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All health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care, yet mobile health technologies may have even more promise. A scoping review examined the research question: “What are the components of culturally competent, mobile health care, and what approaches have clinicians and systems taken to implement this care, train clinicians and evaluate outcomes?” The literature search from January 2000 to March 2020 focused on keywords in four concept areas: (1) competencies; (2) mobile health; (3) culture; and (4) clinical care. Of 2471 papers, 183 papers were directly relevant to the concepts. Few studies and professional organizations’ publications specifically discuss skills or competencies for mobile health and cultural factors. Existing telehealth competency sets (i.e., video, social media, mobile health, telebehavioral health, asynchronous) have limited cultural components, and one outline of culturally competencies exists without mention of technology. The landscape of culturally competence is expanded with cultural humility and safety constructs. New sets of mobile health and cultural competencies were constructed—with integration where possible—and training and administrative approaches are suggested. Effectiveness research is needed to implement and evaluate mobile health and cultural competencies. Research is also needed to understand how these competencies align with telehealth, rural health, and unique populations (e.g., refugees, Indigenous peoples, migrant workers, gender diverse groups). Outreach and advocacy for the inclusion of people with lived and living experience is essential to this research.

Medical healthcare settings have begun to use telepsychiatry and telebehavioral health to improve access to evidence-based care for culturally diverse patients. This paper is a companion paper to another, which focused on components of culturally competent clinical care, fundamental approaches, and linkage of outcomes to competencies. An administrative foundation is needed to address workforce, program evaluation, and short- and long-term financing and reimbursement issues. This paper focuses on three questions, particularly related to medical settings: (1) What administrative approaches facilitate culturally competent care via telebehavioral health? (2) What outcomes should be prioritized for program evaluation? (3) What financing and reimbursement approaches help to overcome/prevent obstacles/barriers and promote sustainability? Administrators need an approach to evaluation, interprofessional/disciplinary teams, stepped/comparable models of care, and telebehavioral health to leverage expertise. Clinicians and team members need integrated cultural and telebehavioral health skills and all members of a clinic/system need to support diversity by reducing stigmatization, facilitating language access and flexibly adapting practices. On one hand, telehealth and culturally competent care are just part of regular services, but on the other hand, few accommodations are made for these in short- and long-term financing and reimbursement streams. Building a viable system and sustaining requires prevention/management of many barriers/obstacles. Populations need culturally competent care and telebehavioral access. More quantitative/qualitative research/evaluation is suggested to improve the approach and outcomes.

Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.

The authors assessed whether a 1-h didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves cultural competence of general psychiatry residents. Psychiatry residents at six residency programs completed demographics and pre-intervention questionnaires, were exposed to a 1-h session on the CFI, and completed a post-intervention questionnaire. Repeated measures ANCOVA compared pre- to post-intervention change. Linear regression assessed whether previous cultural experience predicted post-intervention scores. Mean scores on the questionnaire significantly changed from pre- to post-intervention (p

The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p

This article describes the process of change in an academic department of psychiatry that has led to the development of a diversity initiative in teaching, research, recruitment, and services. The authors performed a literature review of diversity initiatives using PubMed. The authors then wrote a case study of the development of a diversity initiative at UC Davis. Some articles on diversity initiatives were found, but none that detailed the administrative process, funding, or sustainability of such initiatives. In 1999, the UC Davis Department of Psychiatry and Behavioral Sciences recognized the importance of issues of diversity and established the Diversity Advisory Committee, a group of department faculty and residents that explores and addresses the diversity needs of the department. In our observations, there are at least three requirements for a successful diversity initiative: a diverse patient population, a “critical mass” of interested faculty, and support of the administration. With these three factors in place, the Diversity Advisory Committee produced four Continuing Medical Education symposia focused on diversity topics, developed a 4-year cultural psychiatry curriculum and a 4-year religion and spirituality curriculum within the residency, and supported nine residents who received awards from the APA’ s Minority Fellowships in 8 years. Future plans include department-wide and medical school faculty-wide diversity training, educational research, and a postgraduate fellowship in cultural psychiatry. This article shows that a diversity initiative can be undertaken with interested minority and nonminority faculty, administrative support, and a diverse patient population. The authors hope this article will provide assistance to other academic departments in developing diversity initiatives.

The authors aim to evaluate the effectiveness of a presentation designed to increase cultural competence. A measure was developed to evaluate the attainment of knowledge and attitude objectives by first-year medical students who watched a presentation on the effect of culture on the doctor-patient relationship and effective methods of interpretation for non-English-speaking patients. The test was administered before and after the presentation and data were analyzed using a linear mixed-effects regression model. Both knowledge and attitudes improved over the course of the lecture. Those who give individual presentations in multiple instructor medical school courses should supplement their course evaluations with lecture-specific surveys targeted to their specific learning objectives for knowledge and attitudes.

Feature films have been used for teaching in psychiatry for many years to demonstrate diagnoses, but the use of documentary and instructional films in resident and staff cultural competence training have not been extensively written about in the medical and psychological literature. This article will describe the films that have been used by the authors and suggest methods for their use in cultural competence and diversity training.A literature search was done using MEDLINE and PsychINFO and the authors were asked to describe their teaching methods.One article was found detailing the use of videotapes as a stimulus but not for cultural competence education, and two articles were found documenting the use of The Color of Fear as a stimulus for the discussion of racism. However, many educators use these films all across the country for the purpose of opening discussion about racism.Documentary, instructional, and public service announcements can be useful in teaching culturally competent assessment and treatment.

Advances in information technology enable the practicing psychiatrist's quest to keep up-to-date with new discoveries in psychiatry, as well as to meet recertification requirements. However, physicians' computer skills do not always keep up with technology, nor do they take advantage of online search and continuing education services. This article describes the rationale for using electronic databases and training, as well as basic computer skills, computer equipment, and important online resources for psychiatrists to meet their continuing education and recertification needs quickly, easily, and conveniently.A literature review was performed using PUBMED and Google to find articles related to recertification, physician's technology adoption and computer skills, evidence-based medicine, and basic approaches to lifelong learning using computers and the Internet, and resources for lifelong learning.Psychiatrists are required to master a discrete set of information for board certification, and to maintain that knowledge for recertification. Surveys have shown that although most physicians use computers, the majority use them for personal or business purposes, and not for accessing Continuing Medical Education (CME) programs (1). The Council on Graduate Medical Education requires the acquisition of medical informatics skills for the Undergraduate Medical Education for the 21st Century (UME-21) curriculum project (2). There is a growing body of literature outlining basic computer skills and competencies for physicians to access online textbooks, databases, journals, and CME programs.Psychiatrists can benefit from learning how to use computers and the Internet to keep current with the advances in the field. Skills now being taught in medical school and residency are equally important for practicing psychiatrists to learn and master.

The primary care physician is increasingly important in the delivery of mental health services in the primary care setting. A review of investigations from several decades reveals that mental disorders are present in approximately 25% of primary care patients. [24] Primary care practices serve as the de facto hidden mental health network, providing the sole contact for over 50% of patients with mental illness. [21] Overall, approximately 60% to 70% of patients with anxiety, mood, somatoform, chemical dependency, and psychotic disorders are seen within the primary care setting. [25] Psychotic disorders occur in about 1% of patients in the primary care setting [14] and 3% in the general population. [20] This rate is lower than rates for depression (5%-10%), general anxiety disorder (1.6%-11.9%), panic disorder (1.6%-11%), alcohol disorders (5%-15%), other substance disorders (5.0%-7.1%), somatization disorder (2%-3%), and hypochondriasis (0.5%-6.3%). [13] At least 30% of patients with a psychotic disorder are treated in the primary care setting, [20] and in recent years, this may have increased. These patients have significantly decreased quality of life, capacity to work, and ability to maintain relationships. Patients with a psychotic disorder commit suicide at a rate of 10%. [19]

Received February 21, 2008; accepted March 26, 2008. Dr. Lim isaffiliated with the Department of Psychiatry and BehavioralSciencesat the University of California Davis School of Medicine; Dr. Lu isaffiliated with the Department of Psychiatry at the UniversityofCali-fornia San Francisco. Address correspondence to Russell F. Lim,M.D., Psychiatry and Behavioral Sciences, UC Davis School ofMedicine, 2230 Stockton Blvd., Sacramento, CA 95817; rflim@ucdavis.edu (e-mail).Copyright 2008 Academic Psychiatry

Cultural beliefs, medical traditions, and language are just some of the characteristics that distinguish the uniqueness and distinctness of mental illness within Asian American community compared to other U.S. populations. The assessment, diagnosis, and treatment for ethnic Asian patients affected by mental illness requires culturally appropriate and flexible approaches for effective service delivery. Working with the families of schizophrenia and bipolar patients, as well as addressing the stigma associated with mental illness is especially important for Asian American patients, even more than mainstream and other American ethnic groups.. Of note, there is a limited number of studies on schizophrenia and no research on bipolar disorders among Asian Americans. Recommendations for better service delivery include specific guidelines for assessment and treatment of Asian American clients, particularly noting some of the particular needs of an individual subgroup (language, for example) within the general minority community.

Psychiatric residency programs have had chief residents for many years, and several articles previously published describe the chief residents' unique role as both faculty and resident. This article describes chief resident roles and responsibilities and explores trends in academic psychiatry departments from 1995 to 2006.The authors mailed a survey about the roles and responsibilities of chief resident positions to psychiatric residency training directors using the American Association of Directors of Psychiatric Residency Training (AADPRT) mailing list in 1995 and e-mailed the AADPRT e-mail list in 2006. Data were collected by mail in 1995 and collected in 2006 by a web-based survey similar to the instrument used in 1995.Joint selection of chief resident by faculty and residents, 12-month terms, protected time for administrative duties, and written job descriptions were helpful features common to most programs.Our results demonstrate that the majority of general psychiatry residency programs use the joint selection method with a negotiated job description, as well as a 12-month term.

Since 1980, the racial/ethnic diversity of the United States has rapidly increased. Also in this time, though the population of the United States has aged in general, the difference between the youngest and oldest age groups and their percentage of non-White population has widened (U.S. Census Bureau, 2002). From 1980 to 2000, the population of races other than White non-hispanic grew by 88% while the White non-hispanic population grew by 7.9%. By 2000, four states and the District of Columbia had minority populations in total exceeding 50% of the population. Data on age by race and Hispanic origin reveals that throughout the period between 1980 and 2000 White non-Hispanics and Asian and Pacific Islanders were relatively older than Black Americans, American Indians and Alaska Natives, and Hispanic Americans. The median age for White non-Hispanics in 1980 was 31.7-years-old and in 2000 was

of seeker, writer, and reader described by Roberts and Termuehlen (1) is reduced to a less-personal dyadic relationship of writer and reader. Also, the institution asking for the LOR usually assures the writer of confidentiality of her/his letter. Most frequently, the privately-spoken suggested solution is. . . . to decline to write the LOR if one cannot write a positive one. It is certainly easier and politically less challenging than writing a laborious evaluation; yet, is it right and ethical? Should the committee keep trying to get positive letters until it gets some? What is the point of writing only “positive” LOR? Don’t we have the responsibility and obligation to the profession and the society to write the “objective” evaluation we are asked for? I suggest that it is ethical and that it goes directly to the honesty of letter-writing suggested by Roberts and Termuehlen (1) and Larkin and Marco (4) to write an objective, noninflated LOR, rather than refuse to write one because it would not be positive. Richard Balon, M.D.