Racial, Ethnic and Cultural Diversity


The US population has grown exponentially in recent years.  The proportion of minorities in Missouri and nationwide is expected to continue growing in the coming years (See population counts and estimates from Missouri Economic Research and Information Center, Missouri Census Data Center, Pew Research Center, and US Census Bureau). 

As minority populations continue to grow, so do the disparitiesin our healthcare system.  Racial and ethnic health disparities in acute and chronic illness are well documented, yet there is limited research on rehabilitation and outcomes related to traumatic brain injury (TBI). What we do know is that minority communities tend to experience higher rates of TBI (see data from TBI Model Systems: www.tbindsc.org).  They are less likely to access certain medical and rehabilitation services, and they have worse long-term outcomes.

Given the high incidence rate of TBI in minority communities, the exploration of racial, ethnic, and cultural issues related to rehabilitation and outcomes is paramount. The resources suggested here can help organizations, individuals, and service providers begin to understand these issues and take steps to enhance their own ability to serve diverse populations. 


Resources for Organizations to Build Cultural Competence

Cultural competence has been defined as“a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations”.1 Organizations that are culturally competent value diversity, conduct self-assessment, and seek to learn about and adapt to the cultural contexts of the people they serve.2  Here are a few suggested steps and resources3:

Step 1:  Understand local, regional, and national trends related to population changes






Step 2:  Develop knowledge and understanding of the cultures represented in your community and build relationships with formal and informal leaders of various population groups

The Missouri Health Literacy Mapping Tool (http://www.rand.org/health/projects/missouri-health-literacy/mapping-tool.html) offers an interactive map to track health literacy rates by area, population, or other factors.

The   Provider’s Guide to Quality and Culture includes resources for understanding and interacting with diverse populations (http://erc.msh.org/mainpage.cfm?file=5.0.htm&module=provider&language=English&ggroup=&mgroup).

Step 3:  Develop organizational strategies to improve responsiveness to diverse populations

The National Center on Cultural Competency offers several organizational self-assessment tools, as well as online training modules and useful data (http://nccc.georgetown.edu/).

The Office of Minority Health offers resources including The National Standards for Culturally and Linguistically Appropriate Services (http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15).

A presentation from Dr. Allen Lewis, an expert on cultural issues in health and disability, entitled Strategies to Help Your TBI organization Embrace Cultural Competency (https://tbitac.norc.org/download/Cultural%20Competency%20Lewis.pdf).

 Step 4:  Know where to find resources to help your organization develop an action plan

The National Center for Cultural Competence at Georgetown University (http://nccc.georgetown.edu/) offers a wealth of resources related to cultural competency, including a guide to planning an organizational self-assessment (http://www11.georgetown.edu/research/gucchd/nccc/documents/ncccorgselfassess.pdf).

The US Department of Health and Senior Services Office of Minority Health (http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3)

The National Prevention Information Network (http://www.cdcnpin.org/scripts/population/culture.asp)

The US DHSS Health Resources and Services Administration (http://www.hrsa.gov/culturalcompetence/index.html)


Resources for Individuals to Build Cultural Competency

Each of us as professionals serving people with TBI can assess and strengthen our own cultural competency. To build your knowledge, skills, and comfort level working with people from diverse backgrounds, consider a few general tips4:

  1. Examine your own assumptions and cultural perspectives.
  2. Seek a basis for understanding, rather than judging.
  3. Learn about communication patterns of various cultures and racial/ethnic groups.
  4. Express respect for practices, values, and beliefs different from your own.
  5. Be willing to acquire new behaviors and perspectives. 

Additional resources with specific how to’s and learning opportunities:




Provider/client interaction tips


 Culturally competent health care providers’ guide


Training and information offered by the Cross Cultural Health Care Program



1Cross, T.L., Bazron, B.J., Dennis, K.W., Isaacs, M.R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed, volume 1. CASSP Technical Assistance Center, Georgetown University Child Development Center, Washington, DC.\

2National Center on Cultural Competence. (n.d.). Conceptual frameworks/models, guiding values and principles.  Retrieved from http://nccc.georgetown.edu/foundations/frameworks.html.

3Willis, D.. (2010). Building capacity to work with diverse populations. Training seminar, UMKC-Institute for Human Development, Kansas City, MO.

4UMKC-Institute for Human Development. (2011).  Advanced training for options consultants (Training curriculum). Kansas City, MO: Author.