Journal of Vocational Rehabilitation 29 (2008) 77–91 77

IOS Press

Cultural competence training with

organizations serving people with disabilities
from diverse cultural backgrounds
Tina Taylor-Ritzlera,∗ , Fabricio Balcazara, Shawn Dimpflb , Yolanda Suarez-Balcazar a,
Celestine Willisa and Rachel Schiffc
a
University of Illinois at Chicago, Chicago, IL, USA
b
University of Groningen, Groningen, The Netherlands
c
Claremont Graduate College, Claremont, CA, USA

Revised March 2008

Accepted March 2008

Abstract. This article describes the cultural competence training approach used by the Center for Capacity Building on Minorities
with Disabilities Research with agencies that serve people with disabilities from different cultural backgrounds. The outcomes of
the training on participants’ individual levels of cultural knowledge, physical environment, attitudes, values and communication
styles are presented. Data on the agencies’ ability to set, pursue and attain organizational goals related to cultural competence is
also presented. A total of 287 staff members representing 84 organizations completed individual-level assessment instruments.
In addition, 43 organizations elected to receive follow-along support related to organizational cultural competence goals. Results
indicated that participants experienced significant post-training improvements in cultural knowledge, physical environments,
and values, attitudes and communication styles. In addition, after 6 months of follow-along support, participants were actively
pursuing with progress or had achieved the majority of the cultural competence goals they set during training. The potential
benefits and challenges of providing cultural competence training to staff that serve ethnic minority individuals with disabilities
are discussed.

Keywords: Ethnic minorities with disabilities, cultural competence, training, outcomes

1. Introduction increased, so has the number of people of color with

The U.S. population is becoming increasingly di-
verse. Currently, 30% of the U.S. population is made
up of ethnic minorities and estimates project that peo-
ple of color will become about half of the population by
the year 2050 if current immigration and natality rates
continue [24]. As the number of people of color has
∗ Address for correspondence: Tina Taylor-Ritzler, Center for Ca-
pacity Building on Minorities with Disabilities Research, Depart-
ment of Disability and Human Development, University of Illinois
at Chicago, 1640 W. Roosevelt Road (m/c 626), Chicago, IL 60608,
USA. E-mail: tritzler@uic.edu.
disabilities [11]. Recent findings indicate that African
Americans and Native Americans have the highest rates
of disability, equaling or exceeding 20% of their pop-
ulation [24]. Moreover, people of color with disabil-
ities have significantly worse outcomes in education,
employment, health and social services compared with
those who are White [26,27]. As a result of the grow-
ing evidence of poor outcomes for people of color,
awareness about the need for cultural competency in
providing services to diverse populations in the U.S. is
increasing at the Federal, State and local levels [1,15,
23]. Cultural competence training has emerged as one
method of developing or improving the effectiveness

1052-2263/08/$17.00  2008 – IOS Press and the authors. All rights reserved
78 T. Taylor-Ritzler et al. / Cultural competence training
Desire to Engage
Fig. 1. Cultural competence conceptual framework of the Center for Capacity Building on Minorities with Disabilities Research.
of service providers in meeting the needs of diverse
consumers [17,22].
Studies of the effectiveness of cultural competence
trainings have appeared in many fields, including
medicine [2,7], nursing [6,18], and counseling [1,10].
However, few studies have presented approaches for
training staff from organizations serving people with
disabilities or the outcomes of these training efforts.
One such study was conducted by Moffat and Tung [15]
in which a culture brokering model was tested with
staff at an independent living center (described below).
However, more research is needed in this area, in partic-
ular research that examines the impact of cultural com-
petence training at both individual and organizational
levels. Therefore, the purpose of the present study was
to describe the training approach used by the Center
for Capacity Building on Minorities with Disabilities
Research (the Center) at the University of Illinois at
Chicago (UIC) and to examine the outcomes of the
training at the individual and organizational levels. We
also discuss the implications of cultural competence
training for the delivery of services to ethnic minority
consumers with disabilities.
1.1. Defining cultural competence
Several definitions of cultural competence are avail-
able in the literature. Among them is understanding
that culture profoundly influences individual’s beliefs,
practices, behaviors and the outcomes of most inter-
ventions and services [4,6]. Another aspect of cul-
tural competence is the service providers’ ability to
understand the values and beliefs of the person they
are providing services to and adjust their therapeutic
strategies and/or services to meet his or her individu-
al needs [8]. As such, cultural competence general-
ly focuses on understanding the different experiences
of members of diverse cultural and/or ethnic groups,
attempting to address the barriers in communication
across cultures and helping develop professionals’ abil-
ities to work effectively with individuals from various
cultural backgrounds [16].
Conceptualizations of cultural competence also vary.
Balcazar, Willis, Suarez-Balcazar, and Alvarado [3]
conducted a review of 18 cultural competence models
from the fields of nursing, counseling, social work, and
public health. Based on a process that included first
the identification of the most commonly used compo-
nents across models and then a preliminary factor anal-
ysis [3], they conceptualized cultural competence as an
ongoing process that includes five critical components.
The Center’s Cultural Competence model ([3,21]; see
Fig. 1) has both individual and organizational levels
of influence. At the individual level, the elements are
(1) desire to engage, referring to the individual’s will-
ingness to participate and learn about cultural diversi-
ty; (2) development of critical awareness of personal
biases towards others who are different in any dimen-
sion of cultural diversity; (3) knowledge of the mul-
tiple factors that can influence diversity and familiar-
ization with selected characteristics, histories, values,
beliefs, and behaviors of members of diverse cultural
groups; and (4) development and practice of skills for
working effectively with other individuals from diverse
cultural backgrounds. In addition, the implementation
of these individual-level elements of cultural compe-
 T. Taylor-Ritzler et al. / Cultural competence training
tence is facilitated or hindered by a fifth critical ele-
ment, the degree of organizational support for cultural
competence where the service providers work. Organi-
zational support varies in the degree to which agencies
may encourage or hinder cultural competence through
policies, procedures, allocation of resources and every-
day practices. The model includes a detailed analysis
of the factors that influence cultural diversity. These
factors are divided in two main categories: observable
and non-observable. Balcazar et al. [3] identified five
observable factors, including race, age, visible disabil-
ity, gender, and attractiveness/appearance. They have
also identified 16 non-observable factors that include:
disability (hidden), family and community support, ex-
periences of oppression (which included knowledge of
rights and services and sense of entitlement), socioe-
conomic status (which includes political involvement),
religion (which included beliefs and values), level of
education, degree of acculturation (which includes lan-
guage mastery/fluency and cultural identity), immigra-
tion status, level of urbanicity (urban vs. rural), and
sexual orientation. According to this model, these 21
factors affect perceptions and interactions among peo-
ple within all types of service settings. The training em-
phasizes that service providers must consider these fac-
tors in their interactions with consumers from diverse
groups, and that racial differences are only a window
to the complexities of human diversity.
1.2. Approaches to cultural competence training
Currently there are two main approaches to cultural
competence training. One common method of increas-
ing cultural competence among providers in a number
of fields (e.g., nursing and counseling psychology) is to
include cultural competence training in graduate-level
coursework as part of the students’ professional devel-
opment (e.g. [12]). A second way of increasing cultural
competence is to train staff who is already working in
service agencies as part of their job development and in
some professions, as part of required certification for
state licensing (e.g. [15,25]). Regardless of prior expo-
sure to training in post-secondary or professional train-
ing programs, on-the-job cultural competence train-
ing may be especially important as consumers seek-
ing services from all types of disability service provid-
ing agencies are increasingly likely to be from diverse
cultural and/or ethnic backgrounds, while the profes-
sionals who manage the organizations continue to be
primarily white and middle class [15]. Paradoxically,
many direct service personnel in institutions serving in-
79
dividuals with development disabilities and/or mental
illnesses are minorities themselves, particularly in large
cities, because of the often low-wages paid by these
positions. This factor introduces additional complexity
to the racial and class relations in most institutions of
this type.
On-the-job cultural competence training programs
vary widely in the intensity and method of training used.
Three studies exemplify this diversity. Sergison’s [25]
cultural competence and antiracism training for child-
health workers was a one-day training program that in-
cluded sessions describing the ethnic minority popu-
lation in England, discussed topics like stereotyping,
empathy, racism, and communication and offered sug-
gestions for ways to improve practices. Moffat and
Tung’s [15] evaluation of training using the CIRRIE
culture brokering model [19] was designed to increase
the cultural competence of independent living center
staff. Over two days of training, participants were in-
troduced to the concepts of race, ethnicity and culture,
including disability culture and the culture of indepen-
dent living, and the processes involved in the cultural
brokering model. This model was developed to help
service providers identify intervening conditions that
lead to cultural conflict and to assist them in develop-
ing interventions to resolve the conflicts and achieve
positive service outcomes. Finally, Abernethy’s [1]
cultural proficiency training was designed to improve
the cultural competence of clinical managers and it is
delivered over four days for a total of 20-hours. This
curriculum was divided into three modules including
culture-general and culture-specific content focused on
Latinos, African Americans, West Indians, and South-
east Asians. Cultural competence training generally
includes a combination of lecture, discussions, group
activities and case studies.
The primary method of evaluating cultural com-
petence trainings has been pre-post comparisons of
training participants’ cultural knowledge, attitudes and
skills. After conducting a systematic review of cultur-
al competence trainings for health care providers that
used a variety of training approaches, Beach and his
colleagues [5] concluded that “there is excellent evi-
dence that cultural competence training improves the
knowledge of health professionals. . . and good evi-
dence that cultural competence training improves the
attitudes and skills of health professionals” (p. 356). In
addition, using pre-post assessments of components of
their culture brokering training with independent living
center staff, Moffat and Tung [15] found that partic-
ipants’ scores improved significantly within the three
80 T. Taylor-Ritzler et al. / Cultural competence training
domains of their cultural competence questionnaire:
physical environment, materials and resources; com-
munication styles; and values and attitudes. Few stud-
ies have reported organizational-level impacts of cul-
tural competence trainings, despite recommendations
for improvements at this level.
In summary, research has shown that there is a
need for providing training in cultural competence to
providers who serve people of color with disabilities
as well as a need to examine the effectiveness of such
training [15]. In addition, the majority of cultural com-
petence trainings have been evaluated using pre-post
assessments of participants’ improvements in knowl-
edge, attitudes and skills. Little attention has been paid
to organizational factors that influence the application
of individual competencies into organizational practice.
1.3. The current study
The purpose of the current study was to describe the
training approach used by the Center and present data
on the impact of training at individual and organiza-
tional levels. We assessed the impact of the training on
changes in participants’ knowledge, physical environ-
ment, attitudes, values and communication styles and
also on their ability to set, pursue and attain organiza-
tional goals related to cultural competence. Specifical-
ly, we sought to answer the following questions:
1. Did participants gain knowledge related to mul-
ticulturalism as a result of participating in the
training?
2. Did participants’ physical environments change
as a result of participating in the training?
3. Did participants’ attitudes, values, and commu-
nication styles change as a result of participating
in the training?
4. What types of goals did participants set?
5. What barriers and facilitators did participants en-
counter when working on their goals?
6. What were participants’ levels of goal accom-
plishment?
7. What was the process of organizational goal ac-
complishment?
2. Methods
2.1. Background: The center mission and training
context
The Center was funded by the National Institute
on Disability and Rehabilitation Research (NIDRR) in
2004 to increase the capacity, through research and dis-
semination efforts, of State Vocational Rehabilitation
Agencies (VR), Centers for Independent Living and
community-based organizations (CBOs) serving indi-
viduals with developmental disabilties and/or mental
illnesses to provide services that lead to positive reha-
bilitation outcomes for ethnic minority individuals with
disabilities. As part of its ongoing activities, the Center
provides, upon request, cultural competence training to
staff members of these agencies.
It is important to note that just as participants are
involved in the training voluntarily, their involvement
in the assessment of the training effectiveness is also
voluntary. We differentiate between the cultural com-
petence training (which is a public service and not a re-
search activity) and the assessment of the effectiveness
of this training (which is a research activity). Train-
ing participants were not required to participate in the
research component and no data were collected from
training participants who did not sign a consent form.
The Center’s cultural competence training [2] was
designed to increase participants’ levels of critical
awareness, knowledge about the factors that influence
cultural diversity and multicultural skills, following
the conceptual model of Balcazar et al. [3], described
above. The training process included first a review of
various constructs like discrimination, racism, prejud-
ism, oppression and white priviledge; followed by a re-
view of the Center’s cultural competence model and the
factors that impact cultural diversity, using examples
from African American, Latino and/or Asian American
populations. The last part of the process included a re-
view of effective outreach strategies for minority pop-
ulations and the goal setting excersice. From our first
training experiences, we have understood that cultural
competence can not be achieve through a one-day train-
ing event. Rather, achieving cultural competence is an
on-going process of gradual improvement and the goal
setting exercise allowed us to set the stage for engaging
training participants in this process.
The trainings described here were a full day (7 hours
including two 15-minute breaks and a one-hour lunch
break) and consisted of lectures, group discussions,
large and small group activities, and an organization-
al goal-setting exercise. Training was typically pro-
vided by Balcazar and Willis, who together with the
remaining authors comprised the training evaluation
team. Training rooms were typically set up with par-
ticipants sitting together at tables of eight to 10 people.
The first two hours were spent providing participants
with an overview of the Center’s cultural competence
 T. Taylor-Ritzler et al. / Cultural competence training
model and engaging them in exercises to increase crit-
ical awareness. The following two hours were spent
in a more formal lecture, presenting information about
the factors that impact cultural divbersity and their ap-
plication to the context of African Americans, Latinos
and/or Asian Americans, depending on the needs of the
participants, as initial orientations to working with con-
sumers from these cultures. The last two hours of the
training were devoted to supporting organizations to set
goals to increase their organization’s effectiveness in
serving consumers from diverse cultural backgrounds.
During the goal setting exercise, participants were of-
fered up to six months of monthly follow-along phone
consultation and technical assistance from Center staff
to support their pursuit of these organizational goals.
2.2. Participants
2.2.1. Training participants
Twelve trainings were conducted in 2005 and 2006.
A total of 549 individuals representing 92 organiza-
tions participated in these trainings. Trainings were
conducted in 11 cities in six Midwestern states. Five
trainings were organized by the Region V Rehabilita-
tion Continuing Education Program (RCEP), which is
part of a regional network of training providers for VR
and CBO agencies serving individuals with disabilities
funded by the Rehabilitation Services Administration.
These trainings included 176 participants representing
50 community-based organizations and 79 participants
representing 42 VR offices. Between one and seven
staff from each organization attended training togeth-
er. In addition, seven trainings were conducted at indi-
vidual organizations that invited us to train their staff.
These trainings included 294 participants. Across all
of the trainings, participants tended to be direct service
staff or mid-level managers.
2.2.2. Study participants
Of the participants trained, 287 staff members repre-
senting 84 organizations consented to participate in the
evaluation of the training and completed assessment in-
struments. In addition, participants at 43 organizations
elected to set, pursue and receive follow-along support
related to the organizational cultural competence goals
they set during training.
81
2.3. Data collection instruments
2.3.1. Training Satisfaction Survey
Two instruments were used to assess participants’
satisfaction with the cultural competence training. At
the RCEP trainings, a satisfaction survey developed by
RCEP was used to assess participants’ satisfaction with
training. Participants were asked to rate the following
statements: “The presenter stated the objectives clear-
ly”, “The presenter(s) were well prepared and knowl-
edgeable regarding their particular topic”, “The presen-
ter helped me readily understand the session content”,
“Session content matched stated objectives” and “I ac-
quired techniques, skills, or approaches that can be ap-
plied on the job” using a 5-point Likert scale. In addi-
tion, the survey included an open-ended item for com-
ments regarding the session presenter(s) and methods.
To reduce the burden on research participants we did
not administer the Center satisfaction survey to RCEP
training participants.
At the remaining seven organization-specific train-
ings, trainers adminstered the satisfaction survey devel-
oped by the Center. This instrument asked participants
to rate their perceptions of usefulness and their satis-
faction with the concepts presented, the framework, the
examples and the materials/handouts distributed using
a 5-point Likert scale where 1 = least useful/very un-
satisfied and 5 = most useful/very satisfied.
2.3.2. Cultural knowledge assessment
This measure was adapted from Moffat and Tung [15]
and includes 14 items designed to assess participants’
basic knowledge related to multiculturalism and infor-
mation about US immigrant groups. Items were word-
ed as statements. For example, items include “Most
minority populations are receiving welfare benefits”
and “Asians value harmony while European Americans
value mastery.” Participants were asked to indicate
whether the item was true or false, or whether they did
not know the veracity of the statement.
2.3.3. Physical environment, resources and materials
assessment
This measure was adapted from Moffat and Tung [15]
and includes 8 items designed to assess the extent to
which participants’ work environments are appropri-
ate and welcoming for people from different cultures.
Items include “I display information about resources in
the community that minority clients and families may
benefit from” and “I use different mechanisms to obtain
feedback from consumers about how to improve the
82 T. Taylor-Ritzler et al. / Cultural competence training
agency’s services”. These items were measured using
a 4-point Likert scale where 1 = never, 2 = rarely, 3 =
occasionally and 4 = frequently.
2.3.4. Values and attitudes assessment
This measure was adapted from Moffat and Tung [15]
and includes 15 items designed to assess participants’
values and attitudes related to multiculturalism and peo-
ple from different cultural backgrounds. Items include:
“I avoid imposing values, which may conflict or be in-
consistent with those of cultures or ethnic groups oth-
er than my own” and “I understand and accept that
family is defined differently by different cultures” and
were measured using a 4-point Likert scale where 1 =
strongly disagree, 2 = disagree, 3 = agree and 4 =
strongly agree.
2.3.5. Communication style assessment
This measure was also adapted from Moffat and
Tung [15] and includes five items designed to assess
participants’ communication styles related to multi-
culturalism and people from different cultural back-
grounds. Items include “When interacting with clients
and families that have language barriers I always keep
in mind that a language barrier does not necessarily
reflect my client’s level of intellectual functioning” and
“A client’s limited ability to speak the language of the
dominant culture has no bearing on my client’s ability
to communicate effectively in his or her language of
origin” and were measured using a 4-point Likert scale
where 1 = strongly disagree, 2 = disagree, 3 = agree
and 4 = strongly agree.
2.3.6. Goal setting form
This form was developed for the Center’s cultural
competence training. The form includes open fields
for participants to write up to three goals related to in-
creasing their organization’s cultural competence. Par-
ticipants were asked to follow the SMART guidelines
for setting goals (goals must be simple, measurable, at-
tainable, realistic and appropriate for the timeline pro-
posed). For each goal that they chose to set, partici-
pants were asked to answer three closed-ended ques-
tions: (1) “How important is the goal to you?” (where
3 = very important, 2 = somewhat important and 1
= not very important); (2) “How motivated are you to
accomplish this goal?” (where 5 = very motivated, 3 =
somewhat motivated and 1 = not very motivated); and
(3) “How urgent is this goal for you?” (where 5 = very
urgent, 3 = somewhat urgent and 1 = not very urgent).
In addition, participants were asked two open-ended
questions for each goal they set: “What facilitators do
you anticipate encountering?” and “What barriers do
you anticipate encountering?”
2.3.7. Goal follow-up form
This form was developed to follow the progress
and accomplishment of goals set by organizations that
agreed to receive follow-along support. The form in-
cludes fields to write the name and phone number of
the contact person for the organization as well as the
goal statements (up to three). For each goal, the form
includes fields to record the date of each follow-up
(monthly for up to six months), progress notes for each
goal and level of goal accomplishment measured on
an 8-point scale (where 1 = deterioration [organization
was farther from goal accomplishment at the time of
the follow-up call than when the goal was set during
training], 2 = goal dropped [no intent to continue], 3
= goal put on hold [intent to continue at a future time],
4 = active pursuit of goal with none or little progress,
5 = active pursuit of goal with substantial progress, 6
= accomplished less than desirable goal, 7 = accom-
plished goal as expected, and 8 = accomplished more
than desirable goal).
2.4. Data collection procedure
2.4.1. Informed consent
At the beginning of the training, participants were
asked whether they would like to participate in the as-
sessment of the effectiveness of the training. In brief,
we shared with participants that: (1) there were no
risks to participation; (2) all responses would be kept
confidential and participants were not obligated to an-
swer any question that made them uncomfortable; (3)
participants would be asked to complete the mesaures
described above; and (4) participants would receive
support to accomplish their organizational goals relat-
ed to cultural competence through monthly follow-up
phone calls. Those who consented to participate were
considered both training and research participants.
2.4.2. During training measures
At the beginning of each training, research partici-
pants were asked to complete the four baseline mea-
sures: Cultural Knowledge Assessment; Physical Envi-
ronment, Resources and Materials Assessment; Values
and Attitudes Assessment, and Communication Styles
Assessment.
At the end of the training, participants were involved
in an exercise to set goals to improve their organiza-
 T. Taylor-Ritzler et al. / Cultural competence training
tion’s cultural competence. Participants were asked to
sit with others from their agency, department and/or
program to set goals and to select a contact person for
the follow-ups. All contact persons were asked to pro-
vide contact information so that Center staff could fol-
low up with them to provide consultation and technical
assistance, as needed, during the six months following
the training, and to assess their degree of goal accom-
plishment. Training participants who did not consent
to participate in the research were not asked to fill out
any of the assessment forms but could participate in the
group process of setting goals for their organization.
The goal setting exercise lasted about 90 minutes. At
the end of the training, research participants complet-
ed the Cultural Knowledge Assessment (post-measure)
and the Training Satisfaction Survey.
2.4.3. After-training follow-up measures
About two months after each training we engaged
in two types of follow-up activities. First, we sent
the Physical Environment, Resources, and Materials
Assessment, the Values and Attitudes Assessment, and
the Communication Styles Assessment to each research
participant through the U.S. Postal Service along with
a stamped, self-addressed envelope for them to return
the completed surveys to us.
Second, a member of our team called the designat-
ed representative from each organization or program
who participated in the goal setting exercise and who
agreed to be contacted to follow up on their organi-
zation’s cultural competence goal(s). We called this
contact person monthly for up to six months in order to
determine the organization’s level of progress in work-
ing toward their goal(s) and to provide any technial
assistance that the organization needed. The number
of follow up calls was based on the contact person’s
availability and continued willingness to participate in
follow-along contacts.
2.5. Data analysis procedures
We used a variety of procedures to analyze the effects
of the training on participants’ knowledge, physical
environment, attitudes, communication styles, cultural
competence goal accomplishment and overall training
satisfaction. All data were entered into and analyzed
using the Statistical Package for the Social Sciences
Version 14.0. To analyze the Cultural Knowledge As-
sessment we assessed the correctness of participants’
responses to each item. Then we crosstabulated par-
ticipants’ responses (correct and incorrect by pre- and
83
post-assessment) and used the McNemar test [14] to
determine the degree to which participants’ cultural
knowledge increased as a result of training. To an-
alyze the Physical Environment, Resources and Ma-
terials Assessment, the Values, Behaviors, Attitudes,
and the Communication Style Assessment we calculat-
ed paired-samples t-tests for each item and on overall
averages computed for each measure.
We used a number of methods to analyze the or-
ganizational goals set by participants. Two gradu-
ate research assistants coded the goal statements, fa-
cilitators and barriers to goal accomplishment. We
assessed inter-coder reliability [13] and established
80.8%, 73.6%, and 75.9% for goal statements, facilita-
tors and barriers, respectively. We also conducted fre-
quency counts of the number of goals set, and of each
goal type, facilitator type, barrier type and goal accom-
plishment score. In addition, the third author read all of
the notes recorded during follow-along monthly phone
contacts and developed a process model of goal ac-
complishment and failure. This model was shared with
the first and fifth authors and discussed at length. The
validity and reliability of the model was cross-checked
with the data and the authors came to consensus on its
final form.
3. Results
3.1. Satisfaction with training
Using the RCEP Region V training satisfaction mea-
sure, participants reported an average satisfaction rat-
ing of 3.54. Using the satisfaction survey developed by
the Center, participants’ average satisfaction rating was
4.64. Overall, participants reported being moderately
to highly satisfied with the training content, presenters,
exercises and materials.
3.2. Cultural knowledge assessment
As reported in Table 1, analyses of the Cultural
Knowledge Assessment indicated statistically signifi-
cant improvements in knowledge at post-test on nine
of the 14 items assessed. These items included recog-
nizing U.S. mainstream values of independence; cur-
rent data indicate that about one in 10 Americans was
born outside the U.S.; immigrants from rural areas ex-
perience significant challenges dealing with social ser-
vice networks; and most minority populations are not
receiving welfare benefits. No significant increases in
84 T. Taylor-Ritzler et al. / Cultural competence training

Table 1
Cultural knowledge assessment results
Percent Correct Percent Correct p value
at Baseline Post Training (McNemar statistic)
1. Culture, race, and ethnicity are interchangeable words. (False) 88 82 0.01∗
2. Generally, the mainstream culture in the US tends to place importance on 84 92 0.00∗
independence. (True)
3. Cultural competence is a continuing developmental process. (True) 98 98 1.00
4. Today, approximately one in ten Americans was born outside the US. 54 80 0.00∗
5. Today, the largest population of foreign-born Americans is Asian. 47 47 1.00
6. Most Asian immigrants become US citizens. 21 24 0.43
7. Culture is the belief systems and value orientations that influence customs 91 97 0.01∗
and norms. (True)
8. Race is the category to which others assign individuals on the basis of physical 84 91 0.08
characteristics. (True)
9. Racism is when individuals are treated differently according to their culture 41 37 0.62
and beliefs. (False)
10. Children of immigrant racial minorities remain minorities, while the children 64 89 0.00∗
of White immigrants become part of the majority. (True)
11. Latinos with disabilities are more likely to receive fewer services and are 67 91 0.00∗
often neglected by the service delivery system. (True)
12. Immigrants that migrate from rural areas have more challenges dealing with 53 90 0.00∗
the social service network, in part because they lack a sense entitlement.
(True)
13. Asians value harmony while European Americans value mastery. (True) 40 76 0.00∗
14. Most minority populations are receiving welfare benefits. (False) 66 93 0.00∗
∗p < 0.05.

Table 2
Physical environment, resources and materials assessment
Baseline Mean Post-Training p value
(SD) Mean (SD) (t-statistic)
1. I display information about resources in the community that minority clients and families 3.14 (0.89) 3.18 (0.89) 0.00∗
may benefit from.
2. I display pictures, posters, artwork, and other décor that reflects the cultures and ethnic 2.69 (1.08) 2.93 (1.12) 0.00∗
backgrounds of clients served by my program or agency.
3. I ensure that magazines, brochures, and other printed materials in reception areas are of 2.69 (1.15) 3.12 (0.96) 0.00∗
interest to and reflect the different cultures and ethnic backgrounds of individuals and
families served by my program or agency.
4. When using videos, films, or other media resources for education or other interventions, 2.67 (1.05) 3.12 (0.88) 0.00∗
I ensure that they reflect the cultures and ethnic background of individuals and families
served by my program or agency.
5. I ensure that printed information disseminated by my agency or program takes into 3.10 (0.84) 3.27 (0.84) 0.01∗
account the diversity of the various cultures served by my program or agency.
6. I use different mechanisms to obtain feedback from consumers about how to improve 3.16 (0.95) 3.36 (0.72) 0.00∗
the agency’s services.
7. My agency or program’s physical environment (reception area) is appropriate for fami- 2.80 (1.17) 2.88 (1.07) 0.00∗
lies with small children.
8. My agency or program does not have the resources to provide materials in the preferred 2.66 (1.27) 2.42 (1.10) 0.85
language of clients.
Average Across Items 2.68 (0.55) 2.98 (0.56) 0.01∗
∗p < 0.05.

knowledge were observed on two items that appeared
to have ceiling effects (items 3 and 8 in Table 1). Fi-
nally, two items and/or the training content related to
these items may have confused some participants. The
number of people responding correctly to items 5 “to-
day, the largest population of foreign-born Americans
is Asian” and 9 “racism is when individuals are treat-
ed differently according to their culture and beliefs”
(rather than to their race) was low and there were no
significant increases in knowledge from pre- to post-
training. Further, it is noteworthy that significantly
fewer training participants answered item 1 “culture,
race and ethnicity are interchangeable words” correctly
after the training than before the training.
 T. Taylor-Ritzler et al. / Cultural competence training 85

Table 3
Values and attitudes assessment
Baseline Mean Post-Training p value
(SD) Mean (SD) (t-statistic)
1. I avoid imposing values, which may conflict or be inconsistent with those of cultures 3.19 (0.64) 3.37 (0.61) 0.02∗
or ethnic groups other than my own.
2. I screen books, movies, and other media resources for negative cultural, ethnic, or 2.98 (0.64) 3.30 (1.5) 0.18
racial stereotypes before sharing them with individuals and families served by my
program or agency.
3. I intervene in an appropriate manner when I observe other staff or clients within my 3.19 (0.62) 3.24 (0.54) 0.56
program or agency engaging in behaviors, which show cultural insensitivity, racial
biases and prejudice.
4. I recognize and accept that individuals from culturally diverse backgrounds may desire 3.37 (0.52) 3.52 (0.50) 0.04∗
varying degrees of acculturation into the dominant culture.
5. I understand and accept that family is defined differently by different cultures. 3.57 (0.59) 3.65 (0.48) 0.20
6. I accept and respect that male-female roles may vary significantly among different 3.42 (0.62) 3.50 (0.57) 0.23
cultures (e.g. who makes major decisions for the family).
7. I understand that age and life cycle factors must be considered in interactions with 3.47 (0.57) 3.58 (0.50) 0.09
individuals and families (e.g. high value placed on the decision of elders).
8. Even though my personal viewpoints may differ, I accept my clients and their families 3.52 (0.57) 3.52 (0.57) 1.00
as the ultimate decision makers for services and supports impacting their lives.
9. I accept that religion and other beliefs may influence how individuals and families 3.53 (0.57) 3.67 (0.47) 0.02∗
respond to illnesses, disease, and death.
10. I understand that the perception of health, wellness and preventive health services have 3.36 (0.61) 3.52 (0.50) 0.07
different meanings to different cultural or ethnic groups.
11. I recognize and accept that folk and religious beliefs may influence an individual’s or 3.41 (0.59) 3.52 (0.57) 0.16
family’s reaction and approach to disability.
12. I understand that grief and bereavement are influenced by culture. 3.50 (0.57) 3.52 (0.57) 0.82
13. I seek input from clients, families or other key community informants that will assist 3.37 (0.62) 3.35 (0.58) 0.83
in adapting services to respond to the needs and preferences of diverse groups served
by my agency.
14. Before visiting or providing services in the home setting, I seek information on accept- 2.93 (0.66) 3.33 (0.69) 0.00∗
able behaviors, courtesies, customs, and expectations that are unique to the diverse
groups served by my program or agency.
15. I am aware of the socio-economic and environmental risk factors that contribute to 3.05 (0.59) 3.38 (0.50) 0.00∗
destitution among ethnically diverse populations served by my program or agency.
Average Across Items 3.35 (0.39) 3.47 (0.42) 0.01∗
∗p < 0.05.

3.3. Physical environment, resources, and materials
assessment
As reported in Table 2, paired t-test results indi-
cated significant improvements from pre-training to
two months post-training in the physical environments
of participants on seven of the eight items assessed.
Specifically, improvements were related to the appro-
priateness of printed information, materials and other
media for clients of different cultural backgrounds. It
is noteworthy that participants did not report that their
agencies had resources to provide materials in the pre-
ferred language of clients.
3.4. Values and attitudes assessment
As reported in Table 3, paired t-test results indi-
cated significant improvements from the pre- to the
two-months post-training assessment of values and at-
titudes. Specifically, results indicated significant im-
provements in participants’ reports that they did not
impose their own values on others; that they accepted
individuals’ desires for varying degrees of accultura-
tion; accepted the role of religion in illness, disease and
death; were aware of factors that contribute to poverty;
and sought information on acceptable courtesies and
customs before visiting or providing services in home
settings. Interestingly, responses to all of the items in
this measure were at or above a value of three on this
4-point scale at post-test, indicating possible ceiling
effects or social desirability biases in measurement.
3.5. Communication styles assessment
As reported in Table 4, paired samples t-test results
indicated only one significant improvement from pre-
to post-training in participants’ communication styles.
Specifically, results indicated significant improvements
86 T. Taylor-Ritzler et al. / Cultural competence training

Table 4
Communication styles assessment
Baseline Mean Post-Training p value
(SD) Mean (SD) (t-statistic)
1. When interacting with clients and families that have language barriers I always keep in 3.53 (0.65) 3.75 (0.44) 0.06
mind that a language barrier does not necessarily reflect my client’s level of intellectual
functioning.
2. A client’s limited ability to speak the language of the dominant culture has no bearing 3.34 (0.81) 3.70 (0.46) 0.00*
on my client’s ability to communicate effectively in his or her language of origin.
3. For individuals and families who speak languages or dialects other than English, I at- 2.78 (0.81) 2.80 (0.78) 0.86
tempt to learn and use key words in their language so that I am better able to communicate
with them during assessment, or other services.
4. I attempt to determine any familial colloquialisms used by my clients or families that 3.06 (0.70) 3.08 (0.80) 0.88
may impact on assessment, or services.
5. I understand that it may be necessary to use alternatives to written communications for 3.25 (0.62) 3.35 (0.53) 0.24
some clients and families, as word of mouth may be a preferred method of receiving
information.
∗p < 0.05.

in participants’ reports that their clients’ linguistic com-
petence in English did not affect their competence in
communicating in their language of origin. Howev-
er, results also indicated that participants’ baseline and
post intervention levels of attempts to communicate
with their program participants in alternative ways (oth-
er than spoken or written English) were both high,
which also suggests a possible ceiling effect.
3.6. Goal accomplishment
3.6.1. Goals set
Overall, staff from 81 organizations set a total of 185
goals. Staff from each organization set between one
and three goals to improve their organization’s cultural
competence (M = 2.28); 15 organizations set one goal,
28 set two goals, and 38 set three goals.
Goals were grouped into four categories. The major-
ity of the goals set were related to increasing the cultur-
al competence of the organization, services and/or staff
(n = 93, 50%). Goals such as “to provide cultural com-
petency training to agency staff” and “offering basic in-
formation materials in other languages/formats” were
included in this category. The second largest group
of goals were concerned with improving outreach to
specific communities (n = 46, 25%). Goals in this
category included “outreach to Hispanic organizations
and populations” and “increase outreach activities to
the African American community.” The third category
of goals was to improve the community impact of the
organization (n = 26, 14%), for example, “to change
image of organization” and “to reduce stigma.” The
fourth and smallest group of goals was related to im-
proving the diversity of the organization’s staff (n =
22, 12%). Goals like “hire bilingual staff” and “hire
paraprofessionals from the community” were grouped
into this category.
3.6.2. Facilitators to goal accomplishment
When participants set their goals, they identified
three types of potential facilitators to goal accomplish-
ment: (1) individuals within their organization who
could provide specific assistance or who would likely
support the goal, such as staff or management (n =
65, 52%); (2) outside organizations in the community
to learn from or partner with, such as other social ser-
vice agencies or government agencies (n = 49, 39%);
and (3) the Center for Capacity Building on Minorities
with Disabilities Research for training materials or staff
consultation (n = 12, 10%).
3.6.3. Barriers to goal accomplishment
In addition, when participants set their goals they
identified six types of potential barriers to goal accom-
plishment: (1) reluctance to change among staff and
management (n = 75, 33%); (2) lack of money (n =
45, 20%); (3) lack of necessary resources such as train-
ing or technical assistance (n = 45, 20%); (4) lack of
time (n = 36, 16%); (5) lack of bilingual staff (n =
23, 10%); and (6) lack of diversity among staff and
management (n = 4, 2%). The biggest impediment
to goal accomplishment that many of the organizations
faced was their own unwillingness to change, mani-
fested at different levels within the organization. Some
staff considered cultural competence to be unnecessary
or unimportant given other pressing concerns and given
that management was unwilling to institute new poli-
cies and practices.
3.6.4. Goal accomplishment
Our team successfully completed between one and
six follow-up interviews with 43 of the organizations.
Out of the goals that were set, goal attainment data
 T. Taylor-Ritzler et al. / Cultural competence training
Table 5
Goal accomplishment
Level of Goal Accomplishment Score
1. Deterioration
2. Goal dropped
3. Goal put on hold
4. Active pursuit, no progress
5. Active pursuit, some progress
6. Accomplished less than desired goal
7. Accomplished goal as expected
8. Accomplished more than expected
Total
was obtained for 100 goals at these organizations. The
majority of the organizational goals was being active-
ly pursued with some progress (50%) or had been ac-
complished at the time of the final follow-up (20%).
The remaining goals were either put on hold (20%),
dropped (9%), or had deteriorated (1%) (see Table 5
for percentages for each category of goal attainment).
Based on the data collected through interviews with
contact people at each of the organizations, we devel-
oped a process model of goal accomplishment to de-
scribe the processes involved in goal accomplishment
(see Fig. 2). There are five types of agents includ-
ed in the process model: (1) the individual service
provider(s) who attended the training and set the goal;
(2) the director/supervisor/upper management of the
organization; (3) other staff within the organization; (4)
other outside organizations; and (5) the broader com-
munity of the organization. As noted above, there were
four categories of goals, and consistent with our model
of cultural competence, there were also individual and
organizational levels of support for achieving cultural
competence. Grounded in the follow-along data, we
found evidence of all of these elements, operating in
concert and leading organizations either to goal accom-
plishment success or to a lack of success.
The process of goal accomplishment, and therefore
our model, begins with the individual(s) who sets the
goal at the training. As illustrated in Fig. 2, when the
individual(s) returned to his or her organization after
training, they either sought support for working toward
each goal from their director/supervisor/upper manage-
ment of the organization, staff within the organization,
outside organizations or from the broader community.
If they encountered resistance from these agents and
did not gain their support, one of two things occurred.
Either the individual(s) who set the goal became dis-
couraged and abandoned the goal, or extremely moti-
vated and dedicated individual(s) persevered and con-
tinued to pursue the goal without assistance or by seek-
ing and securing support from other agent(s) until the
87
Number of Goals Percentage of Goals
1 1%
9 9%
20 20%
14 14%
37 37%
7 7%
10 10%
2 2%
100 100%
goal was achieved. Any of the five involved agents
could determine the success of a goal by supporting
or failing to support it and by facilitating or impeding
other agents’ efforts to attain the goal. Although it is
possible for an individual(s) within an organization to
improve the cultural competence of the organization
without the support of the management of the organi-
zation and other staff within the organization, this was
rare and usually related to less complex and job-specific
activities. More commonly, in order to improve the
cultural competence of an organization, the commit-
ment of management and other staff was critical. In
addition, partnerships with other community organiza-
tions, already established within ethnic communities,
were also often found to be critical. Below we present
three brief scenarios from our data to further clarify
how the process of goal accomplishment worked within
the organizations that participated in the training.
Scenario 1. Goal: Change office hours to be more
accessible to those who have alternate schedules and
to parents who work. In order to better serve her clients
by being available to provide services outside of typical
business hours, the individual who set the goal submit-
ted a formal request for flex time. In response, her su-
pervisor sent her an official letter of denial. She further
inquired within her organization about how to obtain
flex time. At the time of the last follow-up contact
the individual had not received a response. In other
words, the individual who set the goal was dedicated
and willing to change her schedule to accommodate the
needs of her consumers. However, goal attainment was
scored as 4 (active pursue–little progress) due to the
lack of support and flexibility of the upper management
of the organization.
Scenario 2. Goal: Increase Hispanic Outreach. The
individual who set the goal received support from oth-
er staff and management in her organization. Collec-
tively, they committed to conducting outreach within
the Hispanic community. They distributed their orga-
nization’s brochures that had been translated into Span-
88 T. Taylor-Ritzler et al. / Cultural competence training
Fig. 2. Process model of goal accomplishment.
ish at a clinic in the Hispanic community. The clinic
supported their efforts. They also attended advocacy
meetings of their State Council on Disabilities and the
local Latino Family Festival and Expo. At the time
of the last follow-up, the organization was planning to
continue their outreach efforts in the Hispanic commu-
nity. As a result of a shared commitment within the
organization and a partnership with the community to
educate the Latino community about their organization
and to educate themselves about the community, this
organization increased the number of Latino clients it
served and accomplished its goal as expected with a
goal attainment score of 7.
Scenario 3. Goal: Increase cultural competence of
staff. The individual who set the goal reported that af-
ter the training he was very excited about the changes
being worked on by staff and management of his orga-
nization. The organization as a whole committed to de-
veloping guidelines for culturally competent clinicians
because some clinicians were inappropriately referring
Asian consumers for services. To insure that the or-
ganization understood the experiences of Asians in the
community and of the clinicians seeing them, the orga-
nization elected to conduct focus groups with members
of both groups (clinicians and Asian consumers). In
addition, in order to recruit clinical staff that matched
the culture and languages of the Asian community, the
organization engaged in targeted recruitment of bilin-
gual and bicultural Speech and Language Pathologists.
As a result of these multiple efforts and engaging mul-
tiple consituencies in the process, staff at multiple lev-
els of the organization benefited from increased cultur-
al awareness, knowledge and organizational resources.
In addition, the community benefited through the im-
proved accessibility of services for Asians with disabil-
ities. As a result, this organization exceeded its ex-
pected level of goal accomplishment with a score of 8
(accomplished more than expected).
4. Discussion
The purpose of the current study was to describe
the training approach used by the Center for Capacity
Building on Minorities with Disability Research and
present individual and organizational outcomes of these
trainings. To accomplish this purpose we assessed
the impact of the training on changes in participants’
 T. Taylor-Ritzler et al. / Cultural competence training
knowledge, physical environment, attitudes and values,
and communication styles and also on their ability to
set, pursue and attain goals related to organizational
cultural competence.
The results suggest that participants were moderate-
ly to highly satisfied with the training content, presen-
ters, exercises and materials. Analyses of the Cultural
Knowledge Assessment indicated statistically signifi-
cant improvements in knowledge related to nine of the
14 items assessed. We also found significant improve-
ments from pre- to post-training in the physical envi-
ronments of participants on seven of the eight items
assessed and in values and attitudes. On the other hand,
we only found one significant improvement from pre- to
post-training in participants’ communication styles. Fi-
nally, goal attainment data was obtained for 100 (54%)
of the goals that were set and the majority of the orga-
nizational goals were being actively pursued with some
progress or had been accomplished at the time of the
final follow-up (70%).
Cultural competence is a complex process that re-
quires both individual and organizational willingness
and commitment to change. At the individual level,
the process requires individual examination of personal
biases, increased knowledge of the factors that impact
cultural diversity, skills and practice. At the organiza-
tional level, we found that support for individuals pur-
suing cultural competence changes is critical for suc-
cess. We have developed and empirically evaluated a
cultural competence training model that seems to gen-
erate positive changes when combined with on-going
follow-up and technical assistance.
Our approach to cultural competence training is
unique, as we have not seen other models that provide
ongoing follow-along support to training participants.
Trainings typically require one day of attendance from
participants and evaluations are pre-post comparisons
of knowledge, attitudes, values and/or satisfaction. We
have found that goal attainment is an effective strate-
gy to assess the impact of training interventions like
the one we presented here. The goal setting process
increases the degree of commitment of trained partic-
ipants and changes their relationship with the training
process. The goal setting process challenges partici-
pants to pursue their goals and seek change. The pro-
cess model of goal accomplishment presents a unique
view of the interaction of multiple individual and orga-
nizational factors that influence the outcomes of goal
setting. This model was developed on the basis of the
empirical findings and reports collected from training
participants and as such represents an important source
89
of insight about the supports and challenges that peo-
ple encounter in their efforts to institute change with-
in the organizations where they work, including other
agencies in the community with which they need to
relate.
As we have seen, achieving cultural competence
within an organization is neither quick nor simple, but
is an ongoing process involving a multitude of factors.
All organizations are not created equal. Each one will
encounter a unique mixture of facilitators, barriers, and
varying levels of commitment within the organization
and the community they serve. Some will be fortunate
enough to have few if any barriers, plentiful support,
and strong staff dedication leading to successful orga-
nizational change. In contrast, others might be fraught
with barriers, encounter constant resistance, and have
lackluster staff dedication. However, all hope is not lost
for these organizations. Sometimes it takes only the
dedication and passion of a single individual to spark a
fire that will spread through the staff, management, col-
laborators, and community that can revolutionize the
way they think about, act towards, and serve the diverse
populations that rely upon their services.
We encountered several challenges in the process of
conducting this study. First is the difficulty in schedul-
ing the follow-up contacts with agency volunteers.
Many phone calls were needed to collect the progress
reports–more than anticipated. In addition, some of
the organizational representatives appeared frustrated
by the lack of support they received from supervisors
or outside agencies. Overall, we encountered a great
deal of contrast given the number of agencies involved,
with some engaging in very positive change efforts and
others continuing with “business as usual”.
It was encouraging for us to discover that some of the
trainees developed acute critical awareness of their or-
ganization’s need for improvement and became cham-
pions of the cause. Some may have been critically
aware before the training and used the event to pro-
pel their cause. Yet others may have developed their
awareness as a result of the training and the event led
them to become motivated to advocate for change. For
example, one training participant told us that after a
critical discussion we had during our training about
how some agencies serving individuals with develop-
mental disabilities publicly post clients’ daily routines
and act vigorously to enforce these routines according
to a preset schedule, he returned to his agency the next
day and removed his clients’ schedules from the wall.
This action led the staff to have a very interesting dis-
cussion of non-oppressive ways of engaging clients in
90 T. Taylor-Ritzler et al. / Cultural competence training
performing their daily activities, particularly with more
freedom of choice.
Agencies face many challenges to providing cultur-
ally competent services, but we discovered that many
staff members are willing and/or eager to try to resolve
these challenges if they are given an opportunity and/or
the resources to do so. We were pleased to discover that
most training participants were willing to try to pursue
goals to improve their organization’s cultural compe-
tence. When we engaged the top managers of several
agencies in the training process, the benefits were even
greater, because they had the resources and decision
making capacity to commit to needed changes. Based
on those experiences, we are now engaged in the pro-
cess of adapting a new instrument to assess organiza-
tional readiness for change. We plan in future applica-
tions of the cultural competence training with specific
agencies to distribute this instrument in advance of the
training in order to have a better baseline understanding
of the organization’s capacity for change. Through this
understanding we hope to help agency staff examine in
a more critical way particular areas of strength and/or
need, such as staffing capacity, adaptability and train-
ing, and the organizational climate for cohesion, auton-
omy, communication, stress, change and leadership.
Future research should examine the link between
staff training in cultural competence and consumer out-
comes and satisfaction. We did not examine the impact
of our training efforts on the clients’ experiences. This
is not easy to do and often overlooked. It is difficult
to determine whether or not and how the agency staff
actually changes their behavior regarding their interac-
tions with minority individuals as a result of one-day of
training. In fact, we never expected dramatic changes
and for that reason instituted the goal setting process.
One approximation to addressing this issue is for agen-
cies to conduct repeated consumer evaluations of staff
performance, allowing clients opportunities to provide
feedback on the quality of the services received. Such
evaluations could include clients’ perceptions of the
cultural competence, awareness and/or appropriateness
of the staff member providing their services. These
data could allow agencies to identify specific areas of
improvement and target staff members in need of train-
ing.
The findings of this study suggest that goal setting
can be a useful mechanism to allow cultural compe-
tence training participants to engage in a process of or-
ganizational change, and that such efforts can be sup-
ported or frustrated by management, co-workers, out-
side organizations and/or the local community. We do
not propose that cultural competence training is a mag-
ical cure of the problems faced by agencies serving
minority individuals with disabilities. Many of these
problems are more directly related to funding short-
ages than training needs. However, improved cultural
competence allows staff members to examine in a more
critical way their interactions with their consumers and
with other staff members in the organization. The
training can also allow participants to develop skills
and knowledge to improve their understanding and ac-
ceptance of individual differences. Achieving cultural
competence is a quest that can take staff members on
a path of change, improving the quality of the services
they provide and benefiting the recipients of services.
Acknowledgments
This work was funded by the National Institute on
Disability and Rehabilitation Research (NIDRR), U.S.
Department of Education through a grant to the Cen-
ter for Capacity Building on Minorities with Disabil-
ities Research at the University of Illinois at Chica-
go (Grant # H133A040007). The opinions expressed
herein are those of the authors and not necessarily those
of NIDRR.
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