JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION

2017, VOL. 27, NO. 3, 271–288

http://dx.doi.org/10.1080/10474412.2017.1287574

Acculturation and Help-Seeking Behavior in Consultation:

A Sociocultural Framework for Mental Health Service
Andy V. Phama, Anisa N. Goforthb, Heejung Chunc, Sara Castro-Olivod,
and Annela Costaa
a
Florida International University; bUniversity of Montana-Missoula; cNew Mexico State University;
d
Texas A&M University

ABSTRACT ARTICLE HISTORY

Many immigrant and ethnic minority families demonstrate Received 25 August 2016
reluctance to pursue or utilize mental health services in com- Revised 16 December 2016
munity-based and clinical settings, which often leads to poorer Accepted 11 January 2017
quality of care for children and greater likelihood of early
termination. Cultural variations in help-seeking behavior and
acculturation are likely to influence consultation participation
and process for mental health services. Thus, examining socio-
cultural context of the consultants, consultees, and clients is
critical to the success of multicultural consultation and out-
comes. The purpose of the article is to (a) address processes
and barriers when engaging in multicultural consultation in
community-based and clinical settings, (b) outline the socio-
cultural context in relation to parent help-seeking behavior,
and (c) discuss the effect of acculturation and related socio-
cultural factors in the participation and process of consultation.

Over the years, the influx of immigrants in the United States from many parts of
the world has introduced needs for advanced training for mental health practi-
tioners, particularly when engaging in consultative practices. Consultation is one
venue for obtaining mental health service for families; however, studies have
shown that ethnic minority and immigrant families are less likely to pursue and
utilize mental health services compared to Caucasian families, with ethnic
minority youth having poorer quality of care and greater likelihood of early
termination, particularly in clinical or primary health care settings (Mendoza,
2009). Moreover, families may encounter contextual-structural barriers includ-
ing language differences, shortage of personnel trained to work with culturally
diverse families, and lack of knowledge of available mental health services or
resources (e.g., financial support, transportation, child care; American
Psychological Association [APA], 2013). School-based mental health or psycho-
logical services, on the other hand, serve to reduce such barriers to care, yet they
are often not responsive to the cultural values or needs of diverse communities
(Guo, Kataoka, Bear, & Lau, 2014). In addition, racial and sociopolitical contexts

CONTACT Andy V. Pham avpham@fiu.edu Florida International University, Leadership and Professional
Studies, 11200 SW 8th St, Miami, FL, 33199.
© 2017 Taylor & Francis
272 A. V. PHAM ET AL.

(e.g., racial tensions in media, anti-immigrant sentiment during and after elec-
tions in the United States) influence families’ sense of belonging and their
willingness to seek help from professionals whose culture or ethnic background
may differ from their own (Salas, Ayon, & Gurrola, 2013). Common socio-
cultural factors related to acculturation, stigma related to mental health pro-
blems, and the value parents place on solving problems within the family unit
are likely to influence these ethnic disparities in service utilization
(Pham, Carlson, & Kosciulek, 2010). These factors have implications for many
consultants working in community-based or clinical (e.g., outpatient) settings
where mental health services are provided (Snowden & Yamada, 2005).
Multicultural consultation has been used as a common framework in the
provision of academic and behavioral support to underserved youth and
families primarily within school settings (Ingraham, 2000). Described as a
framework or lens for understanding the influence of culture on consulta-
tion, multicultural consultation is not tied to any specific model of consulta-
tion (e.g., behavioral, consultee-centered, instructional consultation), yet
limited studies have applied this framework to non-school-based settings.
Multicultural consultation has been also described as a culturally sensitive
indirect service in which consultants adjust their practices to address the
needs and values of the consultee and/or the client (Ingraham, 2003; Tarver-
Behring & Ingraham, 1998). A component from this framework emphasizes
“cultural variations in the consultation constellation or triad” (Ingraham,
2000, p. 323), which considers the perceived cultural similarities and differ-
ences between consultant, consultee, and client and how these factors influ-
ence the process and outcomes of consultation. For example, it is possible
that a Muslim American immigrant parent and child may have different
worldviews or cultural perspectives due to their differing levels of accultura-
tion, particularly if the child is adapting to the U.S. mainstream culture more
readily than the parent. These cultural variations, we argue, also play a
significant role in whether parents decide to seek help for their children’s
mental health problems. Parents may be reluctant to participate in consulta-
tion unless professionals use sensitive approaches, such as one-downsman-
ship (Caplan & Caplan, 1993) or cultural humility (Goforth, 2016) to foster
positive relationship.
Another related consultation model is participatory cultural-specific con-
sultation (PCSC; Nastasi, Varjas, Berstein & Jayasena, 2000), which focuses
on designing, implementing, and evaluating interventions that are relevant to
the targeted culture, while identifying and addressing the culture-specific
needs of the individual (Nastasi, 2006). This model emphasizes that consul-
tation is participatory, in lieu of collaborative, as both consultants and
consultees engage in a partnership, with equal participation and involvement.
In contrast with Ingraham’s (2000) framework, PSCS integrates ethnographic
and participatory action research by systematically examining culture along
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 273

with data-based problem-solving approaches when developing interventions

with the aim of social change. In other words, change efforts must address
the role of culture in promoting and sustaining behavior patterns and out-
comes by key stakeholders (Nastasi et al., 2000).
Both of these models emphasize the need to engage in culturally respon-
sive practices that address sociocultural factors in consultation. Although
attention to cultural issues has been emphasized when working with families
of diverse racial and multilingual backgrounds, Ingraham (2000) noted that
many studies in the consultation literature do not closely examine cultural
variations that influence consultation at both individual and group levels,
and even less so with immigrant families. Ramirez, Lepage, Kratochwill, and
Duffy (1998) proposed a list of multicultural school-based consultation vari-
ables (e.g., level of acculturation, beliefs, values, perceived nature of present-
ing problem) that can influence consultation outcomes, but these variables
have yet to be explored empirically or integrated into a framework that
considers the processes of multicultural consultation (Ingraham, 2000).
Thus, we emphasize in this article these factors, particularly help-seeking
behavior and acculturation, when discussing the sociocultural context of
consultation.
A broader understanding of diversity, beyond race and ethnicity, is needed
to more fully understand the range of cultural diversity that is prevalent in
consultation systems, whether in community-based or clinical settings. The
participation and process of multicultural consultation may likely occur
differently in these settings compared to schools, depending on the severity
of the problem and the parent’s decision to seek help in those settings.
Indeed, empirical studies have explored the influence of consultant and/or
consultee race and ethnicity (Duncan & Pryzwansky, 1993; Rogers, 1998),
along with qualitative methods and case studies in cross-cultural contexts
and school settings (Miranda, 2016). In this article, we add to the existing
multicultural consultation literature by (a) addressing processes and barriers
when engaging in multicultural consultation in community-based and clin-
ical settings, (b) outlining the sociocultural context in relation to parent help-
seeking behavior, and (c) discussing the effect of acculturation and related
sociocultural factors in the participation and process of consultation.

Consultation from a sociocultural context

The role of sociocultural context must be recognized in order to provide
ethical and appropriate levels of treatment when engaging in consultation
with immigrant and ethnic minority families. This perspective stems from
Bronfenbrenner’s (1994) ecological-systems theory, which proposes that
child development and experiences are a result of reciprocal interactions
between individuals and their environments. The ecology of the child is
274 A. V. PHAM ET AL.

first described within his or her immediate sociocultural context, or the

microsystem (e.g., family, teachers, peers). The mesosystem encompasses the
interaction of those contexts (e.g., interactions between home and school).
This system is further embedded within a larger sociocultural context,
including the exosystem (e.g., parent occupation), which largely affects the
microsystem but does not have an active role in the child’s immediate
context, and the macrosystem (e.g., cultural and societal attitudes, political
and economic systems), which represents societal and economic contexts in
which the child lives.
We extend the ecological-systems theory by using an integrative theore-
tical model of development (e.g., Garcia-Coll et al., 1996), which focuses on
the unique experiences of immigrant and ethnic minority children as they
adapt to mainstream culture. Garcia Coll et al. (1996) emphasized how
developmental outcomes must be understood in terms of demographic con-
texts (e.g., living in urban or rural community) and social stratification
(e.g., race, ethnicity, social class). The effects of this stratification may create
common sociocultural processes among individuals of color, regardless of
ethnicity or immigrant status, to form an adaptive culture that is defined by a
set of goals, attitudes, and behaviors that differ from the mainstream culture
(Marks & Garcia-Coll, 2007). Children and families are exposed to similar
environments (e.g., community, neighborhoods, health care systems) across
cultures, ethnic groups, and socioeconomic backgrounds; however, macro-
system variables such as poverty, prejudice, and segregation can affect many
immigrant families and children of color in these settings, where consultation
takes place.
Consultants are encouraged to evaluate how these settings (a) promote or
inhibit consultative processes and client outcomes and (b) influence adap-
tive cultures that are created in response to children’s and families’ accul-
turation. For example, acculturating parents must negotiate whether to
retain their native cultural values and parenting practices and/or adopt
strategies when deciding to participate in a parent training program.
Consultation outcomes can be negatively affected by incongruence between
institutional ideologies and cultural or familial values, also known as inhi-
biting environments (Garcia-Coll et al., 1996). Promoting environments, on
the other hand, result from compatibility between the values, goals, and
expectations of the consultants and those of the consultees in those parti-
cular settings (Garcia-Coll et al., 1996). Thus, inhibiting environments can
turn into promoting environments when consultants support both consul-
tee and client outcomes and when strategies are co-constructed strategies in
order to achieve mutual understanding and common ground. Adaptive
cultures are thus a product of the parent and/or child’s cultural history
and the contextual demands placed by the environment.
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 275

Immigration status, family acculturation, and help-seeking behavior are

important factors that influence cultural adaptation and integration
(Blanco-Vega, Castro-Olivo, & Merrell, 2008; see Figure 1). Immigrants
often struggle balancing their native culture with the mainstream culture
throughout the acculturation process. Those holding a multicultural ideol-
ogy believe that all cultural groups should have the opportunity to retain
their basic cultural norms, values, and traditions within a greater cultural
context (Sam & Berry, 2010). According to this perspective, the country
benefits from the presence of diverse groups that bring a broad array of
skills. Consultants should therefore consider the sociocultural context of
the parents and children with whom they work and, more important,
evaluate the cultural climate of the setting where consultation occurs. In
community-based and clinical settings, this may involve assessing the con-
sultant’s own culture and biases, culturally adapting evidence-based prac-
tices, providing mental health literacy, and forging relationships with
churches and schools (APA, 2013). This awareness may help to promote
parent help-seeking behavior and intervention acceptability.

Parent help-seeking behavior

The motivation to seek assistance is considered an essential element to the
success of consultation. However, many consultation case studies and sce-
narios often have consultees (e.g., parents or teachers) already participating
in consultation with little understanding or background of the circumstances
that drive this decision making (Boulter & Rickwood, 2013). Consultees may

Help-Seeking Behavior
Acculturation
Problem recognition Multicultural
Sociocultural context
Parent appraisal of child
Parent acculturation Consultation
behavior
Child acculturation Stigma of mental health
problems

Immigration Experience and Acculturative Stress

Context
Circumstances of exit
Circumstances of entrance
to mainstream culture
Cultural Adaptation and
Family acculturation gaps Integration
Cultural identity and lack of
cultural congruity Mental health awareness
Cognitive appraisals of and outcomes
prejudice and discrimination

Figure 1. Cultural variations of acculturation and help-seeking behavior in addressing mental

health needs of immigrant and ethnic minority populations. Adapted from Blanco-Vega et al.
(2008).
276 A. V. PHAM ET AL.

ask or request services if they desire to seek them out, or they may feel
pushed into working with consultants due to external forces (e.g., school
referral). With regard to the latter, for example, a teacher expresses concern
to parents about their child who is being disruptive in the classroom, but the
parents may reluctantly work with an outside consultant (e.g., psychologist or
psychiatrist) because they may not believe that it is their problem. Yet, little
attention has been paid to the dynamics of parent help-seeking behavior,
particularly in relation to consultation of child mental health issues. Brown,
Pryzwansky, and Schulte (2006) describe help-seeking behavior as a powerful
variable that determines who does or does not seek consultation, how
involved they become, and how successful the intervention planning and
implementation will be.
Help-seeking is a process that initially suggests a linear progression (Logan &
King, 2001), but alternative models have been adapted to describe a more
complex and multifactorial process when taking into account parent recognition
of the problem (e.g., Stiffman, Pescosolido, & Cabassa, 2004). From both
ecological systems and integrative theory of development perspectives
(Bronfenbrenner, 1994; Garcia-Coll et al., 1996), several factors influence parent
appraisals of child behavior and components of help-seeking behavior, including
the type and severity of the problem, child factors (e.g., age and sex), parent and
family factors (e.g., family constellation, parent well-being), sociocultural values
and beliefs (e.g., perceptions of causes of mental health problems), and service
characteristics (e.g., culturally responsive or bilingual services; Cauce et al. 2002).
Moreover, barriers to help-seeking behavior include perceptions of stigma
associated with mental health problems (Hui, Wong, & Fu, 2014; Pham et al.,
2010), perceived consequences of feeling blamed (Shanley, Reid, & Evans, 2008),
and potentially having the child removed from the family (Sayal et al., 2010),
which can be most concerning for immigrant families. These barriers can be
especially important in understanding why some parents recognize that a
problem exists but choose not to seek help, especially within clinical or primary
health care settings. We will discuss sociocultural factors related to problem
identification and beliefs about mental health issues, since help-seeking behavior
can be either facilitated or derailed by these factors.

Parent perception and appraisal of problem

Consultant and consultee can differ greatly in their perceptions and apprai-
sals of their child’s behaviors, whether these behaviors are concerning
enough to be considered a problem, and whether the problem warrants
outside intervention (see Figure 1). In most cases, the identification of a
child’s or adolescent’s mental health problems, along with decisions about
help seeking and intervention implementation, are determined by the child’s
mother, in consultation with family members, including her child
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 277

(Cauce et al., 2002). The way parents or caregivers view their children’s
problems may be incongruent with how consultants assess and determine
symptoms. For example, a consultant may be more likely to identify a child’s
escape behaviors as an issue related to anxiety and academic frustration
rather than laziness or lack of motivation, as could sometimes be viewed
by family members. When under financial or social distress, parents may be
less sensitive or less apt to notice their child’s mental health concerns
(Yeh et al., 2005). In either clinical or primary care settings, consultants
may consider conducting routine screening of parent well-being, as it is
important to examine the effect of parental stress on appraisals of child
behavior and parents’ willingness to seek help for child behavior problems
(Godoy, Mian, Eisenhower & Carter, 2014). This approach may allow con-
sultants to establish rapport, provide resources or alternative sources of
support, and understand the cultural context of their decision-making
process.
When a trusting relationship is formed, the next step is often for the
consultant and consultee to discuss the roles that each will take in consulta-
tion. Although these initial roles aim to establish a nonhierarchical and
nonprescriptive relationship between the parties, this expectation can vary
across cultures and depending on the type and severity of the problem
(Brown et al., 2005). In some scenarios, particularly in clinical settings, a
consultee may believe that the role of the consultant is to provide and
implement solutions to the problems, as consultants are the ones being
sought for help. There are also tendencies for either side to focus on efforts
to “fix” the problem within the child, family, or school. Consultants can assist
consultees by proactively and jointly reframing the focus toward designing,
implementing, and evaluating solutions. They should also aim to use a
nondeficit approach by focusing on shared strengths of the consultee and
client, while adopting an open and nonjudgmental attitude (Newman &
Ingraham, 2016). When consultees (and maybe consultants) perceive fault
and place blame on others for the child’s problems, then the consultation
relationship is at risk. Considering that parents may bring different cultural
beliefs to the consultation process or treatment context, discrepancies
between the beliefs of the consultants and consultees may persist.
Many ethnic minority or immigrant parents also may not understand the
triadic nature of consultation, which often focuses on changing behaviors of
the consultee in order to improve client or child outcomes (Pham, 2015). For
example, the psychologist (consultant) presents concerns of the child’s
aggressive and disruptive behavior, yet parents (consultee) may view the
cause as “lack of structure or support” from the psychologist. Therefore,
consultants must carefully assess parents’ beliefs regarding expectations and
goals of consultation and the responsibilities regarding intervention accept-
ability and implementation. Instead of placing fault on either party, the
278 A. V. PHAM ET AL.

consultant can encourage parents to share ideas on how “structure and

support” is framed in their culture that would help promote and elicit
acceptable behavior of the child at home. The consultant can also bridge
perspectives with the parent, while encouraging the parent to share strategies
that have worked and have not worked with the child at home. In that way,
the consultant can incorporate input while working together to co-create
concrete goals and interventions that are meaningful and acceptable for the
parent.

Stigma related to child mental health problems

Although consultants and consultees may be able to identify the problem,
consultees many not necessarily seek out or follow through with intervention
due to stigma associated with mental health problems (Hinshaw & Stier, 2008;
Parcesepe & Cabassa, 2013). Stigma in this context refers to a set of negative
cultural attitudes, beliefs, and behaviors that influence the individual, or the
general public, to fear, reject, avoid, and discriminate against those with mental
health problems (Gary, 2005). There is evidence to suggest that stigma related
to mental health problems and service utilization is more prevalent among
ethnic minorities and immigrants compared to educated, middle-class White
communities (Hinshaw, 2005; Turner, Jensen-Doss, & Heffer, 2015). Those
individuals who are most vulnerable to prejudice and discrimination because
of their ethnic minority and immigrant status are also likely to experience
increased stigma when faced with mental health problems (Gary, 2005).
Promoting mental health awareness through multicultural consultation
could aid in decreasing stigmatizing views, thus increasing the likelihood
that parents would seek help and follow through with consultation and
intervention. Power (2010) suggested that promotion of mental health infor-
mation in school- and community-based settings would (a) increase public
understanding and acceptance of child mental health issues and (b) build
resiliency in families. This promotion can be done by increasing mental
health literacy, which aids in recognition, management, and prevention of
mental health concerns (Jorm et al., 1997; Lam, 2014). Because many parents
from impoverished communities may come with suspicions and misinforma-
tion about mental health, consultants can open a dialogue early to under-
stand their cultural beliefs and expectations, along with any perceptual
barriers to intervention (Lam, 2014). Consultants empathize with the con-
sultee’s experiences and emotions and engage in perspective taking to view
concerns related to the problem, along with stigma, through the lens of the
consultee. By doing so, consultants are able to express unconditional positive
regard and respect for the complexity of challenges that both consultees and
clients experience. Consultants can then discuss contextual information,
including risk factors and manifestations of the problem during the problem
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 279

identification stage, and subsequently provide additional resources on mental

health awareness (e.g., books, websites, videos) to support and empower the
consultee throughout the consultation process (Jorm et al., 1997).
Opportunities to meet with other families who have similar experiences
can help increase the consultee’s social support network.
With regard to building resiliency early in consultation, cultural and
mental health awareness would allow consultees to access new knowledge
and skills and successfully adapt to their new social worlds and networks. For
example, at the community level, immigrant families have been found to rely
heavily on spiritual communities for social support (e.g., Goforth et al., 2016)
during the early stages of immigration. Consultees who participate in reli-
gious systems or organizations exhibit resiliency by demonstrating greater
family cohesion and learn coping skills (Goforth et al., 2016). Religious
traditions provide a sense of belonging and familiarity along with a connec-
tion to their heritage culture, particularly after migration. Consultants can
informally assess children’s or parents’ social support and engagement by
determining activities that families regularly participate in, such as member-
ship in community, clubs, and churches or other places of worship
(e.g., temple, mosque).
Establishing a shared partnership with the consultee also requires the
consultant to adopt an attitude of “cultural humility” (Goforth, 2016),
which can help to reduce stigma. Using cultural humility, the consultant
engages in continual self-reflection and self-critique and does not assume
that his or her personal beliefs are superior to others. Doing so helps the
consultant normalize the experience of the consultee and convey compassion
before broaching topics regarding mental health awareness. Opening the
consultation process with a discussion about strengths and mental health
resources may help parents to develop trust necessary to share sensitive
information with the consultant. Consultants respect and build on their
own cultural awareness as well as the consultees’ cultural knowledge to
determine collaboratively what services and support would be acceptable
for all parties involved.

Acculturation
To provide culturally responsive consultation, it is important for the
consultant to understand his or her own culture and the culture of the
consultee (Ingraham, 2000). One component of culture is acculturation,
which is broadly described as a process of psychological, social, and beha-
vioral change that results from engaging and navigating multiple cultural
environments (Berry, 1997). This construct is complex because it allows for
bidirectional effects, or how the consultee (e.g., parent) and client (e.g., child)
280 A. V. PHAM ET AL.

participate in the new mainstream culture (i.e., host culture) while retaining
their heritage cultural experiences (i.e., native culture).
An understanding of acculturation of both consultee and client is neces-
sary to facilitate consultation outcomes. Although any individual can experi-
ence acculturation when coming into contact with a new or different culture,
scholars have conceptualized acculturation as a cultural socialization to the
mainstream culture (e.g., Berry, 1997). Immigration changes families’ daily
experiences and plays an important role in how families adjust and interact
in various contexts. These processes of acculturation can also lead to altera-
tions of interpersonal social networks and extraction from one socioeco-
nomic system into another.
Families respond to the immigration experience in several ways. When
acculturation is viewed as bilinear, it describes the level to which individuals
maintain their heritage culture and/or participate in the mainstream culture
(Yoon, Langrehr, & Ong, 2011). Traditional acculturation models suggest that
this process can occur along a linear path where immigrants may resist becom-
ing acculturated to the mainstream culture and thus are still immersed in the
heritage culture. Other individuals may be completely immersed in the main-
stream culture, while gradually shedding their heritage cultural orientation.
However, the balancing of dual cultures may or may not occur independently
from each other, such that immigrants can still adopt and maintain beliefs or
customs from more than one culture. According to Sam and Berry (2010),
individuals who demonstrate integration, or those who selectively adopt both
heritage and mainstream cultures to some degree, experience less stress and
achieve more positive cultural adaptations than those who reject or avoid either
culture. However, integration can only be attained when mainstream society or
the community is open and inclusive in its orientation toward cultural diversity.
Thus, multicultural consultation requires mutual acceptance from both cultures
to attain integration. This strategy requires consultees to adopt the basic values
of the larger community, while at the same time consultants must be prepared to
adapt to meet the needs of consultees and clients.
Consultants should also understand that acculturation is multidimensional,
where individuals may have differing levels of acceptance of or engagement
in specific cultural references, such as values, identity, language use, media
preferences, worldviews, traditions, and behaviors (Yoon et al., 2011).
Because acculturation is a process that occurs in a sociocultural context,
the individual may selectively retain and/or adopt values and attitudes
depending on the demands encountered in the cultural environment
(e.g., school, work, home). Whether immigration is voluntary or involuntary,
families are uprooted from their original environment, severing social and
cultural ties with their community in order to form new ones in a different
environment. Thus, the process of acculturation can be stressful for both
parent and child.
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 281

Acculturative stress
Acculturative stress is conceptualized as the behavioral response to intercul-
tural contact and is a way to understand how the interaction between cultures
affects an individual physically, psychologically, and/or socially (Berry, Kim,
Minde, & Mok, 1987). Acculturative stress is associated with the degree to
which individuals cope with the stressor related with the process of accultura-
tion. Consultants should take into account immigrant parents who are most
vulnerable to both acculturative stress and parental stress when working with
an acculturating child who exhibits mental health problems. Differences in
how parents and children cope with the demands of acculturative stress can
influence psychological outcomes (Wrobel, Farrag, & Hymes, 2009). Indeed,
recent studies of immigrant families have shown that high levels of accultura-
tive stress are associated with more internalizing symptoms among youth
(Goforth et al., 2016; Sirin, Ryce, Gupta, & Rogers-Sirin, 2013), decreased
school belonging (Roche & Kuperminc, 2012), and decline in family cohesion
(Dillon, de la Rosa, & Ibanez, 2013). Thus, acculturative stress adds another
layer of complexity that consultants should take into account, particularly
when developing intervention.

Family acculturation gap

Although parent and child may come from similar cultural backgrounds,
generational differences in acculturation and acculturative stress can exist in
families. Many researchers have focused on “expected” acculturation gaps,
where children are typically more acculturated than parents in the main-
stream culture (e.g., Costigan & Dokis, 2006); however, a review of studies
suggests that this type of family acculturation gap does not lead to youth
maladjustment (Telzer, 2010). Smokowski and Bacallao (2007) suggested that
in the case of Mexican families, parents welcomed higher levels of accultura-
tion in their children and suggested that biculturalism (i.e., acceptance of
both native and mainstream culture) and integration foster resiliency, adjust-
ment, and high self-esteem in youth.
Studies have shown that another type of family acculturation gap, where
parents acculturate faster than their children, contributes to acculturative
stressors (e.g., parent-child conflict), which leads to increased internalizing or
externalizing behavior in children (Ho & Birman, 2010; Rasmi, Chuang, &
Hennig, 2015). For example, if a mother who is an immigrant from
Honduras decides to seek intervention support for her child born in the
United States, the consultant and consultee would likely need to develop an
intervention plan that would take into account the child’s likely differing
acculturation level, especially if the child experiences significant difficulties
adapting to the mainstream culture compared to the child’s mother. Rasmi
282 A. V. PHAM ET AL.

et al. (2014) found that Arab Canadian adolescents who were more oriented
toward their heritage culture than their parents experienced greater family
conflict and youth maladjustment. These findings suggest that among immi-
grant families, it may be normative for children to be acculturated more than
parents; however, adverse outcomes may arise if children retain more of their
heritage culture than parents (Telzer, 2010). Consultants therefore should be
aware of these cross-generational acculturative patterns when working with
consultees and clients, as this likely would influence intervention develop-
ment and outcomes. Acculturating parents may likely negotiate between
traditional child-rearing practices or evidence-based behavioral interven-
tions. Immigrant youth may feel isolated or may not feel accepted in the
mainstream culture and thus would likely experience stress as they struggle
with their own cultural identity (Goforth, Pham, & Oka, 2015).

Cultural identity and lack of cultural congruity

Cultural identity can be viewed as how individuals perceive themselves as
cultural beings and as part of a larger cultural group, while also considering
their values, beliefs, and traditions. It is closely tied with acculturation since
cultural identity is salient for ethnic minorities and immigrants who have
encountered discrimination and prejudice (Berry, Phinney, Sam, & Vedder,
2006; Chun, Marin, Schwartz, Pham, & Castro-Olivo, 2016). While cultural
identity is not typically the focus of consultation, Ingraham (2000) argued
that cultural saliency, or the perception of identity between consultant or
consultee, may influence the consultation process (Leong, 1996). In this
framework, the multicultural consultant searches for ways to establish trust
and connections by finding points of commonality and shared understanding
during consultation. The consultant may also acknowledge and respect
differences if they are salient.
We expand on this idea by emphasizing the importance of cultural con-
gruity. Cultural congruity is defined as the cultural fit between the indivi-
dual’s culture and the mainstream culture (Gloria, Castellanos, & Orozco,
2005; Hill & Torres, 2010). As discussed earlier from Garcia-Coll and col-
leagues’ (1996) theoretical model, lack of cultural congruity (or cultural
incongruity) is reported whenever consultants and consultees are exposed
to two cultures that differ in values, expectations, and beliefs. Because the
consultant’s culture may contrast with the consultee’s cultural values and
belief systems, it is not uncommon to experience cultural mismatch, espe-
cially if there is disagreement in how each party views the role of the parent
with regard to intervention. For example, Hill and Torres (2010) argued that
many Latina/o parents are responsible for teaching their children to be
moral, responsible, and respectful, as part of being “well educated.”
Although much of the literature on consultation promotes “partnerships”
 JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 283

and “collaboration,” particularly in consultee-centered consultation, many

parents may feel uncomfortable with being “equal partners” with profes-
sionals in a clinical or primary care setting, which can lead to intervention
paralysis, or the inability to develop the intervention (Ingraham, 2000).
Because of the differences in expectations between consultant and consultee,
parents may be reluctant to engage in a consultation relationship if they
believe their own authority and responsibilities at home are questioned (Yan
& Lin, 2005). Consultants who demonstrate empathy and use one-down-
smanship (Caplan & Caplan, 1993) can join the consultee in a positive
partnership to learn more about the consultee’s and client’s worldviews and
frames of reference.
When determining cultural saliency, consultants are often left to inference
or stereotype since it may be awkward to ask about the consultee’s cultural
identity directly. Instead, consultants can gather information from the con-
sultee about their experiences and behaviors relating to acculturation.
Consultants can inquire about the consultee’s relationship with friends and
family, language proficiency and use at home and/or at school, perceptions of
mental health, sources of information gathered regarding mental health, and
previous strategies employed to address the client’s problem. By focusing on
these topics, consultants may have better awareness and understanding of the
consultee’s and client’s acculturation levels and the context in which the family
addressed the problem. Several acculturation scales may be used to explore
parent’s and child’s cultural values, beliefs, customs, language, and socializa-
tion. Examples include the Stephenson Multigroup Acculturation Scale
(SMAS; Stephenson, 2000) and the Vancouver Index of Acculturation (VIA;
Ryder, Alden, & Palhaus, 2000). Research and practice should continue to
develop and validate methods for learning about the consultee’s perceptions,
values, worldviews, and cultural identity in order to understand how culture
influences the participation and process of mental health consultation.

Future research and directions

There is a great need for researchers and practitioners to understand the
sociocultural context of consultation, yet research exploring family accultura-
tion processes and help-seeking behavior is relatively nascent. Multicultural
consultation has been primarily applied to and examined in school settings
(Ingraham, 2000); however, the goal of this article was to expand on this
framework by elaborating on particular sociocultural issues relevant to
immigrant populations that can affect consultation in nonschool settings.
Thus, future research may consider employing this framework with immi-
grant parents taking into consideration the sociocultural factors highlighted
above, as well as the type and severity of the child’s mental health problem
(e.g., adjustment, anxiety, depression). Studies should also continue to
284 A. V. PHAM ET AL.

explore parent perceptions of mental health problems and intervention and

the effectiveness of mental health literacy (Jorm et al., 1997) in reducing
stigma and improving client outcomes from consultation.
The few studies that have investigated parent and child acculturation often
use level of English proficiency or number of years resided in the United Studies
as proxies for acculturation (Betts, Bolt, Decker, Muskens, & Marston, 2009);
however, doing so underscores the complexity of the acculturation construct.
Descriptive qualitative methods (e.g., focus groups) or case studies may help in
obtaining a comprehensive view of the family’s unique acculturation experi-
ences in relation to consultation process and outcomes. Researchers and practi-
tioners should also consider conducting culture-specific needs assessment to
identify critical factors when providing consultation services to parents and
families. This information can help with future training of culturally responsive
mental health practitioners for working with diverse families.
Due to the emphasis on reducing ethnic and racial disparities of mental health
service utilization, another area of study is to explore facilitators and barriers of
help seeking in various settings that provide mental health services. Research can
also examine how different media or sources of information can assist with help
seeking and parental knowledge of mental health of both parents and children or
adolescents (e.g., videos, pamphlets, websites, etc.). This can help with bridging
communication with consultants using shared vocabulary along with increasing
knowledge of mental health problem identification and intervention.
In conclusion, consultants are, and increasingly will be, serving diverse
families in a variety of settings. With perceived racial tensions becoming wide-
spread in the United States, consultants must consider the critical role of
sociocultural contexts in the families’ experiences of immigration, accultura-
tion, and help seeking. Cultural variations associated with these experiences
have implications in the consultee’s participation and process of consultation,
utilization of mental health services, and cultural adaptation and integration in
mainstream society. It is our hope that this framework will stimulate additional
inquiry, research, and reflection as the topic of immigration and mental health
has become central in light of recent sociopolitical events in this nation.

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Notes on contributors
Andy Pham, PhD, is an assistant professor of School Psychology at Florida International
University.
Anisa N. Goforth, PhD, is the director of the School Psychology Graduate Training Programs
at the University of Montana.
Heejung Chun, PhD, is an associate professor of Counseling & Educational Psychology at
New Mexico State University.
Sara Castro-Olivo, PhD, is an associate professor of Educational Psychology at Texas A&M
University.
Annela Costa, EdS,is a graduate of the School Psychology program at Florida International
University. She is currently a doctoral student in the Exceptional Student Education program
at Florida International University.

Note: The authors report that, to the best of their knowledge, neither they nor their affiliated
institutions have financial or personal relationships or affiliations that could influence or bias
the opinions, decisions, or work presented in this article.
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