Arpana G. Inman Lehigh University. Marisol M. Meza, Andraé L. Brown Seton Hall University

Transcription

1 Journal of Marital and Family Therapy,Vol. 30, No. 3, STUDENT FACULTY PERCEPTIONS OF MULTICULTURAL TRAINING IN ACCREDITED MARRIAGE AND FAMILY THERAPY PROGRAMS IN RELATION TO STUDENTS SELF-REPORTED COMPETENCE Arpana G. Inman Lehigh University Marisol M. Meza, Andraé L. Brown Seton Hall University Byron K. Hargrove 1199 SEIU Employment, Training, and Job Security Program Although the marriage and family therapy field s recent attention to multicultural issues is laudable, there appears to be little clarity on what constitutes an effective multicultural training program and the impact of the effects of such training on trainee multicultural competence. The field continues to be challenged at different levels training, practice, research, the setting of the standards and the work of the Commission on Accreditation for Marriage and Family Therapy Education, and the goals and strategic plan of the American Association for Marriage and Family Therapy Board. This study focused on assessing the extent of multicultural integration at different levels of training and the relationship between such training and students perception of their own multicultural competence. Ethnic minorities are the fastest growing populations in the United States. It is estimated that people of color will be a majority by the year 2050 (U.S. Department of Health and Human Services, 2001). As the U.S. continues to grow numerically in its racial and ethnic diversity, caseloads of clinicians are going to become increasingly varied. As a result the potential for multicultural interactions among clients, therapists, and supervisors will dramatically rise. This changing racial ethnic composition of the U.S. carries significant clinical, political, and social implications for the training of marriage and family therapists engaging in ethical and culturally sensitive clinical practice. Thus, the purpose of this study was to examine the relevance and integration of multicultural issues in marriage and family therapy (MFT) programs and its relation to therapist competence in working with racially ethnically diverse clients. Call for Multicultural Competence in the MFT Field Within the last few decades, several scholars have noted the need for MFT programs to integrate multicultural issues proactively (e.g., Carter & McGoldrick, 1999; Falicov, 1995; Green, 1998a; Hardy & Laszloffy, 1992; Killian & Hardy, 1998; McGoldrick, 1998; McGoldrick, Giordano, & Pearce, 1996; Preli & Bernard, 1993). Furthermore, the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE, 1988, 1997, 2000, 2002) has discussed the need to respect and attend to issues of Arpana G. Inman, PhD, Counseling Psychology Program, Lehigh University; Marisol M. Meza, MEd, EdS, and Andraé L. Brown, MEd, EdS, Marriage and Family Program, Seton Hall University; Byron K. Hargrove, PhD, 1199 SEIU Employment, Training, and Job Security Program, New York, NY. Correspondence concerning this article should be addressed to Arpana G. Inman, Counseling Psychology Program, Department of Education and Human Services, 111 Research Drive, Lehigh University, Bethlehem, Pennsylvania, E- mail: agi2@lehigh.edu 373

2 Page 374 race, ethnicity, gender, age, culture, socioeconomic status, sexual orientation, religion, and other forms of diversity in guiding the training of multicultural competence within these programs. Multicultural competence has been typically conceptualized as encompassing three aspects: Therapist s awareness of own culture, therapist s knowledge of culturally different clients, and therapist s ability to engage in culturally appropriate skills when working with diverse clients (Sue, Arredondo, & McDavis, 1992). In line with this, there has been increasing coverage of multicultural issues at national conferences and development of new multicultural conceptual models incorporating these competencies within the field (Almeida, Woods, Messineo, & Font, 1998; McGoldrick, 1998). Despite this general consensus among proponents of the multicultural movement, MFT programs, institutions, and professional organizations continue to struggle with incorporation of diversity issues at different levels, a challenge reflected in the COAMFTE standards as well since Although there appears to be an intellectual debate on the inclusion of cultural issues (Sierra, 1997), incorporation of multicultural issues has not been adequately and fully addressed within many MFT training programs (e.g., McDowell, Fang, Brownlee, Young, & Khanna, 2002; Preli & Bernard, 1993). Hardy (1990) feels that there has been a total disregard for a systemic epistemology (i.e., larger sociocultural contexts) within training programs, specifically for students working with minority families. One way of achieving multicultural competence in programs has been through focusing on racial diversity among students. There have been some attempts at investigating this aspect within MFT programs and organizations. For example, in Wilson and Stith s (1993) survey of 29 COAMFTE-accredited MFT programs, 80% reported attempts at recruiting minority students with only 29% of the programs considering themselves successful in this area. They also found that less than 1% of master s degrees and only 1.8% of doctoral degrees were awarded to African Americans during the preceding 10 years. During the same year, the American Family Therapy Academy had a membership of only 1.4% African American, 1.1% Asian American, and 2.8% Latino/a American (Green, 1998a). Sierra s (1997) survey of nonaccredited and accredited MFT programs revealed accredited programs to be significantly less racially diverse than nonaccredited programs, a theme that continues to be reflected in current training programs. For example, in annual reports submitted by accredited MFT programs from July 1999 January 2001, 79 programs reported that 80% of their student body consisted of European Americans (McDowell et al., 2002). Annual reports submitted by 85 programs in 2002 revealed 77% of their student body consisted of European Americans, 8% African Americans, 4% Asian Americans, 6% Hispanic Americans,.6% Native Americans, and 4.4% other (E. J. James, COAMFTE, personal communication, February 26, 2003). Although the racial representation reflects general population trends within groups (e.g., 75% Whites, 3.6% Asian Americans, 12.9% African Americans, 12.5% Hispanic Americans,.9% Native Americans; U.S. Census, 2000), there continues to be an underrepresentation of therapists of color in the field (Green, 1998a). Specifically, in 1995, a survey conducted by the California Association of Marriage and Family Therapists indicated that out of 12,900 family therapists, 94% were European American, whereas 66% of their clients were from other racial groups (Green, 1998a). Olmedo (1994) revealed that graduates of color saw twice as many clients of color as compared with White graduates, and they were more likely to work in public-sector agencies serving families of color. As the U.S. continues to diversify ethnically and racially over the next 50 years, the caseloads of both White therapists and therapists of color will increasingly be composed of families of color suggesting a strong need for training to be multiculturally sensitive (Green, 1998a). Thus, it becomes relevant to examine the integration of multicultural issues in training programs. Multicultural Integration in MFT Programs Several proponents of diversity have advocated addressing multicultural issues in training programs and in the field. For example, Deacon and Piercy (2000) identified qualitative methods to evaluate MFT training programs, whereas Nelson et al. (2001) examined the role of ethnicity within the therapeutic process and highlighted some themes pertaining to training of ethnicity-sensitive family therapists. Other researchers (Deacon & Piercy, 2000; Green, 1998b; Hardy, 1990; Hardy & Laszloffy, 1992; Killian & Hardy, 1998; McDowell et al., 2002; Nelson et al., 2001) within the family therapy field have offered specific guidelines for increasing multicultural competence within graduate training programs (see Table 1). 374

3 Page 375 Table 1 Guidelines for Inclusion of Multicultural Competencies Derived from the Literature 1. Distributing multicultural competencies as goals to achieve within programs (Green, 1998b) 2. Conducting program evaluations/consultations by both in-house personnel (e.g., students and faculty) as well as independent authorities on achievement of multicultural issues (Deacon & Piercy, 2000; Green, 1998b; McDowell et al., 2002) 3. Developing a multicultural faculty leadership amongst both White faculty and faculty of color (Green, 1998b; Hardy, 1990; McDowell et al., 2002) 4. Having 20% of faculty and student representative of minority groups with attention to recruitment and retention policies (with recruitment of minorities at different levels faculty, students, support staff, executive level staff) (Green, 1998b; Hardy, 1990; Hardy & Laszloffy, 1992; McDowell et al., 2002) 5. Developing prerequisite faculty and supervisors training in multicultural issues (Green, 1998b; McDowell et al., 2002) 6. Coteaching of intercultural awareness, mentoring and training by leaders of different cultural groups and interdisciplinary teams (Green, 1998b; Hardy & Laszloffy, 1992; McDowell et al., 2002; Nelson et al., 2001) 7. Dispersing and integrating multicultural content (e.g., incorporating social cultural sensitivity and experiential exercises, discussing both similarities and differences) in all areas of curriculum and the programs (Green, 1998b; Hardy, 1990; Hardy & Laszloffy, 1992; Killian & Hardy, 1998; McDowell et al., 2002) 8. Including multicultural content in clinical supervision, practica, as well as having racially, socially sensitive supervisors working with supervisees (Green, 1998b; Hardy, 1990; Hardy & Laszloffy, 1992; McDowell et al., 2002) 9. Providing opportunities for faculty student specialized work in multicultural issues (Green, 1998b; Hardy, 1990) 10. Evaluating instructors and students on their multicultural competence (Green, 1998b; McDowell et al., 2002) 11. Developing a multicultural institute on campus (McDowell et al., 2002) 12. Having a social and cultural environment/structure conducive to diversity issues and mentoring of faculty and students of color (Hardy & Laszloffy, 1992; McDowell et al., 2002) Despite this, few studies have looked at the incorporation of multicultural issues at different levels in MFT training programs. For example, Turner and Botkin s study (1993) surveyed accredited MFT programs primarily in terms of their incorporation of ethnic and gender issues within coursework, among faculty, and in faculty research interests. They reported limited diversity, especially among people in authority (e.g., program directors, faculty, and supervisors). Sierra (1997) conducted a more comprehensive study examining the extent to which MFT programs have incorporated multicultural training/competencies at different levels. Sierra (1997) used the Multicultural Training in Marriage and Family Therapy Survey Instrument and compared director s perceptions of their nonaccredited and accredited MFT programs with regard to multicultural training in their programs. Results showed that 56% of the programs required their students to take a multiculturally focused course, 44% offered an elective course in multicultural issues, and 31% offered students the option of a subspecialty in multicultural counseling. She also found an underrepresen- 375

4 Page 376 tation of African American (8%) and Latino/a (5%) faculty within these programs. Of specific interest was the fact that in contrast to nonaccredited programs, programs accredited by COAMFTE had fewer full-time minority faculty members. These results are significant given the changing demographics of the US and the specific challenges this presents for students in training. Importance of Multiple Perspectives One of the limitations of Sierra s study was that she examined perceptions of program directors alone without including student perspectives, thus allowing for only a single lens on the situation. In a study carried out by Constantine, Ladany, Inman, and Ponterotto (1996), perceptions of both students and faculty in Counseling Psychology programs were compared, providing for a more comprehensive perspective on multicultural training in programs. In conducting this study, the authors were interested not only in examining the extent to which accredited American Association for Marriage and Family Therapy (AAMFT) programs had incorporated multicultural issues in their training programs since 1997, but also were concerned with obtaining a broader systemic view within these programs. Thus, we expanded Constantine et al. s (1996) and Sierra s (1997) studies. The first purpose of this study was to examine perceptions of multicultural training within MFT programs from multiple perspectives. Specifically, we examined both student and faculty perceptions of multicultural training and incorporation of multicultural competencies in MFT training programs. The Multicultural Competency Checklist (MCC; Ponterotto, Alexander, & Grieger, 1995) was used for the purposes of our study. Although developed within the context of counseling psychology, we believed that the MCC aptly captures the suggestions put forth by different researchers (e.g., Green) as well as the COAMFTE standards. Program Multicultural Competencies and Trainee Multicultural Competence Although training programs may recognize the importance of attending to multicultural issues (e.g., race, ethnicity, gender) and proactively integrate these aspects of diversity into their training curriculum, there is little empirical literature that has looked at how this training might translate to the trainee s own sense of multicultural competence. A recent study by Constantine, Juby, and Liang (2001), examined the relationship between multicultural counseling competencies and race-related attitudes among White MFTs. They found a positive relationship between number of multicultural counseling courses and self-perceived multicultural competence. In addition, they showed that those with high levels of racism and low levels of White racial identity reported lower levels of self-perceived multicultural awareness. These authors suggested that therapists inability to respond to the impact of racial and cultural backgrounds on culturally diverse clients can result in decreased therapeutic effectiveness with these clients. The parallel process that might exist between MFT training programs and a therapist s cultural competence has direct, practical consequences for the culturally sensitive treatment given to clients. Culturally sensitive treatment refers to a therapist s ability to understand and respond to the influence of racial and cultural factors within the context of a therapeutic relationship. Thus, the second goal of this investigation was to examine how the integration of multicultural issues in MFT training programs translates to student s own sense of multicultural competence. Multicultural competency refers to one s sociopolitical awareness, cultural sensitivity and knowledge, and cross-cultural counseling skill (LaFromboise, Coleman & Hernandez, 1991). The Cross-Cultural Counseling InventoryRevised (CCCI-R; LaFromboise et al., 1991) was employed to assess student s multicultural awareness, knowledge, and skills in working with racially ethnically diverse families. METHOD Participants Respondents were 123 master s, postgraduate, and doctoral students, and 61 faculty from 63 COAMFTE-accredited MFT programs. Specifically, student participants consisted of 40 males (33%) and 81 females (66%); 2 (1%) participants did not respond to this question. Their average age was years 376

5 Page 377 (SD = 10.71). Eight-six (70%) participants were White, 14 (11%) were African American, 2 (2%)were Asian American, 4 (3%) were Hispanic American, 1 (0.8%) was Native American, 6 (5%) were biracial/bicultural, and 10 (8.2%) did not specify their race or ethnicity. These participants represented MFT programs in 28 states, and had been enrolled in their programs for a mean of 3.43 years (SD = 2.01). One hundred and one (82%) student participants reported having taken at least one course focusing on diversity, having seen on average clients of color (SD = 59.14, range = 0 525), and White clients (SD = , range = 0 650). In rating the importance of multicultural education on a 6-point scale with anchors from not at all important to imperative, students seemed more likely to believe that multicultural education should be part of MFT programs (M = 5.14, SD = 1.12). With regard to faculty participation, the sample consisted of 27 (44%) males and 34 (56%) females, with an average age of years (SD = 9.72). Racial composition consisted of 52 (85%) Whites, 1 (1%) African American, 2 (3%) Asian Americans, 3 (5%) Hispanic Americans, and 3 (6%) participants who did not indicate their race or ethnicity. In rating the importance of multicultural education on a 6-point scale with anchors from not at all important to imperative, faculty also seemed more likely to believe that multicultural education should be part of MFT programs (M = 5.36, SD =.86). Procedure Recruitment of students occurred in two ways. The first involved asking training directors to distribute eight survey packets to students in their accredited programs. Of the 63 programs, two training programs sent back the entire packet (eight students and one faculty questionnaire each) because students had graduated, and 13 programs indicated that they had not received the packets. Because of an initial response rate of 8%, the second method involved randomly selecting potential student participants from a mailing list provided by AAMFT. Student survey packets consisted of a cover letter, the Multicultural Competencies Checklist (MCC), the Cross Cultural Counseling Inventory-Revised (CCCI-R), a demographic form, and a postage-paid return envelope. Out of a total of 611 possible questionnaires, a total of 123 were returned, resulting in a response rate of approximately 20% for students. Recruitment of faculty involved randomly selecting potential participants from the program directory of each of the 63 training programs. The survey packet consisted of a cover letter, the MCC, a demographic form, and a postage-paid return envelope. Out of a total of 199 possible questionnaires, a total of 61 faculty responded to the study, resulting in a response rate of approximately 31%. The above response rates are a conservative figure, because it is not known how many student surveys were actually received and handed out to the students by their training directors. However, response rates for both students and faculty appear to fall within the common return rate for mail surveys (Heppner, Kivlighan, & Wampold, 1998; Kerlinger & Lee, 2000). Measures Multicultural Competency Checklist (MCC). The MCC (Ponterotto et al., 1995), a theoretically derived instrument from a thematic analysis of the multicultural literature, was designed to (a) assist counseling and counseling psychology training programs in assessing their multicultural program development efforts in certain competency areas, and (b) guide these programs in their efforts to address multicultural issues (for specific items, refer to Table 2). The MCC is a 22-item self-report measure that evaluates a program s multicultural training in six categories: Minority representation, curriculum issues, counseling practice and supervision, research considerations, student and faculty competency evaluations, and physical environments. Respondents are asked to rate whether their program has met or not met a given competency. Specifically, met refers to strengths within the program and not met refers to a weaknesses in the program related to multicultural issues. The MCC with 21 items was used for the current study as it captured the mandates put forth by COAMFTE (1997, 2002), and researchers (e.g., Green, 1998b; Table 1) in the field. For this study, the Kuder-Richardson reliability coefficient for the entire measure was.80. Cross-Cultural Counseling Inventory-Revised (CCCI-R). The CCCI-R (LaFromboise et al., 1991) a 20item, self-report measure, rated on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree) reflects a therapist s ability to work with clients from other cultures. The measure was based on the cultural counseling competencies delineated by the Education and Training Committee of the American 377

6 Page 378 Table 2 Comparison of Frequencies and Percentages of Competencies Met by Students and Faculty in Accredited MFT Programs Competency Minority representation 1. At least 30% of faculty represent racial/ ethnic minority populations. 2. At least 30 % of faculty are bilingual. 3. At least 30% of students in the program represent racial/ethnic minority populations. 4. At least 30% of support staff (e.g., secretarial staff, graduate student assistant pool) represent racial/ethnic minority populations. Curriculum issues 5. The program has a required multicultural counseling course. 6. The program has one or more additional courses in the area that are required or recommended (e.g., advanced multicultural counseling research seminar, or an advanced clinical issues course). 7. Multicultural issues are integrated into all coursework. All program faculty can specify how this is done in their courses. Furthermore, syllabi clearly reflect multicultural inclusion. 8. A diversity of teaching strategies and procedures are employed in the classroom. For example, both cooperative learning and individual achievement approaches are utilized. Counseling practice and supervision 9. Students are exposed to a multicultural clientele during fieldwork. At least 30% of clients seen by students are non-white. 10. Multicultural issues are considered an important component of clinical supervision whether the supervision is conducted by program faculty or on-site supervisors. The program has a mechanism to monitor the quality of field supervision. 11. The program has an active Multicultural Affairs Committee composed of faculty and students. The committee provides leadership and support to the program with regard to multicultural issues. 378 Student n % Faculty n % * !2

7 Page 379 Table 2 (continued) Comparison of Frequencies and Percentages of Competencies Met by Students and Faculty in Accredited MFT Programs Competency Research considerations 12. The program has a faculty member whose primary research interest is in multicultural issues. 13. There is clear faculty research productivity in multicultural issues. This is evidenced by faculty journal publications and conference presentations on multicultural issues. 14. Students are actively mentored in multicultural research. This is evidenced by student-faculty co-authored work on multicultural issues and completed dissertations on these issues. 15. Diverse research methodologies are apparent in faculty and student research. Both quantitative and qualitative research methods are utilized. Student and faculty competency evaluation 16. One component of students yearly (and end of program) evaluations is their sensitivity to and knowledge of multicultural issues. The program has a mechanism for assessing this competency (e.g., relevant questions are included on student evaluation forms). 17. One component of faculty teaching evaluations is the ability to integrate multicultural issues into the course. Faculty are also assessed on their ability to make all students, regardless of cultural background, feel equally comfortable in class. The program has a mechanism to assess this competency (e.g., questions on student evaluations of professors). 18. Multicultural issues are reflected in comprehensive examinations completed by students. 19. The program incorporates a reliable and valid paperand-pencil or behavioral assessment of students multicultural competency at some point in the program. Student n % Faculty n % ** ** * !2 9.07** Psychological Association s Division 17 (Sue et al., 1992). Within the context of this measure, multicultural competence refers to assessing a person s cross-cultural counseling skill (use of appropriate communication skills and ability to convey comfort with cultural differences), sociopolitical awareness (ability to recognize strengths and limitations regarding cross-cultural counseling), and cultural sensitivity (ability to empathize with client s feelings and understand interpersonal and environmental demands placed on client). Examples of items for the CCCI-R include, have the ability to communicate a variety of verbal and nonverbal 379

8 Page 380 Table 2 (continued) Comparison of Frequencies and Percentages of Competencies Met by Students and Faculty in Accredited MFT Programs Competency Student n % Physical environment 20. The physical surroundings of the program area reflect an appreciation of cultural diversity, (e.g., art work [posters, paintings] is multicultural in nature and readily visible to students, staff, faculty, and visitors upon entering the program area, faculty offices, etc.). 21. There is a Multicultural Resource Center of some form in the program area (or within the department or academic unit) where students can convene. Cultural diversity is reflected in the décor of the Room and in the resources available (e.g., books, journals, films, etc.). Faculty n %! Note. These items were taken from the Multicultural Competency Checklist (MCC, Ponterotto, J. G., Alexander, C. M., & Grieger, I. (1995). The MCC is copyrighted by Joseph G. Ponterotto and is reproduced with his permission. *p <.05. **p <.01. messages with clients from race-based cultural groups other than your own, understand the current sociopolitical climate and its impact on clients from race-based cultural groups other than our own, and are aware of how your own values might affect client s from race-based cultural groups other than your own. The CCCI-R was modified for the purpose of our investigation: students were asked to rate their own cultural competence in working with clients from racial or ethnic groups other than their own. All adjustments to the items were within the advised limits provided by the scale s authors. As recommended by the instrument developers, with the current sample, a sum score of all the items was used, resulting in a Cronbach s alpha coefficient of.81. The scale has been reported to demonstrate good content, criterionrelated, and construct validity (Sabnani & Ponterotto, 1992). Content validity of the CCCI-R was based on expert ratings. The scale has also been shown to distinguish among counselors varying in multicultural competence (LaFromboise et al., 1991). Demographic Questionnaire. Student and faculty respondents were asked to provide information about their age, gender, race, state in which the academic program was located, number of formal multicultural courses taken, and to rate the extent to which they believe multicultural issues are important to include in MFT training programs. Students were additionally asked to provide information on year of graduate program, highest degree received, degree seeking, and number of clients of color and White clients seen. RESULTS The primary purpose of this study was to examine students and faculty perceptions of multicultural training in MFT training programs. On the MCC, respondents reported a mean of (SD = 4.89) competencies met out of 21. Table 2 contains frequencies, percentages, and significance of percentage difference (calculated through the!2 statistic), of multicultural competencies that students and faculty perceived as being met in their programs. Findings are reported based on met (strength) and not met (weakness) competencies for students and faculty and discrepancies evident between the two groups. 380

9 Page 381 Multicultural Competencies Within the minority representation category, approximately 80% of students and faculty perceived their programs as not having adequate representation of racial/ethnic minority (item 1) and bilingual faculty (item 2). With regard to representation of racial/ethnic students in programs (item 3), 62% of students and 58% of faculty perceived this competency as not being met. Furthermore, > 75% of students, as compared with approximately 60% of faculty, perceived their programs not to have sufficient representation of diverse support staff within their programs (item 4). Of these findings, the percentage difference between students and faculty on item 4 alone was significant (p <.05) With regard to the curriculum issues category, nearly 80% of faculty and students reported having at least one required multicultural course (item 5). Fifty percent of students, as compared with 57%, of faculty reported that the program had one or more additional multicultural courses required/recommended (item 6). Furthermore, although 75% faculty reported that multicultural issues were integrated into all coursework (item 7), only 67% students believed this to be true. In contrast, > 90% of students and faculty perceived diverse teaching strategies to be employed in classrooms (item 8). None of these percentage differences were significant. Within the counseling practice and supervision category, > 80% of students and faculty considered multicultural issues to be important components of clinical supervision (item 10). Although both perceived the importance of multicultural issues in clinical supervision, there seemed to be some inconsistency with regard to exposure to diverse clientele. Specifically, item 9 (exposure to multicultural [non-white] clientele during field work) showed a 15% discrepancy between students and faculty. Although the percentage difference was not found to be significant, 68% of the faculty, as compared with only 53% of students, reported this competency as being met. In this category the multicultural competencies that was perceived by both student and faculty to be least frequently met was item 11 (i.e., multicultural affairs committee). Twenty-two percent of students, as compared with 21% of faculty, perceived this competency as being met. None of the percentage differences were found to be significant. Within the research consideration category, both students and faculty perceived neither of the competencies as being met within this category. Specifically, the 24% difference between student and faculty perceptions on item 12 (program has faculty member whose primary research interest is in multicultural issues) and the 34% difference on item 13 (there is clear faculty research productivity in multicultural issues as evidenced in journal publications and conference presentations) were both found to be significant (p <.001). On the presentations on multicultural issues category, only 26% of students, as compared with 57% of faculty, perceived item 14 (students are actively mentored in multicultural research as evidenced by coauthored work) as being met. The 31-point discrepancy was significant (p <.001). In addition, 87% of faculty, as compared with 77% of students, reported that diverse research methodologies were incorporated within faculty and student research (item 15). This difference of 10 percentage points was significant (p <.05). In responding to the items under student faculty competency evaluations category, 57% of students, as compared with 63% of faculty, reported that the program had a mechanism for assessing student multicultural competency (item 16). The program s ability to assess faculty multicultural competence in terms of integration of multicultural issues and making students comfortable in class (item 17) resulted in a percentage difference of 12 points. Sixty-two percent of students reported it as a met competency, as compared with 50% of faculty. Sixty percent of students and 72% of faculty reported that multicultural issues were reflected in comprehensive examinations completed by students (item 18). Approximately 75% 79% of faculty and students reported that programs did not use reliable and valid paper-and-pencil behavioral assessment of multicultural competencies within the program (item 19). None of the percentage differences reached significance. Finally, with regard to the physical environment category, more faculty (72%) than students (66%) perceived the physical surroundings of the program as reflecting an appreciation of cultural diversity (item 20). Although faculty had more favorable impressions of the surroundings, a small but equal percentage of 381

10 Page 382 faculty (35%) and students (36%) indicated that there was a Multicultural Resource Center within the program (item 21). Neither of these findings reached significance. Relationship of Multicultural Integration in Training Programs to Self-reported Multicultural Competence A second purpose of the study was to examine how the integration of multicultural issues in MFT training programs translates to students own sense of multicultural competence. A Pearson correlation between perception of integration of multicultural issues in training programs (scores on the MCC) and selfreported multicultural competence (scores on the CCCI-R) did not result in a statistically significant relationship (r =.08, p =.4). Additional Analyses To assess whether demographic variables were differentially related to self-reported multicultural competence, a series of correlations were conducted. Of the different variables examined (i.e., age, gender, year of program, highest degree seeking, number of formal courses taken, and race), results showed a significant relationship between self-reported multicultural competencies and three variables: Age (r =.23, p <.05), number of formal course taken (r =.20, p <.05), and highest degree seeking (r =.32, p <. 01, n = 120). DISCUSSION The primary purpose of this study was to assess the extent to which MFT students and faculty perceived their training programs to meet multicultural competencies on the MCC (Ponterotto et al., 1995). Results allowed for direct comparisons between responses of faculty and students within these training programs. In comparing the percentages of faculty and student perceptions on the 21 competencies, there seemed to be a high degree of consistency across these competencies (see Table 2). Similar to Constantine et al. s (1996) study, faculty in our study perceived more frequent integration of multicultural issues as compared with students. Results will be discussed within the context of strengths (met competencies) and weaknesses (unmet competencies) of accredited MFT programs with some reference to COAMFTE standards. Finally, implications of the relationship of program s multicultural characteristics to student perceptions of multicultural competence will be discussed. Met Competencies Programs were seen to have met several multicultural competencies. Specifically, participant s perceived strength within the following categories: Curriculum issues, counseling practice and supervision, and presentations on multicultural issues. Several researchers have proposed the need for programs to have a single course in multicultural issues (Nelson et al., 2001) as well as incorporate multicultural content in all areas of the curriculum. Furthermore, while COAMFTE standards (version 10, 10.1) do not dictate a single course in multicultural issues, they mandate integrating diversity issues into the curriculum (300.01), including content on issues of gender, sexual orientation (320.06), and significant material on diversity and discrimination (320.07). A majority of the participants in the current study perceived their programs to meet both criteria. These findings are promising when compared with Sierra s (1997) study. In contrast with 56% of programs in Sierra s study, in this study, we found a significant increase in the number of accredited programs requiring students to take a single course in multicultural issues. Although faculty seemed to have a more favorable impression of multicultural integration as compared with students, the 12-point percentage difference may be a function of capturing the complexity of multicultural competencies into one simple definition of diversity. This may be reflective of two factors: (a) Whether all cultural groups perceive their experiences, histories, and cultures as being represented within the curriculum, and (b) the levels to which multicultural issues are integrated within the curriculum. Specifically, Banks (2003) identifies 4 approaches that may be used to integrate multicultural education into the curriculum, namely, contribution (adding discrete cultural elements), additive (adding concepts without 382

11 Page 383 changing curriculum/structure of the course or adding a single course), transformation (changing the structure of the curriculum by integrating multiculturalism throughout the curriculum), and social action (changing the structure of the curriculum with a focus on critical consciousness and social action). It may be important for both students and faculty to challenge each other to develop a broader cultural perspective (McGoldrick et al., 1999). With all counseling being cross-cultural, training programs can best serve students by developing an open dialogue between students and faculty on these issues (McDowell et al., 2002). Using a participatory evaluative process (Deacon & Piercy, 2000) can create an empowering social system within the training program (Banks, 2003) while also increasing personal awareness and responsibility among faculty and students, an aspect consistent with a systemic approach. Another strength within the context of curriculum issues pertained to teaching strategies. More than 90% of students and faculty perceived diverse teaching strategies being employed in classrooms. These findings may not be surprising given that MFT programs seem to recognize the importance of systemic approaches in studying aspects within the field. Thus, the use of content and process experiences, and individual and collaborative learning experiences may be related to the theoretical framework within which the field functions rather than primarily attending to multicultural issues. Within the category of counseling practice and supervision, both students and faculty saw strengths related to clinical supervision. Specifically, > 82% students and faculty considered multicultural issues as important components of clinical supervision. Two factors might contribute to this finding, the increasing diverse client populations, and standards , and (COAMFTE version 10), which require programs to have diverse supervisors in age, culture, and so on. These results are encouraging, given the clinical practice focus of MFT programs and the role that training of supervisors has played in the field. This emphasis also allows for students and faculty to be responsible and accountable for culturally effective practice. Providing both content and process experiences, increasing racial and ethnic self-awareness, recognizing the role of oppression, and using an ecological framework in supervision and training are important in enhancing cultural perspectives for students and supervisors (Arnold, 1993; Inman & Nath, 2002). A final strength was related to presentations on multicultural issues. Seventy-seven percent of students and 87% of faculty perceived diverse research methods (qualitative and quantitative) being incorporated in student faculty research. These findings are promising. Providing students with opportunities to participate in different methodologies may allow them to conceptualize and design research within the context of multicultural complexity inherent in populations, and generalizing of research findings to similar populations of individuals. Unmet Competencies Although several strengths were identified within the accredited programs, participants noted several weaknesses as well. Specifically, they found significant deficits in the following categories: Minority representation, research considerations, student faculty competency evaluations, and physical environment. Several researchers (e.g., Green, 1998b; McDowell et al., 2002) have strongly advocated creating a cultural climate and integration of diversity at different levels of a program to ensure development of socially/culturally sensitive clinicians. Participants in the current study perceived a general underrepresentation of racial/ethnic minorities at different levels in the training programs, that is, students, faculty, and support staff. These results are comparable to Sierra s (1997) findings of accredited programs being significantly less racially diverse than are nonaccredited programs. Furthermore, findings may be a function of the geographical location of the programs as well as the ongoing struggles that MFT programs might have in recruitment. In examining the standards regarding this area, what was interesting to note was that the standards pertaining to program personnel in the COAMFTE versions of October 1988 (201.5, 301.2), Version 9.0 (130.08, ) and 10.0 (130.8, , , ) were removed in the most recent version of the standards (10.1). It is debatable if the findings in the current study are directly related to this change (as the study was conducted prior to this recent revision). However, accreditation standards, licensing standards, and professional organizations (e.g., American Family Therapy Academy, AAMFT) certainly have an 383

12 Page 384 influence on ensuring quality training in MFT programs. If programs are reporting an underrepresentation of racial ethnic minority personnel while attempting to adhere to COAMFTE mandates, what might the implications be with the removal of this category within the standards? Multicultural competency and multicultural education relate not only to the curriculum content but the entire environment. Having an inadequate representation of different ethnic and racial groups denies students the opportunity to learn from each other s perspectives and frames of references. If the sample in our study is any reflection of the current status of MFT programs, the potential disparity in numbers of students of color to numbers of faculty of color in MFT programs is problematic. The presence of an adequate representation of faculty of color and bilingual faculty members has broader educational consequences beyond academics. Faculty of color are important in serving as mentors and role models, as well as reflecting the experiences, and cultures of students of color. In addition, these faculty may not only affect retention rates of students but also be able to offer perspectives on cultural issues that other faculty may not be able to provide (Constantine et al., 1996). Although discouraging, a not so surprising finding was related to research considerations. While faculty had a more favorable impression of faculty productivity and primary research interest in multicultural issues as compared with students, neither faculty nor students perceived this as a met competence. Interestingly there has been much written about the lack of research productivity within MFT programs in the recent literature (e.g., Crane, Wampler, Sprenkle, Sandberg, & Hovestadt, 2002; Johnson, Sandberg, & Miller, 1999; McWey et al., 2002). Furthermore, COAMFTE does not propose a standard related to research and multicultural issues, and this might potentially add to the lack of attention in this area. Other factors that might contribute to this deficiency may be a general MFT culture that values practice over research, limited faculty research role models, inadequate research curriculum geared toward producing MFT related multicultural research (Crane et al., 2002), and finally the type of students who responded to the survey. Our sample consisted primarily of master s-level students who may not participate in research within their programs, perhaps resulting in a lack of awareness of research being conducted by program faculty. Given the recent focus on empirically based treatments (e.g., AAMFT 2001 annual conference) and the need for a stronger research climate (Crane et al., 2002), it may be important for programs and accreditation bodies to evaluate the importance placed on conducting research and research training within programs (McWey et al., 2002). Encouraging student faculty involvement in multicultural research activities will not only advance student understanding of the integration of theory, research, and practice (Olson, 1976), but will also allow clinicians to evaluate their clinical work empirically (Johnson et al., 1999) within a cultural context. This can increase cultural awareness and reduce the gap that currently exists between clinical research and clinical practice within the MFT field (Sprenkle & Moon, 1996). Another weakness was related to student faculty competency evaluations. More than 75% of faculty and students reported that programs did not use reliable and valid behavioral assessment of multicultural competencies within programs. Although researchers (e.g., McDowell et al., 2002) have addressed the need to incorporate multicultural issues within programs, perhaps the struggle to operationalize competence in behavioral terms may hamper the process. As students and faculty continue to have cross-cultural interactions, incorporating an evaluative component to assess level of cultural sensitivity and competence from both within the program and assessment from independent authorities (Deacon & Piercy, 2000; Green, 1998b; McDowell et al., 2002; Nelson et al., 2001) will help hold students and faculty accountable. Relationship of Multicultural Integration in Training Programs to Self-reported Multicultural Competence A second purpose of the study was to examine how perception of multicultural competencies in training programs translates to self-perceived multicultural counseling. Interestingly, results showed a lack of relationship between these two variables. These findings may be a function of several factors. One explanation for these results may be a function of the assumptions underlying the relationship between program characteristics and student outcome of multicultural competence. One important activity in creating multicultural awareness is providing a learning environment that promotes multicultural learning (Santigo-Rivera & Moody, 2003). Certainly program characteristics in the form of minority representation, curriculum exposure, research, counseling, and supervision practices as well as the physical environment 384

13 Page 385 are important in impacting student multicultural training. However, the mere presence and exposure to these characteristics may not be sufficient in creating a sense of multicultural competence. Given the complexity of multiculturalism, cultural competence cannot be gleaned from a single criterion (i.e., program environment). The environment might merely be a stepping stone to heighten the awareness and ethics of multiculturalism. Authors (Killian & Hardy, 1998; McDowell et al., 2002) suggest going beyond typical efforts of diverse recruitment and celebrations of diversity by moving toward a deeper, active, integrated commitment to diversity-creating shifts in ideology that result in second-order, systemic change (McDowell et al., 2002, p. 180). It may be important for programs (faculty and students) and organizations (e.g., COAMFTE, AAMFT) to engage in an on-going dialogue of what and how each of these different aspects of the environment might contribute to a sense of multicultural competence. Alternatively, a second explanation for the results may be attributed to the definition of cultural competence. Results may be reflective of the continued struggle that the field is experiencing in defining cultural competence. Competency is defined as the extent to which therapists adhere to and possess behaviors consistent with identified criteria or standards (Beutler, Crago, & Arizmendi, 1986). Multicultural competence refers to the possession of attitudes and beliefs in relation to diverse cultural groups, knowledge about impact of cultural group membership on clients, and appropriate interventions skills in the delivery of culturally sensitive services (Constantine & Ladany, 2001). The competence that one develops is often obtained through formal coursework and supervised experience (Hogan, 1979; Ponterotto, 1997; Sue et al., 1998). For example, how and what multicultural issues are integrated (e.g., contribution, additive, transformation, and social action; Banks, 2003) into coursework and training might affect the sense of competence one experiences. However, there are inconsistent findings regarding the relationship between coursework and multicultural competence (Constantine et al., 1996, 2001; Ladany, Inman, Constantine, & Hofheinz, 1997). Thus, one might need to go beyond formal training and coursework in understanding the relation between multicultural integration and multicultural competence. Furthermore, the current theoretical conceptualization used in training may be limited in accurately assessing cultural competence. A broader conceptualization that goes beyond awareness, knowledge and skills may be needed to understand multicultural competence (Constantine & Ladany, 2000, 2001). These authors suggest the potential for individual factors such as a counselor s worldview, theoretical orientation, value system, cultural group membership, and previous experience as potentially affecting multicultural competence. Thus, Constantine and Ladany (2000, 2001) suggest a framework that includes four themes, namely, (a) Counselor/client individual variables at a personal level (e.g., values, group membership), (b) counselor/client variables at a situational level (e.g., client s presenting issues, readiness for change), (c) multicultural counseling self-efficacy that reflects actual performance rather than self-perceived multicultural skills and finally, (d) an effective counseling working alliance (Bordin, 1979). In light of this, a further analysis of the definition of cultural competence and translation of these criteria to real-life clinical situations may be beneficial in developing a more discrete understanding of the relation between integration and competence (Constantine & Ladany, 2001; Inman & Constantine, 2003). For example, a first step might be to ensure that students receive opportunities for diverse clinical interactions in their practicum setting. The findings in this study suggested that both students and faculty perceived students having limited exposure to non-white clients in their practicum settings. Insufficient exposure to cultural interactions can certainly promote a lower sense of self-efficacy among students. Faculty/clinical coordinators might need to provide closer monitoring of clinical sites to ensure increasing the possibilities for diverse clinical interactions. Other ways to apply the criteria to real life situations might include therapists exploring how their own family-of-origin issue impact the therapeutic process. In vivo experiences within different communities through research projects and other types of fieldwork, and experiential exercises related to one s own experience of oppression, privilege, and awareness of racial issues might be other pathways toward this goal. Finally, interactions with instructors, students, supervisors, and guest lectures from diverse settings can potentially enhance these experiences (McDowell et al., 2002). Third, results may be a function of the measures used. The MCC primarily taps into one s awareness and knowledge and this may not necessarily translate to actual behavioral competence (sense of selfefficacy). Furthermore, the CCCI-R used to assess multicultural competence may not have been sensitive 385

14 Page 386 enough to assess the subtle yet complex aspects (individual variables, working alliance) related to multicultural issues, an issue pertaining to the validity of the measure. Finally, these results may be a function of the current sample in the study. Participants knowledge of the program as well as the interpretation of items may have differed from that intended by the instrument s authors (Schwartz, 1999). Additional Analyses with Demographic Variables and Multicultural Competencies Analyses conducted between self-reported multicultural competence and demographic variables only showed a relationship between self-reported multicultural competence and three variables, namely, age, number of formal courses taken, and highest degree seeking. Results showed that there was a significant positive relationship between self-reported multicultural competencies and age. The potential for exposure to varied experiences as one grows older might allow for a greater appreciation and understanding of diversity issues, resulting in a belief of greater competence. Results also showed a significant and positive relationship between self-reported multicultural competencies and number of formal courses taken. Although empirical research on this relationship is mixed (e.g., Ladany et al., 1997), our findings are consistent with other studies (e.g., Constantine et al., 1996, 2001) that found that those who completed a greater number of multicultural courses reported greater levels of self-reported multicultural competence. There may be several reasons for these findings., training in several multicultural courses may provide students with a more comprehensive framework in understanding the role of contextual factors on client s lives. Second, participation in more courses may promote a greater comfort with self-exploration and knowledge manifesting itself in a personal sense of multicultural competence. Finally, the greater number of courses may be synonymous to a transformationist approach discussed earlier (Banks, 2003). However, given the mixed results in the literature as well as the low positive correlation between number of courses and CCCI-R in our study, results need to be interpreted with caution. Interestingly there seemed to be a significant but negative relationship between self-reported multicultural competence and highest degree seeking. Thus, those who were pursuing higher degrees, for example, a PhD versus a post-master s or a master s degree, seemed to report lower multicultural competence. This may be a function of the increasing complexity inherent within diversity issues. As students are exposed to different milieus that increase their cultural and social awareness, knowledge, and sensitivity, they may start to recognize the need to move beyond a first-order change. They may develop a deeper appreciation and commitment to the multiple levels of diversity that need to be attended to. Furthermore, the development of multicultural competence is an ongoing process. Students sense of competence was assessed at only one time in the program. Understanding the nature and scope of multicultural education and cultural development while assessing students at different points in the program might provide for a more thorough understanding. LIMITATIONS The results of this study and its implications need to be considered in light of several potential limitations., one must use caution in generalizing the results of this study because of the response bias. Those students and faculty who chose to participate may have had a particular interest in the research topic and may potentially be different from those who did not choose to participate. A second limitation is related to self-report measures and an inherent social desirability bias prevalent in responding to such instruments. Both measures used in this study were self-report in nature. Participants interpretation of items may have differed from that intended by the instrument s authors. Furthermore, they may have endorsed expected rather than actual attitudes and behaviors (Schwartz, 1999). A third limitation is the correlational design in examining the relationship between multicultural training and multicultural competence. Such a design precludes one from drawing a cause effect relationship. Finally, multiple chi-squared tests were conducted to assess significance of results on the MCC. These findings need to be interpreted with caution due to the potential for Type-I error. 386

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