A Q&A with Najah Dail, LPC, LCPC, Director of Outpatient Services, Newport Healthcare
By 2044, people from racial minority communities will represent more than half of the US population, according to census data. Yet currently only 17 percent of psychologists in the country are from minority groups, and many practicing clinicians lack the skills and awareness to provide what’s known as culturally competent care.
As defined by the CDC, cultural competence is “the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services.” Najah Dail, LPC, LCPC, Newport Healthcare’s Director of Outpatient Services in Virginia, describes it more succinctly as “being mindful and aware of a client’s cultural values, beliefs, and differences” when providing mental health treatment.
In this Q&A, Najah discusses how we define culture and how cultural competence—or lack of it—can impact teens and young adults seeking care for mental health challenges. A member of Newport Healthcare’s Diversity Advisory Council, Najah joined the Newport team in 2019, and brings more than 10 years of experience in the mental health field, in both direct care and managerial positions. She holds a Master’s in Professional Counseling from Liberty University and a Bachelor’s in psychology from Chowan University.
When we talk about cultural competence, how are we defining “culture”?
When we think of culture, we need to consider all different aspects of a person’s culture—not only race and ethnicity but also age, socioeconomic status, sexual orientation, and gender identity. An individual’s overall background, beliefs, and values make up their cultural identity. There are so many different variables—you might have a client who’s African American but is growing up in a predominantly white environment and upper-class socioeconomic status. And if they identify as LGBTQ, that’s another cultural factor. As clinicians, we need to take all of this into consideration.
How does cultural competence improve outcomes, and what are some of the negative effects when care is not culturally competent?
Culturally competent care allows clients to feel safe, to have someone there who can respect their journey. We’re all different, so we may not be able to relate to everyone, but we can do our best to value and respect what someone else’s experience is like. Being culturally competent creates safety and connection and when those two things are present, it increases the likelihood that the people we work with feel heard and are supported.
One of my recent clients was a young African American female with two Caucasian fathers, and one of the first things one of her dads said to me was, “Is there anyone here who will be providing treatment to my daughter who looks like her, someone my daughter can connect with?” There is a common idea that African Americans don’t seek out mental health services, but the research shows that they do seek care at similar rates as other groups, but they prefer to go to therapy with someone of the same race. Since the percentage of African American therapists is so small [3 percent of US therapists, according to the American Psychological Association], it’s the shortage of providers that is actually preventing them from accessing care, rather than their perception of care in general.
Without cultural competency, treatment can do more harm than good. Clients can feel very invalidated when counselors are not culturally competent. For example, being misgendered is something that LGBTQ kids frequently bring up as being hurtful. A lack of culturally competent care can sometimes lead to misdiagnoses, because mental health symptoms often look different across cultures. Just as depression might look different in girls vs. boys, it can look different in different races. For example, there’s a negative stigma around how African American children display their symptomology, and a clinician who isn’t culturally competent might perceive a child as being angry or withdrawn when those are actually expressions of their anxiety or depression, and they are unable to express or describe those feelings. It’s our job as counselors to properly identify that. When we’re doing a biopsychosocial assessment, it needs to include not only a client’s upbringing and relationship with their parents but also larger social and cultural factors.
Principles of cultural competence, as defined by the CDC:
- Define culture broadly.
- Value clients’ cultural beliefs.
- Recognize complexity in language interpretation.
- Facilitate learning between providers and communities.
- Involve the community in defining and addressing service needs.
- Collaborate with other agencies.
- Professionalize staff hiring and training.
- Institutionalize cultural competence.
What level of cultural competency training is required for clinical providers?
One of the requirements for a master’s level clinician is to complete a course in cultural competency, and it’s an area that most licensing boards look at. There is often an emphasis on cultural competence during supervision. However, building these skills requires more than study and practice; it also requires honest self-reflection. As clinicians, we need to be able to check ourselves at the door. What am I bringing into the room because of my own cultural identity and background? Am I aware of my beliefs and values and how they might influence me? Am I conscious of my own level of privilege and my inherent biases, and how they might come out in therapy with people from different racial or ethnic groups than my own?
Have awareness and education around cultural competency been expanding in recent years?
Yes, there are more conversations being had on this topic, more intentional discussions about what cultural competency training looks like and what culture encompasses. Over the past two years, there has been more awareness and inclusivity in general, and that impacts mental healthcare as well, even to the level of the representation you see in the artwork hanging in treatment settings. I’ve worked in a wide array of settings, from Medicaid-funded services up to higher-income options, and I do see growth in this area. However, there’s still a long way to go, particularly in understanding and recognizing our own personal biases and how that can impact the work we do with clients.
At Newport, because our programs are located in so many different places across the country, our work supporting diversity, equity and inclusion and our work building cultural competence needs to take into consideration multiple regions and cultures. We are as inclusive as possible in our hiring practices, so we can create teams that encompass a wide range of cultural diversity. We’re expanding professional development in cultural competency for our clinicians, and partnering with organizations like the Trevor Project for trainings specific to particular populations. Ultimately, our goal is to provide our clinicians with the tools to address the needs of all the teens and young adults who come to us to heal.