of Population
in State
_______________ ___________________________ ___________________________
_______________ ___________________________ ___________________________
_______________ ___________________________ ___________________________
_______________ ___________________________ ___________________________
_______________ ___________________________ ___________________________

2a. How well are you able to describe within-group differences?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

3. How well are you able to describe the strengths of the groups of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

4. How well are you able to describe the social problems of the groups of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

5. To what extent do you know the following demographic characteristics within communities of color in your service area? (Circle the number of your response for each area.)

  NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4
Unemployment rates 1 2 3 4
Geographical locations 1 2 3 4
Income differentials 1 2 3 4
Educational attainment 1 2 3 4
Birth/death rates 1 2 3 4
Crime rates 1 2 3 4
Homicide rates 1 2 3 4
Owner occupancy rates 1 2 3 4

6. To what extent do you know the following resources regarding people of color in your service area? (Circle the number of your response for each area.)

  NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4
Social historians 1 2 3 4
Informal supports and natural helpers 1 2 3 4
Formal social service agencies 1 2 3 4
Formal leaders 1 2 3 4
Informal leaders 1 2 3 4
Business people 1 2 3 4
Advocates 1 2 3 4
Clergy or spiritualists 1 2 3 4

7. Do you know the prevailing beliefs, customs, norms, and values of the groups of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

8. Do you know the social service needs within communities of color that go unaddressed by the formal social service system?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

9. Do you know of social service needs that can be addressed by natural networks of support within the communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

10. Do you know of any conflicts between or within groups of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

11. Do you know the greeting protocol within the communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

12. Do you know the cultural-specific perspectives of mental health/illness as viewed by the groups of color in your area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

13. Do you understand the conceptual distinction between the terms "immigrant" and "refugee"?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

14. Do you know what languages are used by the communities of color in your area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

15. Are you able to describe the common needs of people of all colors in your community?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

Personal Involvment

16. Do you attend cultural or racial group holidays or functions within the communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

17. Do you interact socially with people of color within your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

18. Do you attend school-based meetings that impact people of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

19. Do you attend community forums or neighborhood meetings within communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

20. Do you patronize businesses owned by people of color in your service area?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

21. Do you pursue recreational or leisure activities within the communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

22. Do you feel safe within communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

23. Do you attend interagency coordination (IAC) meetings that impact service delivery in communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

24. Do you attend community- or culturally based advocacy group meetings within communities of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

Resources and Linkages

25. Does your agency work collaboratively with programs that provide...

  NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4
Employment training? 1 2 3 4
Educational opportunity? 1 2 3 4
Housing? 1 2 3 4
Alcohol/substance treatment? 1 2 3 4
Maternal and child health services? 1 2 3 4
Public health services? 1 2 3 4
Juvenile justice services? 1 2 3 4
Recreation services? 1 2 3 4
Child welfare services? 1 2 3 4
Youth development services? 1 2 3 4

26. Does your agency have linkages with institutions of higher education (e.g., colleges, universities, or professional schools) that can provide accurate information concerning communities of color?

NONE1 A FEW2 SOME3 MANY4

27. Does your agency have linkages with civil rights, human rights, or human relations groups that provide accurate information concerning populations of color?

NONE1 A FEW2 SOME3 MANY4

28. Does your agency have linkages with the U.S. Census Bureau, local planners, Chamber of Commerce, or philanthropic groups who can provide you with accurate information regarding populations of color?

NONE1 A FEW2 SOME3 MANY4

29. Does your agency publish or assist in the publication of information focusing on cultural groups of color?

NONE1 A FEW2 SOME3 MANY4

30. Has your agency conducted or participated in a needs assessment utilizing consumer or family members of colors as respondents?

NONE1 A FEW2 SOME3 MANY4

31. Has your agency conducted or participated in a needs assessment utilizing consumer or family members of color as respondents?

NONE1 A FEW2 SOME3 MANY4

32. Does your agency have linkages with advocates for communities of color who can provide reliable information regarding community opinions about diverse and important issues?

NONE1 A FEW2 SOME3 MANY4

33. Does your agency conduct open house-type events to which you invite providers, consumers, and others concerned with service delivery to communities of color?

NONE1 A FEW2 SOME3 MANY4

34. Does staff utilize cultural consultants who can help them work more effectively within a cultural context?

NONE1 A FEW2 SOME3 MANY4

35. Does your agency utilize interpreters to work with non-English speaking persons?

NONE1 A FEW2 SOME3 MANY4

36. Does your agency subscribe to publications (local or national) in order to stay abreast of the latest information about populations of color?

NONE1 A FEW2 SOME3 MANY4

37. Does staff have access to culturally related materials (e.g., books and videos)?

NONE1 A FEW2 SOME3 MANY4

38. Do you maintain a personal library with cultural resources?

NONE1 A FEW2 SOME3 MANY4

39. Does your agency staff regularly attend cross-cultural studies?

NONE1 A FEW2 SOME3 MANY4

40. Are agency staff encouraged to take ethnic studies courses?

NONE1 A FEW2 SOME3 MANY4

41. Do agency workspaces contain cultural artifacts?

NONE1 A FEW2 SOME3 MANY4

Staffing

42. Are there people of color on the staff of your agency?

NONE1 A FEW2 SOME3 MANY4

43. Are there people of color represented in...

  NONE1 A FEW2 SOME3 MANY4
Administrative positions? 1 2 3 4
Direct service positions? 1 2 3 4
Administrative support positions? 1 2 3 4
Operational support positions? 1 2 3 4
Board positions? 1 2 3 4
Agency consultants? 1 2 3 4
Case consultants? 1 2 3 4
(Sub) contractors? 1 2 3 4

44. Does your agency...

  NEVER1 SELDOM2 SOMETIMES3 REGULARLY4
Hire natural helpers or other noncredentialed people of color as professionals? 1 2 3 4
Hire practicum students or interns of color? 1 2 3 4
Out-station staff in communities of color? 1 2 3 4
Hire bilingual staff? 1 2 3 4

45. Does your agency prepare new staff to work with people of color?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

46. Does your agency provide training that helps staff work with people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

47. Does your agency emphasize active recruitment of people of color?

NONE1 A LITTLE2 SOME3 A LOT4

48. How well has your agency been able to retain people of color on staff?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

49. Does your agency staff routinely discuss barriers to working across cultures?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

50. Does your agency staff routinely discuss their feelings about working with consumers/coworkers of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

51. Does your agency staff routinely share practiced-based "success stories" involving people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

52. Does your agency direct students of color towards careers in human service or related occupations?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

53. Does your agency convene or reward activities that promote learning new languages relevant to the communities of color that the agency serves?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

Service Delivery and Practice (For Direct Service Only)

54. Are you familiar with limitations of mainstream diagnostic tools as applied to people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

55. Do you discuss racial/cultural issues with consumers in the treatment process?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

56. Do you willingly share information with clients about your personal or professional background?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

57. Do you share some of your personal feelings with clients?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

58. Do you assess client acculturation or assimilation with respect to the mainstream culture?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

59. How well do you see cultural strengths and resources when planning services to clients of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

60. Do you use cultural references or historical accomplishments as a source of empowerment for people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

61. Do you use treatment interventions that have been developed for populations of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

62. Do your treatment plans contain a cultural perspective (e.g., role of extended family, spiritual/religious beliefs, issues related to the formation of cultural identity) that acknowledges different value systems of people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

63. Do you advocate for quality-of-life issues (e.g., employment, housing, educational opportunities) identified as important by communities of color in your service area?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

64. Are you familiar with the use of moderator variables?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

65. Do you use ethnographic interviewing as a technique to gather information that is more accurate?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

66. Do you use self-disclosure in the treatment process?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

67. Do you encourage the involvement of extended family members or significant others in diagnosis, treatment planning, or evaluation of treatment?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

68. Do you see clients outside of your usual office setting?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

69. Do you use clergy from the spiritual community to enhance services to people of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

70. Do you dismiss clients that come late for their appointments?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

71. Do you use consumer satisfaction measures to evaluate service delivery?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

72. Do you ensure that clients of color have transportation, child care, and other arrangements that facilitate access to your services?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

Organization Policy and Procedures

73. As a matter of formal policy, does your agency...

  NO POLICY1 CONSIDERING POLICY2 CURRENTLY WRITING FORMAL POLICY3 POLICY IN PLACE4
Use culture-specific instruments for diagnosis? 1 2 3 4
Use culture-specific treatment approaches? 1 2 3 4
Envision community empowerment as a treatment goal? 1 2 3 4
Review case practice on a regular basis to determine relevancy to clients of color? 1 2 3 4
Provide or facilitate child care? 1 2 3 4
Provide or facilitate transportation (e.g., bus tickets, ride-sharing)? 1 2 3 4
Allow access after regular business hours (e.g., through message-beeper, agreements with crisis providers)? 1 2 3 4
Specifically consider inservice plans? 1 2 3 4
Conduct outreach to community-based organizazations, social service agencies, natural helpers, or extended families? 1 2 3 4
Take referrals from nontraditional sources? 1 2 3 4
Translate agency materials into languages that reflect the linguistic diversity in your service area? 1 2 3 4
Solicit input from groups of color with respect to physical plant location and interior design? 1 2 3 4
Advocate for a better quality of life for persons of color in addition to providing services? 1 2 3 4

74. In general, how well are policies communicated to agency staff?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

75. Is information on ethnicity or culture of clients specifically recorded in your organization's management information system?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

Reaching Out to Communities

76. How well do you ensure that communities of color are aware of your program and the services and resources you offer?

NOT AT ALL1 BARELY2 FAIRLY WELL3 VERY WELL4

77. Does your organization or agency reach out to...

  NEVER1 SELDOM2 SOMETIMES3 REGULARLY4
Churches and other places of worship, clergy persons, ministerial alliances, or indigenous religious leaders in communities of color? 1 2 3 4
Medicine people, health clinics, chiropractors, naturopaths, herbalists, or midwives that provide services in communities of color? 1 2 3 4
Publishers, broadcast or other media sources within communities of color? 1 2 3 4
Formal entities that provide services? 1 2 3 4
Cultural, racial, or tribal organizations where people of color are likely to voice complaints or issues? 1 2 3 4
Business alliances or organizations in communities of color? 1 2 3 4

78. Are people of color depicted on agency brochures or other print media?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

79. Does your agency participate in cultural, political, religious, or other events or festivals sponsored by communities of color?

NOT AT ALL1 SELDOM2 SOMETIMES3 OFTEN4

 

1 The National Fathers' Network. (1996). Cultural competence self-assessment questionnaire: Service provider version. Equal partners: African American fathers and systems of health care: Discussion and resource guide (pp. 19-28). Bellevue, WA: Author. back

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