Professional Psychology: Research and Practice

© 2022 American Psychological Association 2022, Vol. 53, No. 4, 362–371

ISSN: 0735-7028 https://doi.org/10.1037/pro0000469

A Systematic Review of Cultural Competence Trainings for

Mental Health Providers
Wendy Chu, Guillermo Wippold, and Kimberly D. Becker
Department of Psychology, University of South Carolina

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 and 2019 and extracted information about curricular content (e.g., cultural
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

identities), as well as training features (e.g., duration), methods (e.g., instructional strategies), and outcomes
This document is copyrighted by the American Psychological Association or one of its allied publishers.

(i.e., attitudes, knowledge, skills). Training participants included graduate students and practicing profes-
sionals 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.

Public Significance Statement

This review demonstrates that cultural competence trainings are an effective method of shifting attitudes,
increasing knowledge, and developing skills of mental health providers to support the mental health
needs of culturally underserved communities. These findings can be used by developers of cultural
competence trainings to develop, implement, and assess the outcomes of such trainings.

Keywords: cultural competence, training, mental health providers, diversity, systematic review

Supplemental materials: https://doi.org/10.1037/pro0000469.supp

This article was published Online First June 2, 2022.
Wendy Chu https://orcid.org/0000-0001-6596-5987
Guillermo Wippold https://orcid.org/0000-0002-0095-298X
Kimberly D. Becker https://orcid.org/0000-0003-2381-8588
WENDY CHU received her BA in psychology from Macalester College. She
is currently a doctoral student in clinical-community psychology at the
University of South Carolina. Her research interests explore how mental
health providers address culture in treatment with the aim of increasing the
access to and quality of mental health services for culturally underserved
youth and families. She also examines the dissemination and implementation
of evidence-based strategies and practices on treatment engagement in low-
resourced school and community contexts.
GUILLERMO WIPPOLD received his PhD in counseling psychology from
the University of Florida. He is a licensed psychologist and an Assistant
Professor in the Department of Psychology at the University of South
Carolina. His research interests include the concept of health-related quality
of life—a multidimensional conceptualization of health that includes psycho-
logical, physical, and social functioning. His work uses a community-based
participatory research framework to develop, implement, and evaluate health-
promoting interventions among at-risk communities.
KIMBERLY D. BECKER received her PhD in psychology from the University
of Arizona. She is a licensed psychologist and an Associate Professor in the
Department of Psychology at the University of South Carolina. Her research
interests include improving the effectiveness of children’s mental health
services, with specific interests in clinical decision-making and treatment
engagement. She also collaborates with community partners on workforce
training and development.
The authors have no conflicts of interest to disclose. Guillermo Wippold is
funded by the National Institute on Minority Health and Health Disparities of
the National Institutes of Health (K23MD016123). The content is solely the
responsibility of the authors and does not necessarily represent the views of
the National Institutes of Health.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
Wendy Chu, Department of Psychology, University of South Carolina,
1512 Pendleton Street, Columbia, SC 29208, United States. Email:
wchu@email.sc.edu

362
 CULTURAL COMPETENCE TRAININGS REVIEW
Cultural competence is a core value of professional psychology
that is represented in the practice guidelines and mandates of its
governing organizations. The American Psychological Association
(APA) published the Multicultural Guidelines (APA, 2017a) to
provide psychologists with a framework to aid in the provision of
multiculturally competent practice. This document outlines 10
guidelines to taking a strengths-based approach when working
with underserved communities (Clauss-Ehlers et al., 2019). The
APA further demonstrated its commitment to cultural competence
such that the organization went beyond these recommendations to
develop enforceable standards in their Ethical Principles of
Psychologists and Code of Conduct (APA, 2017b). Of particular
importance to delivering multiculturally competent services are
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Ethical Standards 2.01a and 2.01b—Boundaries of Competence,
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which indicates that psychologists must only provide services with
populations and in areas within the boundaries of their competence
based on their education and training and must establish an under-
standing of cultural factors to implement effective services.
Equipping the mental health workforce with cultural competence
involves training professionals to engage in the lifelong, develop-
mental commitment to and practice of providing culturally sensitive
care. Such training could borrow from and build on the APA
Multicultural Guidelines, beginning with understanding oneself
as a multicultural being as a precursor to engaging in culturally
sensitive care and implementing culturally adapted treatments.
Training providers to develop cultural competence is not at odds
with efforts to train providers in culturally adapted treatments or to
initiate systems-level changes to meet the needs of culturally diverse
groups. Rather, training providers is and should be among one of
many strategies to effectively serve culturally underserved groups
and address mental health disparities.
To that end, cultural competence in mental health services can be
understood as the provision of appropriate and effective services that
are sensitive or congruent to the cultural identities of the client (Sue
et al., 1998; Whaley & Davis, 2007). In its broadest definition, an
identity is one’s subjective sense of self. A cultural identity refers to
one’s sense of affiliation and belongingness with a sociocultural
group. These groups have their own defining set of values, beha-
viors, and beliefs embedded within dynamic, intergenerational,
social, historical, and political factors (Whaley & Davis, 2007).
For example, cultural identities may be grouped by race (e.g.,
American Indians), religion (e.g., Muslims), ability status (e.g.,
people with disabilities), or immigration status (e.g., refugee, tem-
porary worker). Inherently, all individuals have cultural identities
and intersecting identities that create unique experiences.
While there has been ambiguity regarding the precise definition of
cultural competence (e.g., Whaley, 2008), there is general agree-
ment that cultural competence is multidimensional. One of the most
widely used frameworks of provider-level cultural competence was
proposed by Sue et al. (1982, 1992). Their tripartite model includes
(a) cultural attitudes (e.g., sensitivity to one’s own values and biases,
and its impacts on one’s perceptions of the client, presenting
problems, and therapeutic relationship); (b) cultural knowledge
(e.g., knowledge about one’s own cultural background, the client’s
cultural background, and how systems operate on those identities
and treatment); and (c) cultural skills (e.g., ability to use therapeutic
strategies that are culturally appropriate and sensitive). Sue and
colleagues’ conceptualization of cultural competence is accepted in
the field to encapsulate an other-orientated stance (e.g., cultural
363
humility) and concrete professional skills to enhance an individual’s
work with others. Importantly, cultural competence is fluid, mean-
ing that there is no point at which a provider’s competence is fully
“attained” and does not require further development. Rather, a
provider’s cultural competence can develop or degrade over time,
depending on their skills to meet the ever-changing needs of clients
and our diversifying society. Therefore, it is of paramount impor-
tance to understand how to effectively and efficiently promote
provider cultural competence.
Due to its strong conceptualization and practical utility, the
tripartite model is routinely applied to inform the assessment of
student and practitioner cultural competence across diverse profes-
sions, including psychologists (e.g., Johnson & Federman, 2014),
school teachers (e.g., Vincent & Torres 2015), public administrators
(e.g., Rice, 2007), and physician assistants (e.g., Domenech
Rodríguez et al., 2019). Across fields, the literature is growing at
a rate that facilitates systematic reviews regarding cultural compe-
tence trainings (e.g., Beach et al., 2005; Benuto et al., 2018; Chipps
et al., 2008; Clifford et al., 2015; Lie et al., 2011; Price et al., 2005;
Truong et al., 2014). These trainings have shown positive outcomes.
For example, Beach et al. (2005) found strong evidence that cultural
competence trainings improve health-care providers’ knowledge,
attitudes, and skills. Findings from studies involving psychologists
tend to converge with those involving other health professionals.
For example, a review by Benuto et al. (2018) found trainings to be
effective in increasing psychologists’ knowledge of topics such as
racism and discrimination. There has also been some evidence for
the effects of cultural competence trainings on patient outcomes in
health care, though there is a lack of a high-quality research to
further examine this relationship (Lie et al., 2011).
These reviews have significantly advanced our understanding of
cultural competence trainings; however, there remain opportunities
to build on their contributions and expand the impact of the
literature. First, the scope of trainings in previous reviews has
been limited to a single cultural identity, specifically race/ethnicity
(e.g., Beach et al., 2005; Price et al., 2005). A systematic review that
broadens the conceptualization of cultural diversity would offer
benefits to the field by extending our understanding of the utility of
cultural competence trainings for a range of cultural identities,
which include those based on race/ethnicity, gender, sexual orien-
tation, religion, socioeconomic class, ability status, immigration
status, among others. Second, there has been no published review
that examines cultural competence trainings in mental health pro-
viders broadly, as the only review focused exclusively on clinical
and counseling psychologists (i.e., Benuto et al., 2018). A review
that expands the scope of mental health providers is of interest to
psychologists because psychologists are leaders in developing,
implementing, and assessing evidence-based cultural competence
trainings for mental health providers. Psychologists can continue to
be on the forefront by understanding, and then adapting, strategies
developed and implemented by other fields that train mental health
providers.
To this end, the first aim of this systematic review was to address
these gaps by reviewing published studies of cultural competence
trainings that had been delivered to mental health providers broadly
(e.g., professional discipline, training level) and for a range of
cultural identities in terms of their features (e.g., training length),
content (e.g., cultures covered), methods (e.g., instructional strate-
gies used), and outcome measurement (e.g., method and domain).
 364 CHU, WIPPOLD, AND BECKER
The second aim was to identify curricula content and methods that
were common in trainings that showed positive outcomes in each
outcome domain (i.e., attitudes, knowledge, skills). By providing a
synthesis of curricula, it is possible to then identify strengths and
opportunities with regard to what has already been and what could
be developed and tested. Additionally, aggregating findings across
studies could reveal patterns about training features associated with
positive growth in cultural competence.
Method
Inclusion and Exclusion Criteria
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Studies had to meet several criteria established a priori to be
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included in this review. Inclusion and exclusion criteria are described
in Table 1 and followed a PICOTS (Population, Intervention,
Comparison, Outcomes, Timing, Setting) framework (Samson &
Schoelles, 2012).
Search Strategy
The review was conducted following the PRISMA guidelines.
Five databases (i.e., PsycINFO [EBSCO], PubMed-MEDLINE
[Ovid], Web of Science [Clarivate], ERIC [EBSCO], Google
Scholar) were searched using an a priori-defined search string:
(cultur* OR multicultur* OR transcultur* OR cross-cultur* OR
diversity) AND (competenc* OR sensitivity OR awareness OR
knowledge) AND (training* OR curriculum* OR teach* OR inter-
vention* OR workshop* OR course* OR development) AND
(“mental health”). Previous reviews and meta-analyses (Anderson
et al., 2003; Beach et al., 2005; Benuto et al., 2018; Bezrukova et al.,
2012; Brock et al., 2019; Chae et al., 2020; Chipps et al., 2008;
Clifford et al., 2015; Govere & Govere, 2016; Lie et al., 2011;
Malott, 2010; Price et al., 2005; Smith et al., 2006; Truong et al.,
2014), reference lists, and additional searches were also utilized to
identify potential articles.
Table 1
Inclusion and Exclusion Criteria
Parameter Inclusion criteria
Publication Studies published in English in peer-reviewed journals
Population At least 50% of training sample consist of individuals who are
receiving graduate training or are currently providing
mental health therapy services
Intervention Any training in standard course or workshop format
Comparison Any comparative or control group if not single-group design
Outcomes At least one cultural competence training outcome measured
for training participant
Timing Any training duration
Publication date after 1/1/1980
Study design Single-group pre–post test
Single-group post test only
Quasi-experimental
Randomized controlled trial
Setting Any setting
Selection Process
The search strategy produced 5,479 articles. After duplicates were
removed using Mendeley, a reference management program, there
were 3,948 remaining articles to be screened using the article title
and abstract. Of the articles screened, 237 were identified as
potentially relevant. Then, the full-text article was retrieved to
determine whether all inclusion criteria were met, removing an
additional 197 articles. The final sample consisted of 40 articles
(Figure 1). A full list of articles included in this review is provided in
the Supplemental Materials.
Data Extraction and Coding Process
To develop a codebook, we referenced previous reviews (Beach
et al., 2005; Benuto et al., 2018; Price et al., 2005) and literature on
cultural competence (Smith et al., 2006; Sue, 2001; Sue et al., 1982,
1992), mental health training (Beidas & Kendall, 2010; Bennett-Levy
et al., 2009; Lyon et al., 2011; Meyers et al., 1998), and learning
strategies (Hattie et al., 1996). The final codebook structure consisted
of four categories (i.e., features, content, method, outcome measure-
ment). Each category included two subcategories that were further
broken into individual codes. The features category included the
training subcategory, which included codes regarding the study design
and training structure (e.g., training duration), and the participants
subcategory, which included codes about the training sample (e.g.,
genders represented). The content category included the cultures
subcategory, which included codes of the cultural identities discussed
in the curriculum (e.g., religious identity), and the topics subcategory,
which included codes of specific topics within each cultural identity
(e.g., stereotypes). The method category included the format subcate-
gory, which captured how the training was conducted (e.g., live,
expert-led), and the strategies subcategory, which included codes of
the instructional methods used (e.g., discussions). The outcome mea-
surement category included the measures subcategory, which included
codes for how outcomes were measured (e.g., self-assessment),
Exclusion criteria
Gray literature (e.g., dissertations, theses, book chapters)
At least 50% of training sample consist of:
Health-care professionals (e.g., physicians, psychiatry
residents, nurses)
Nonproviders (e.g., administrators)
Indirect providers (e.g., supervisors)
Undergraduate students
Study abroad programs
Service-learning courses
None
Satisfaction outcomes only
Noncultural competence-related outcomes
Nonparticipant outcomes
Published before 1/1/1980
Case study
Theoretical study
None
 CULTURAL COMPETENCE TRAININGS REVIEW
Figure 1
PRISMA Flow Diagram
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and the domain subcategory, which included codes on the three
domains of cultural competence (i.e., attitudes, knowledge, skills).
Outcomes that were measured quantitatively were also coded whether
they reached statistical significance or p < .05.
Each article was coded by the first author. For articles that
included multiple studies, each study was coded independently.
The second author coded a random sample (10%) of the articles to
ensure reliability. Any discrepancies were resolved by the first
author. Data were entered and stored in a Microsoft Access database.
Coding reliability was assessed using Cohen’s kappa, a commonly
used measure of interrater reliability (McHugh, 2012). Reliability
between the two raters ranged from moderate to almost perfect
(κ = .67–.98) agreement (Landis & Koch, 1977).
Transparency and Openness
This study’s planned methods and analyses were not shared in
a public registry (i.e., preregistered) prior to conducting the study
365
(APA, 2021). Data may be requested by emailing the corresponding
author.
Results
The final sample included 40 articles published between 1984 and
2019, with many published after 2010 (n = 17, 40.5%). These
40 articles represent 42 trainings and 61 study groups, of which
17 (27.9%) were control groups and 44 (72.1%) were experimental
groups whose participants received cultural competence training.
A total of 37 unique curricula were tested in this sample of studies.
Individual study and training characteristics are provided in the
Supplemental Materials.
Study Characteristics
Study characteristics (n = 42) are presented in Table 2. The
majority of studies were conducted in the United States (78.6%).
Many studies used single group, pre–post test designs (35.7%) and
quantitative methods (45.2%) to assess outcomes. Across all studies,
 366 CHU, WIPPOLD, AND BECKER

Table 2 Content and Methods

Study Characteristics
Curricula content and methods are summarized in Table 3.
Study characteristic n % Among the 37 curricula, the most commonly covered cultural
identities were of race/ethnicity (64.9%), followed by sexual orien-
Design
Single-group pre–post test 15 35.7 tation (45.9%) and general multicultural identity (43.2%). All other
Quasi-experimental 13 31.0 identities, such as those related to gender, religion, ability status, and
Single group post test only 11 26.2 socioeconomic status, were discussed in less than one-quarter of
Randomized controlled trial 3 7.1 curricula. Common topics included sociocultural/historical infor-
Methodology
mation (e.g., legal protections, 89.2%), identity issues (e.g., identity
Quantitative 19 45.2
Mixed 15 35.7 development, 78.4%), and client interactions (e.g., therapeutic
Qualitative 8 19.0 alliance, 75.7%). Discrimination and prejudice (54.1%) were the
Year least discussed topic. Most curricula used a live, expert-led format
>2010
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17 40.5 (91.9%). Curricula were delivered in a course (n = 21) or workshop

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2000–2009 12 35.7
1990–1999 8 19.0 (n = 17) format. One curriculum was tested in both a course and
1980–1989 2 4.8 workshop format. The most common instructional strategies were
Countries didactic lectures (89.2%) and group discussions (86.5%). Assign-
United States 33 78.6 ments (e.g., presentations, 59.5%) and exercises (e.g., privilege
Canada 4 9.5
walk, 59.5%) were also commonly used strategies, while receiving
United Kingdom 3 7.1
Israel 1 2.4 feedback (e.g., after a role-play, 24.3%), providing clinical services
Australia 1 2.4 to clients (16.2%), and modeling (13.5%) were used less often.

Outcome Measurement
samples included at least one participant who was a master’s student
Across the 37 curricula, outcomes were primarily measured
(69.0%), doctoral student (47.6%), and mental health professional
using self-assessments (73.0%). Open-response questions (37.8%),
(31.0%). Across 38 studies (90.5%) that reported the discipline or
journal entries (16.2%), exams (10.8%), behavioral observation
professional fields of participants, study samples included at least
(10.8%), and client-reported assessments of provider competence
one participant who represented counseling psychology (60.5%),
(2.7%) were also used. Common standardized measures included
clinical psychology (34.2%), social work (34.2%), marriage and
the Multicultural Counseling Inventory (Sodowsky et al., 1994),
family therapy (10.5%), psychiatry (10.5%), or other fields such as
Multicultural Awareness Knowledge and Skills Survey (D’Andrea
nursing (15.8%). Studies included mixed-discipline (26.3%) and
et al., 1991), Sexual Orientation Counselor Competency Scale
single discipline samples (73.7%).
(Bidell, 2005), Lesbian, Gay, and Bisexual Affirmative Counseling
The total sample size of trained participants included 1,340
Self-Efficacy Inventory (Dillon & Worthington, 2003), and the
individuals, with sample sizes ranging from 4 to 169 (M = 32.7,
White Racial Identity Attitudes Scale (Helms & Carter, 1990).
SD = 34.4). Of the 25 (59.5%) studies that reported participant age,
the average age was 34.3 years (SD = 6.5). Across 33 (78.6%)
studies that reported gender, all included at least one female Content and Methods Common to Effective Trainings
participant and 24 (72.7%) included at least one male participant.
Across 35 studies (83.3%) that reported participants’ race/ethnicity, The second aim of this review was to describe content and
study samples included at least one participant who was self- methods that were common in curricula that showed positive out-
identified as non-Hispanic White (88.6%), Asian/Asian American comes to the provider. To accomplish this, we first identified the
(51.4%), Black/African American (48.6%), Hispanic/Latinx studies that demonstrated positive outcomes on measures of atti-
(37.1%), Multiracial (22.9%), American Indian/Alaskan Native tudes, knowledge, or skills following the training. Then, we exam-
(17.1%), Middle Eastern and North African (2.9%), and Native ined patterns of the content and methods of these curricula by
Hawaiian/Pacific Islander (2.9%). outcome domain.

Training Characteristics Attitudes

The first aim of this review was to characterize cultural compe-
tence trainings in terms of their features, content, methods, and
outcome measurement. We did this by examining patterns across the
entire sample of 37 curricula.
Features
When reported, the average length of a distinct training session
was 4.0 hr (SD = 2.1) and the total training duration ranged from a
single day to 36 weeks. Few curricula (n = 5; 13.5%) included a
follow-up or booster component.
Of the three domains of cultural competence outcomes, cultural
attitudes were most frequently assessed (n = 33, 89.2%). Quantita-
tive cultural attitudes outcomes were assessed in 22 (66.7%) of these
33 curricula. Of this number, 17 (77.5%) curricula saw statistically
significant impacts in the desired direction on providers’ attitudes
and thus served as the sample for our examination of curricular
content and methods (Table 3, “Attitudes” column). Among these
effective curricula, race/ethnicity was the most frequently discussed
cultural identity (64.7%) and all other cultural identity categories
were discussed in approximately less than a third of curricula. Four
topics (i.e., sociocultural/historical information, identity, client
 CULTURAL COMPETENCE TRAININGS REVIEW 367

Table 3
Curricula Content, Methods, and Outcome Domains

Curricula characteristics by outcome domain

Code All curricula (n = 37) Attitudes (n = 17) Knowledge (n = 15) Skills (n = 15)

Content—Cultures
Race/Ethnicity 24 (64.9%) 11 (64.7%) 8 (53.3%) 8 (53.3%)
Sexual orientation 17 (45.9%) 6 (35.3%) 8 (53.3%) 8 (53.3%)
General multiculturalism 16 (43.2%) 6 (35.3%) 7 (46.7%) 7 (46.7%)
Gender 8 (21.6%) 2 (11.8%) 2 (13.3%) 2 (13.3%)
Religion 6 (16.2%) 2 (11.8%) 2 (13.3%) 2 (13.3%)
Ability status 5 (13.5%) 1 (5.9%) 2 (13.3%) 2 (13.3%)
Socioeconomic status 5 (13.5%) 1 (5.9%) 1 (6.7%) 1 (6.7%)
Immigration status 5 (13.5%) 1 (5.9%) 1 (6.7%) 2 (13.3%)
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Linguistic ability 4 (10.8%) 1 (5.9%) 1 (6.7%) 1 (6.7%)

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Content—Topics
Sociocultural/Historical info 33 (89.2%) 16 (94.1%) 14 (93.3%) 13 (86.7%)
Identity 29 (78.4%) 14 (82.4%) 12 (80.0%) 12 (80.0%)
Client interaction 28 (75.7%) 14 (82.4%) 11 (73.3%) 11 (73.3%)
Stereotype 26 (70.3%) 14 (82.4%) 11 (73.3%) 9 (60.0%)
Mental health 23 (62.2%) 10 (58.8%) 10 (66.7%) 10 (66.7%)
Heritage 23 (62.2%) 12 (70.6%) 10 (66.7%) 9 (60.0%)
Theory 22 (59.5%) 11 (64.7%) 11 (73.3%) 10 (66.7%)
Discrimination/Prejudice 20 (54.1%) 11 (64.7%) 8 (53.3%) 7 (46.7%)
Method—Formats
Live, expert-led 34 (91.9%) 16 (94.1%) 14 (93.3%) 14 (93.3%)
Virtual, expert-led 2 (5.4%) 1 (5.9%) 1 (6.7%) 1 (6.7%)
Live, collaborative 1 (2.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Method—Strategies
Lecture 33 (89.2%) 17 (100.0%) 14 (93.3%) 13 (86.7%)
Discussion 32 (86.5%) 13 (76.5%) 12 (80.0%) 12 (80.0%)
Multimedia 27 (73.0%) 12 (70.6%) 8 (53.3%) 8 (53.3%)
Reading 26 (70.3%) 10 (58.8%) 9 (60.0%) 8 (53.3%)
Assignment 22 (59.5%) 9 (52.9%) 10 (66.7%) 9 (60.0%)
Exercise 22 (59.5%) 10 (58.8%) 11 (73.3%) 8 (53.3%)
Reflection 19 (51.4%) 6 (35.3%) 7 (46.7%) 7 (46.7%)
Direct contact 19 (51.4%) 7 (41.2%) 5 (33.3%) 6 (40.0%)
Role-play 16 (43.2%) 6 (35.3%) 5 (33.3%) 7 (46.7%)
Case scenario 15 (40.5%) 9 (52.9%) 9 (60.0%) 7 (46.7%)
Experiential immersion 10 (27.0%) 5 (29.4%) 3 (20.0%) 4 (26.7%)
Feedback 9 (24.3%) 3 (17.6%) 2 (13.3%) 3 (20.0%)
Clinical experience 6 (16.2%) 1 (5.9%) 2 (13.3%) 3 (20.0%)
Model 5 (13.5%) 2 (11.8%) 1 (6.7%) 1 (6.7%)
Note. For each domain, the n reported represents the number of curricula that yielded statistically significant changes in outcomes for that domain.

interaction, stereotypes) were discussed in over 80% of curricula
that saw changes in cultural attitudes. Mental health diagnosis and
treatment was the least common topic (58.8%). Didactic lectures
appeared in every curriculum (100.0%) that found significant
provider outcomes in attitudes.
Knowledge
Cultural knowledge outcomes were assessed in 30 (81.1%) of the
curricula. Quantitative knowledge outcomes were assessed in 18
(60.0%) of the 30 curricula, of which 15 (83.5%) yielded statistically
significant increases in providers’ cultural knowledge (Table 3,
“Knowledge” column). Among these 15 curricula, race/ethnicity
(53.3%), sexual orientation (53.3%), and general multiculturalism
(46.7%) were the most frequently discussed cultural identities. All
other identities were discussed in less than 15% of curricula. Most
topics, including theory, stereotypes, and client interactions, were
discussed in over two-thirds of trainings, with the most common
topic being sociocultural/historical information (93.3%). The least
common topic discussed was discrimination and prejudice (53.3%).
Lectures (93.3%) and discussion (80.0%) were the two most
common instructional strategy used. Exercises (73.3%), assign-
ments (66.7%), readings, and case scenarios were strategies that
were also frequently used in curricula that saw positive outcomes in
cultural knowledge. More behavioral strategies such as exposure to
others with certain cultural identities (33.3%), role-play (33.3%),
and modeling (6.7%) were used less often.
Skills
Cultural skills outcomes were assessed the least frequently
(n = 25, 67.6%) among curricula. Quantitative outcomes were
assessed in 19 (76.0%) of the 25 curricula that measured cultural
skills. Of these, 15 (78.9%) curricula found statistically significant
increases in providers’ skills (Table 3, “Skills” column). Race/
ethnicity (53.3%), sexual orientation (53.3%), and general multi-
cultural identities (46.7%) were discussed in approximately half of
curricula. All other cultural identities were discussed with lower
 368 CHU, WIPPOLD, AND BECKER
frequency. In addition to sociocultural/historical information and
identity, client interactions (73.3%), theory (66.7%), and mental
health (66.7%) were discussed in curricula that found significant
knowledge outcomes. Lectures (86.7%) and discussion (80.0%)
were the two most common instructional strategies. Role-plays
(46.7%) and reflections were used in approximately half of curric-
ula, while other strategies related to skill acquisition such as
feedback (20.0%) and modeling (6.7%) were used less often.
Discussion
This systematic review aimed to characterize cultural competence
trainings delivered to mental health providers in terms of their
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
features, content, methods, and outcome measurement. In addition,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
this review aimed to identify curricula content and methods that
were common in trainings that showed positive outcomes in each
cultural competence outcome domain (i.e., attitudes, knowledge,
skills). We examined 37 unique training curricula from 40 published
articles and have highlighted our findings to make recommendations
for future trainings.
As previous reviews on cultural competence trainings have
focused primarily on race/ethnicity, we assessed a broad range of
cultural identities and topics in our review. One of the most
important findings from this study is that the cultural identities
represented in the curricula in our review were not equally distrib-
uted. Notably, most curricula focused on race/ethnicity, sexual
orientation, gender, or general multicultural identities. This presents
the question whether mental health providers have the necessary
training to effectively serve individuals who come from other
cultural backgrounds that are not well represented in the literature,
a concern that reflects APA Ethical Standards 2.01a and 2.01b.
Importantly, this review also found that discrimination and preju-
dice was the least discussed topic in curricula. This is concerning as
marginalized individuals frequently experience discrimination in
services, with studies finding that up to 81% of clients experience at
least one microaggression in therapy (Hook et al., 2016). Given that
microaggressions in therapy have been associated with weaker
therapeutic alliance and poorer client outcomes (Owen et al.,
2017), addressing not only how discrimination affects clients’ lived
experiences, but also how providers can reduce discriminatory
behaviors may create a downstream effect of positive outcomes.
Importantly, addressing bias and discrimination in standard work-
force training aligns with policy and practice recommendations
to ameliorate structural racism in mental health service systems
(Alvarez et al., in press).
Another important set of findings involved content and methods
of effective curricula. Effective curricula, as defined by significant
changes in the desired direction, across all outcomes included
sociocultural/historical information, cultural identity, and client
interactions with high frequency. Curricula that yielded positive
outcomes on cultural knowledge and cultural skills also included
theory as a common topic. This aligns with the literature on training
adults, which suggests that discussing how theoretical knowledge
may enhance providers’ understanding or practical application of
cultural competence is a key component to include in curricula
(Yannacci et al., 2006). For curricula that found positive outcomes
on cultural attitudes and knowledge, assignments, exercises, read-
ings, and case scenarios were often used, in addition to lectures and
discussions. Moreover, while some behavioral strategies appeared
in curricula that found significant outcomes in cultural skills, there
were opportunities to leverage more of these strategies to align with
the adult learning and skill acquisition literature.
Overall, these findings are similar to those from previous reviews,
in which didactic strategies were the most commonly used methods
and active learning strategies, specifically modeling, immediate
feedback, and direct clinical experiences, were used less often
(e.g., Beach et al., 2005; Benuto et al., 2018). While didactic
strategies are effective for increasing certain outcomes such as
declarative knowledge (Bennett-Levy et al., 2009), they are not
recommended by the adult learning literature to be used in isolation
or over more active learning strategies. Active strategies such as
role-plays, feedback, and coaching have been found to be most
effective in the training of mental health professionals (Beidas &
Kendall, 2010). The active process of critical reflection, which was
found in about half of curricula, has also been posed as particularly
relevant for adult learners (Mezirow, 1991). Future research should
examine whether cultural competence trainings that capitalize on
active learning strategies such as modeling, role-playing, reflections,
and receiving corrective feedback might be even more effective than
those that rely on didactic instruction, or whether the effects of
active learning strategies might be differentially related to outcomes
at posttraining or more enduring effects over time.
Most studies in the present review used a single group pre–post
study design. While randomized controlled trial designs have high
value to understand the impact of trainings, we recognize that these
rigorous designs may not be feasible for all training developers and
for every context and that it is possible to collect useful training data
using other methods (e.g., pre–post design with multiple outcome
domains, including client perspectives). Relatedly, we found that
training length varied drastically, ranging from a single-day 45-min
workshop to a 9-month bi-weekly commitment. While some litera-
ture suggests single-day workshops alone are ineffective at building
mental health providers’ competencies (Beidas et al., 2012), the
studies in this review demonstrated that both brief and longer
trainings were successful at improving provider outcomes. This
calls the field to consider how trainings can be designed to best
match the contexts where mental health providers work, such as by
adjusting the training duration. Other scholars have also advocated
for trainings supplemented with ongoing contextual support such as
consultation and supervision to consolidate learning from training
(Frank et al., 2020).
Additionally, we found that self-assessment measures were the
most common method of evaluating the impact of training on
providers. While many measures have been validated, self-
assessment evaluations of cultural competence do not necessarily
reflect actual behavior and have been associated with social desir-
ability (Constantine & Ladany, 2000). Future research could exam-
ine whether other methods, such as knowledge tests or behavioral
observation of skills, might provide different assessments of training
outcomes (Kalinoski et al., 2013). It is also important to examine
whether training improves client engagement and treatment out-
comes (Lie et al., 2011). This may be informed by a meta-analysis or
by examining client perspectives on the cultural competence of
training participants.
In addition, we found that the population represented in most
trainings were master’s-level graduate students. It is very positive
that cultural competence is getting attention in the field at the
prelicensure level when professional habits are being established.
 CULTURAL COMPETENCE TRAININGS REVIEW
Examining graduate school curricula and comparing curriculum
requirements to cultural competence standards may inform our
understanding of the role of education and training in developing
cultural competence. At the same time, practicing professionals
were represented in less than one-third of trainings in this review.
Given that postgraduate mental health professionals report that
training can facilitate engagement with underserved populations
(Park et al., 2020), it is important to develop and support providers’
cultural competence after their training and formal education. Thus,
agencies may consider how to promote and foster ongoing devel-
opment of cultural competence for practicing professionals through
providing and rewarding attendance of cultural competence training
opportunities. Governing associations or accrediting bodies may
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
also play a role in requiring regular cultural competence training
This document is copyrighted by the American Psychological Association or one of its allied publishers.
(e.g., continuing education requirements).
Finally, the studies in this review included samples of mental
health providers that represented different professional disciplines.
Specifically, while counseling and clinical psychology trainees and
professionals were often participants, individuals from social work,
marriage and family therapy, and allied health professions (e.g.,
psychiatry, nursing) were also represented in the cultural compe-
tence trainings for mental health providers. In addition, more than
one-quarter of training samples included individuals from different
professional backgrounds. This finding reflects the interdisciplinary
nature of mental health services, which is a context valued by the
APA (2017a; 2017b) that both requires psychology’s attention and
that represents an opportunity for scientific advancement. Although
the number of studies that included individuals from professional
backgrounds other than counseling and clinical psychology was too
small for analytic comparisons with studies of counseling and
clinical psychology trainees, our review found some similar results
to a previous systematic review that examined trainings in clinical
and counseling trainees and psychologists (Benuto et al., 2018),
suggesting that the strategies and methods of other fields are not
widely different from those of counseling and clinical psychology. It
is possible and perhaps desirable for psychologists to borrow from
and build upon strategies implemented within psychology and
across similar fields. Moreover, as the demands of cultural compe-
tency change with time, the cross-fertilization of training ideas
across fields can advance the professional practice and research
of psychology more rapidly than siloed pursuits to address important
issues in our field such as improving the quality of mental health care
for culturally underserved communities.
Limitations
There are several limitations of this review to note. First, this
review gathered curricula information reported only in published,
peer-reviewed manuscripts. Unpublished work and official protocols
were not requested from authors, thus presenting the possibility of
publication bias and omission of curricula information described
elsewhere. Second, novel training approaches, such study abroad
programs, and specific service-learning programs, were also excluded
from this systematic review due to their nonstandard formats. The
studies and trainings in this review only represent information about
cultural competence workshops and courses and therefore exclude
curricula information that is potentially different and unique to these
nonstandard formats. Third, the descriptive nature of this review
cannot be used to deduce causal relationships between specific
369
curriculum elements and training outcomes. To make these claims,
additional statistical testing is needed. Fourth, there is a potential for
bias in the outcomes reported in this review, as most studies relied on
self-assessment measures of cultural competence. However, this is a
limitation of the methodology used in the field rather than of this
specific review. Nevertheless, the patterns from this review provide
training developers another source of information from the evidence
base to use in designing future trainings.
Implications for Research and Curriculum Development
We identified several opportunities, which we pose as questions
for future consideration by researchers/training developers:
1. Could the rigor of the study design be increased to
advance our knowledge of cultural competence trainings
in a meaningful way? For example, could the study
design include a control group or longitudinal/follow-up
data collection methods? Could the study employ an
additive or factorial design to examine the relative
contributions of different training methods or content?
2. Could the curricula include theoretical knowledge to set
the foundation for learning by emphasizing the relevance
of cultural competence to providers and clients alike?
3. Could the curricula expand its focus to identities beyond
race/ethnicity, such as cultural identities related to religion
or immigration status? What are the principles or proce-
dures that generalize across identities?
4. Could the curricula and training expand to include topics
of discrimination and prejudice to gain knowledge about
clients’ experiences and also opportunities for reflection
about mental health providers’ awareness and ability to
address their own discriminatory behaviors, such as mi-
croaggressions, and prejudiced beliefs?
5. Could the training incorporate active learning strategies,
such as case vignettes, role-playing, modeling, and pro-
viding feedback, to support practical application, reflec-
tion, and growth?
6. Could the study include multimethod (e.g., observation,
questionnaire) and multiinformant assessment (e.g.,
trainee, client, supervisor) to examine how methods and
perspectives converge or not?
In summary, this review demonstrates that cultural competence
trainings are generally effective at shifting attitudes, increasing
knowledge, and developing skills of mental health providers. In
considering and applying the mentioned recommendations above,
we hope that the science and practice of cultural competence
trainings can continue to improve to support the mental health
needs of culturally underserved communities.
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Received May 21, 2021
Revision received March 30, 2022
Accepted April 7, 2022 ▪