The purpose of this dissertation is to explore whether rehabilitation counselor/consumer racial similarity is related to rehabilitation services provided and employment outcomes achieved. This research contributes additional information to the research base on how to educate and train practicing vocational rehabilitation counselors to support culturally and linguistically diverse (CLD) consumers more effectively. Information regarding racial dyads may help to articulate whether CLD counselors are more effective with CLD consumers. Utilizing the RSA-911 data file submitted by California for fiscal year 2006 as well as 189 Multicultural Counseling Inventory (MCI) surveys collected on practicing vocational rehabilitation counselors, ANOVA, MANOVA, ANCOVA and chi-square analysis were used to measure relationships among counselor and consumer dyads that were either similar or dissimilar in ethnicity and case service variables and outcome variables. Additional analysis focused on the influence of high versus low cultural competency of rehabilitation counselors and the same consumer case service and outcome variables. Study results revealed statistically significant differences on MCI total scores between counselor ethnic groups, with Hispanic counselors demonstrating the highest mean scores overall on the MCI. In addition, significant differences existed between counselor ethnic groups on MCI total scores, as well as all four subscale scores. Chi-square was used to investigate the effect of counselor ethnicity and cultural competency scores on the case service variables of job search, rehabilitation technology, maintenance and college training, as well as outcome variables of competitive employment. MANOVA and ANCOVA were used for the continuous outcome variables of cost of services, wages at closure and weekly earnings at closure. Significant chi-square results were found for some of the service and outcome variables for both the matched counselor/consumer dyads and the counselor competency score groups. More significant findings existed in the ANCOVA analysis for cultural competency scores than for matched ethnicity groups. Implications of the findings and suggestions for future research are discussed. / text

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Managing language choice in speech-language intervention is increasingly an issue for speech-pathologists treating bilingual children. Frequently L2 approaches only are implemented, resulting in negative effects on L1 acquisition, familial ties, and cultural transmission. This study examined the impact of a bilingual intervention on a school-aged child and her family. Providing intervention and therapy activities in the L1 resulted in increased parental engagement, increased L1 use by the child, and increased awareness of strategies for treating bilingual children among SLPs at the study site.

xiii, 101 p. / Ensuring that psychological interventions are well received and effective among ethnically and culturally diverse groups is at the forefront of psychological research. This study is a nonexperimental, posttest evaluation of differences between European American and ethnocultural group parents' perceptions of the Family Check-Up (FCU), a family-centered, ecologically and community-based intervention that provides family assessment, support, and motivation to change for families coming to counseling. Research has demonstrated the effectiveness of the FCU but has yet to evaluate parent perceptions of the FCU. This study examines features of intervention implementation that lead to treatment satisfaction and adherence by evaluating parent perceptions of (a) the FCU intervention, (b) therapist interpersonal qualities, and (c) therapist multicultural competence. Both parent and observational coder ratings of the intervention were assessed along these dimensions. In the first year of a longitudinal study of the FCU, data were collected from parents of children who attended three public middle schools in a metropolitan area of the Pacific Northwest. Within-subjects analyses were conducted to assure measurement validation and treatment fidelity. A between-subjects multivariate analysis of variance was utilized to examine ethnocultural group differences. Results revealed that all measures demonstrated high internal consistency reliability, high interscale correlations, and good construct validity. Results revealed high interrater agreement between parent ratings of treatment receipt and coder ratings of treatment delivery, indicating treatment fidelity. Results revealed no statistically significant differences in parent perceptions of the FCU intervention, regardless of parent ethnocultural group. Additional analyses demonstrated that observational coders rated family consultants who worked with ethnocultural group parents higher in multicultural competence than those who worked with European American parents. In summary, study results suggest (a) that the measures developed and adapted for this investigation were reliable and valid, and (b) that we found no evidence of perceived differences in the FCU intervention across ethnocultural group and European American parents. The FCU continues to be an intervention that can be successfully implemented among ethnically and culturally diverse families. / Committee in charge: Dr. Benedict McWhirter, Chair; Dr. Elizabeth Stormshak, Member; Dr. Joseph Stevens, Member; Dr. Thomas Dishion, Outside Member

xiv, 134 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Recent mandates for increased multicultural competence training in a variety of fields have stimulated a growing need for reliable and valid multicultural competence assessment instruments. Existing instruments have demonstrated varying levels of reliability and validity in assessing multicultural knowledge, awareness, and skills and have been critiqued for limitations in scope, applicability, and ability to capture the developmental nature of multicultural competence. In an attempt to address limitations of existing measures, this study investigated an original measure of multicultural competence utilizing a stages of change framework. The stages of change model has been applied to many types of behavior change but not yet to the construct of multicultural competence. The participants in this study were undergraduate and graduate students in human services (assessed one time), graduate students in education (assessed before and after participation in a required diversity course), and student services professionals (assessed before and after participation in a multicultural training). Findings suggest that the proposed measure, the Multicultural Competence Stage of Change Scale (MCSCS), has a six factor structure corresponding to the five stages of change and one social acceptability factor. The reliability of the measure was adequate, with values of Cronbach's α above .70 for 4 out of 6 subscales and .82 for the full scale score. The validity of the MCSCS was demonstrated by significant correlations with the Multicultural Awareness, Knowledge, and Skills Scale, Counselor Edition, Revised. Results indicate that student affairs professionals scored significantly higher than education students on the Pre-Contemplation and Preparation subscales and that pre-test scores were significantly lower than post-test scores on the Pre-Contemplation, Contemplation, and Action subscales. This study provides evidence that the MCSCS is a promising measure of multicultural competence stage of change. A discussion of the findings includes strengths of the MCSCS, limitations of this study, future research directions, recommended measure revisions, and applications of the MCSCS to clinical and vocational settings. / Committee in charge: Dr. Ellen McWhirter, Chair; Dr. Krista Chronister; Dr. Joseph Stevens; Dr. Mia Tuan

Speech-language pathology programs utilize short-term study abroad programs to enhance students’ cultural competence. Yet, an investigation of how study abroad impacts students' cultural competence does not exist. This study’s purpose was to investigate the effects of a study abroad program in Mexico on the cultural competence of SLP master's students. A two group, pre/post mixed methods quasi-experimental design was used. Participants included a treatment and control group. Pre/post-trip surveys and semi-structured interviews were completed and analyzed for differences in cultural competence between groups and for growth in cultural competence for the treatment group from pre- to post-trip. Findings indicated that the treatment group demonstrated gains across all components of cultural competence, and had significantly higher post-trip cultural confidence as compared to the control group. Gains in the treatment group’s cultural competence were influenced by gains in cultural and general professional skills and cultural interactions. Implications for the discipline are discussed.

Trans* studies and issues have recently increased in coverage by the media and popular press. With recent changes in the DSM-5 (APA, 2000; APA 2013) and insurance law (HHS, 2014), trans* healthcare has been under increasing scrutiny. While a small number of studies (Bradford, Reisener, Honnold, & Xavier, 2013; Grant et al., 2011; Rounds, McGrath, & Walsh, 2013; Tanner et al., 2014) have documented discrimination and lack of cultural competencies from the perspective of trans* patients, little research exists that examines the training, support, and decision-making processes of medical professionals who treat trans* patients (Snelgrove et al., 2012, p. 2). The goal of this research study is to explore the training and cultural competencies of healthcare professionals in treating trans* patients by surveying and interviewing healthcare professionals about their experiences of trainings, familiarity with practices/protocols, and attitudes toward treating trans* patients. A survey of 35 health care professionals and nine interviews were conducted. These health care professionals, while generally accepting of trans* individuals, still had some reservations about working with trans* patients and suggested that there were many barriers and challenges to providing trans* health care. A majority of health care professionals had little or no familiarity with treatment protocols or diagnoses for trans* patients, and very few had received any type of training (formal or informal) before or after starting working in the health care about trans* patients. While there are many areas in which there perceived challenges and barriers to care, several participants did observe that there has been a shift in health care recently that is moving towards being more inclusive and responsive to trans* patients.

This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors’ degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish (n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson’s correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students’ cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.

BACKGROUND: The United States maternal mortality ratio (MMR) has increased in the past few decades and disparities that negatively impact birthing individuals of color persist. While there are many potential causes for health inequity, distinct factors such as obstetric racism, lack of informed and shared decision-making approaches, and lack of continuous birthing support can prevent positive birthing outcomes. The present study investigates the impact of doula support on perinatal mood disorders while also evaluating potential differences in racial/cultural concordance and cultural competence in the context of the doula-patient relationship, in a Northeastern U.S. urban setting. METHODS: Seven focus group discussions (FGDs) were conducted amongst prenatal and postpartum patients (n=9) and actively practicing doulas (n=18). Participants shared their thoughts and lived experiences related to doula support during the perinatal period through open-ended questions. Researchers transcribed qualitative data from FGDs and analyzed them using a modified grounded theory approach. RESULTS: Five major themes emerged from qualitative data analysis: (1) doula support can reduce stress during the perinatal period, (2) doulas can make the process of seeking out mental health support more efficient, (3) cultural competency in doula care is a learning process (4) racial concordance does not guarantee successful doula-patient relationships, and (5) doulas play an important role in the decision-making process. CONCLUSIONS: The presence of doula support can combat perinatal mood disorders through two pathways identified in the present study. Although there may be distinct differences between culturally competent versus culturally congruent doula-patient relationships, matching by race or culture is not the solution to a fulfilling relationship. Doulas practicing cultural competence and cultural humility – regardless of client background – can make a meaningful impact on the perinatal experience and long-term mental health outcomes. / 2022-11-10T00:00:00Z

Cultural competency is theorized as the sensitivity of practitioners from the dominant culture towards the diverse cultural backgrounds of their patients. Less attention is placed on how communication between providers and patients can enable patients to share their health care beliefs. An evidence review of the literature around the conceptualization of cultural competency in health care was performed, and interviews were conducted aiming to understand what immigrant patients perceive as culturally competent care and its effect on the relationship between them and their providers. Definitions of cultural competence varied, and no conclusive studies linking cultural competence to improved health outcomes were found. Findings from the participant interviews helped to address gaps in the literature by confirming a preference for a patient-centred approach to culturally competent care, in addition to identifying pre-existing expectations for the health care encounter and patient-dependent factors as additional elements influencing the physician-patient relationship.