New Cultural Competence Guidelines for Child and Adolescent Psychiatry

The American Academy of Child and Adolescent Psychiatry (AACAP) Diversity and Culture Committee has developed practice parameters for cultural competence in child and adolescent psychiatric practice. The guidelines are based on an extensive literature review and expert consensus and include the following principles:

  1. Clinicians should identify and address barriers (economic, geographic, insurance, cultural beliefs, stigma, etc.) that may prevent culturally diverse children and their families from obtaining mental health services.
  2. Clinicians should conduct the evaluation in the language in which the child and family are proficient.
  3. Clinicians should understand the impact of dual-language competence on the child’s adaptation and functioning.
  4. Clinicians should be cognizant that cultural biases might interfere with their clinical judgment and work toward addressing these biases.
  5. Clinicians should apply knowledge of cultural differences in developmental progression, idiomatic expressions of distress, and symptomatic presentation for different disorders to the clinical formulation and diagnosis.
  6. Clinicians should assess for a history of immigration-related loss or trauma and community trauma (violence, abuse) in the child and family and address these concerns in treatment.
  7. Clinicians should evaluate and address in treatment the acculturation level and presence of acculturation stress and intergenerational acculturation family conflict in diverse children and families.
  8. Clinicians should make special efforts to include family members and key members of traditional extended families, such as grandparents or other elders, in assessment, treatment planning, and treatment.
  9. Clinicians should evaluate and incorporate cultural strengths (including values, beliefs, and attitudes) in their treatment interventions to enhance the child’s and family’s participation in treatment and its effectiveness.
  10. Clinicians should treat culturally diverse children and their families in familiar settings within their communities whenever possible.
  11. Clinicians should support parents to develop appropriate behavioural management skills consonant with their cultural values and beliefs.
  12. Clinicians should preferentially use evidence-based psychological and pharmacologic interventions specific for the ethnic/racial population of the child and family they are serving.
  13. Clinicians should identify ethnopharmacologic factors (pharmacogenomic, dietary, use of herbal cures) that may influence the child’s response to medications or experience of side effects.

Source: Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Adolescent Psychiatry Committee on Quality, I. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. J Am Acad Child Adolesc Psychiatry, 52(10), 1101-1115. doi: 10.1016/j.jaac.2013.06.019