Culture and Trauma

Culture Counts


Culture Counts

The National Center for Child Traumatic Stress (NCTSN) views enhancing cultural competence as essential to furthering our mission of increasing access to and improving the standard of care for traumatized children, families, and communities across the nation. Our perspective is that cultural awareness, sensitivity, and understanding need to be infused throughout the operations of every level of an organization to be most effective.

We concur with the messages of the Culture, Race, and Ethnicity Supplement to Mental Health: A Report to the Surgeon General that "culture counts," and with the President's New Freedom Commission on Mental Health, which recognizes that achieving the goal of eliminating disparities in mental health services requires improving access to quality care that is culturally competent. As highlighted in these reports, the vision for the future requires involvement action across service sectors, communities, organizations, neighborhoods, families, and individuals in order to effect change in the following ways:

  • Improving access to quality care―such as increasing the number of service facilities (especially in geographically remote areas) and of staff fluent in the languages spoken in the surrounding communities.
  • Reevaluating costs versus benefits of providing culturally appropriate and responsive services.
  • Reducing obstacles (e.g., cultural differences, language barriers) in managed care that can result in underutilization of services, lower-quality care, and poor outcomes.
  • Helping to overcome individuals’ objections to seeking mental health services (such as shame, stigma, and discrimination).
  • Developing and evaluating culturally responsive services with community input and participation.
  • Addressing social adversities (e.g., poverty, community violence, racism, discrimination) and helping to strengthen families―including building on existing supports (such as churches and other spiritual communities).
  • Encouraging positive ethnic identity.
Spotlight on Culture

Data Collection Offers Opportunities for Unpacking the Refugee Experience (2017) (PDF)

At Intersection of Trauma and Disabilities: A New Toolkit for Providers (2016) (PDF)

Trauma and Mental Health Needs of Immigrant Minors, Part one (2015) (PDF)

Trauma and Mental Health Needs of Immigrant Minors, Part Two (2015) (PDF)

Racial Disparities in Juvenile Justice Call for Holistic Approach (2014) (PDF)

Linguistic Competency: a Conversation with Lisette Rivas-Hermina (PDF)

Clinicians Not Immune to Impact of Border Violence (PDF)

Helping Latin-American Immigrant Pregnant Women Exposed to Trauma: Reflections on Mirroring (PDF) 

Working with Immigrant Latin-American Families Exposed to Trauma (PDF)

Working with Immigrant Latin-American Families Exposed to Trauma: Long Version (PDF)

Implementing Cultural Competence (PDF)

The Organizational Journey toward Cultural and Linguistic Competency: Part One (PDF)

The Organizational Journey toward Cultural and Linguistic Competence: Part Two (PDF)

The Organizational Journey toward Cultural and Linguistic Competence: Part Three (PDF)

The Organizational Journey toward Cultural and Linguistic Competence: Part Four (PDF)

For Immigrant Families, Language Opens Door to Healing from Trauma (PDF)

Trust and Acceptance Can Encourage LGBTQ Youth to Disclose Abuse (PDF)

Preventing Youth Suicide in Montana’s Indian County (PDF)

Conversations about Historical Trauma: Part One (PDF)

Conversations about Historical Trauma: Part Two (PDF)

Conversations about Historical Trauma: Part Three (PDF)

To access our Spanish page please click here. This page provides information on child trauma in Spanish and highlights some of our Spanish resources.

Preview Spotlights on Culture:  




There are many definitions of race, ethnicity, culture, and other terms related to cultural competence. For the purpose of identifying a starting point in this ongoing dialogue, we are highlighting definitions proposed in the Supplement to the Surgeon General's Report on Mental Health.

  • Race: a social (not biological) category used to classify people into groups according to a set of characteristics that are socially significant. The concept of race is especially potent when certain social groups are separated, treated as inferior or superior, and given differential access to power and other valued resources.
  • Ethnicity: a common heritage shared by a particular group (Zenner, 1996), including similar history, language, rituals, and preferences.
  • Culture: a common heritage or set of beliefs, norms, and values (DHHS, 1999); the shared, and largely learned, attributes of a group of people; a system of shared meanings. A key aspect of any culture is that it is dynamic.
  • Cultural Identity: the culture with which someone identifies and to which he or she looks for standards of behavior (Cooper & Denner, 1998)
  • Culture-bound syndromes: clusters of symptoms much more common in some culture than in others. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) includes a "Glossary of Culture-Bound Syndromes."
  • Cultural psychiatry or Ethnopsychiatry: the examination of how social, cultural, and biological contexts interact to shape illnesses and reactions to them.
  • Stigma: a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid and discriminate against people with mental illness (Corrigan & Penn, 1999).
  • Cultural competence: the recognition of patients' cultures and the development of a set of skills, knowledge, and policies to deliver effective treatments (Sue & Sue, 1999).
  • Racism and discrimination: umbrella terms referring to beliefs, attitudes, and practices that denigrate individuals or groups because of phenotypic characteristics (e.g., skin color and facial features) or ethnic group affiliation.
  • Click here for all definition footnotes


Special Topics

Page Contents

Refugee Trauma

This page features resources for service system providers on the experiences of refugee children and families including the video and guide 'Children of War', the Refugee Services Toolkit, and resources for working with unaccompanied migrant children.

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Responding to Community Disparities

This page features resources for parents and providers living in areas where there has been community unrest, advice regarding media coverage of these events, guidance on helping children and adolescents who have been exposed to multiple traumas, and materials addressing racism, economic and health disparities, and ways to foster community healing. There are also resources on self-care and tools to assist the first responder community.


Economic Stress

This page includes resources related to economic stress and resilience.

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Page Contents:



Addressing the Mental Health Problems of Border and Immigrant Youth (2009) (PDF)

This special report helps mental health care providers working in the Mexico-US border region understand the diverse cultural, socioeconomic, environmental, and political factors that daily impact the lives of their clients/patients. It offers guidance on how to provide culturally competent care while simultaneously addressing families' misconceptions and knowledge gaps about the causes of mental health problems and their treatment.


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Culture and Trauma Speaker Series

Since 2007, NCTSN clinical and research experts have addressed a variety of cultural and linguistic issues surrounding the treatment of trauma through the Culture and Trauma Speaker Series. The series is designed for Network members but is of value to clinicians, administrators, and policy makers who are interested in the intersection of culture and trauma in children and adolescents. Access the presentations through the NCTSN Learning Center for Child and Adolescent Trauma.


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Culture and Trauma Briefs

Culture and Trauma Brief (Vol 3, No 1): Cultural and Family Differences in Children's Sexual Education and Knowledge (2008) (PDF)
Chidren's knowledge about sexuality varies with developmental age and across families and cultures. This brief examines some of the factors that influence this knowlege. It also offers suggestions to clinicians on how they may work with children who have been sexually abused or who are exhibiting inappropriate sexual behavior in a way that respects those differences.

Culture and Trauma Brief (Vol 2, No 3): Preliminary Adaptations for Working with Traumatized Latino/Hispanic Children and their Families (2007) (PDF)
Find guidance for establishing and maintaining therapeutic relationships with Hispanic/Latino children and families. This brief also provides background statistical information on trauma among this population.

Culture and Trauma Brief (Vol 2, No 2): Organizational Self-Assessment for Cultural and Linguistic Competence (2007) (PDF)
Find facts about Organizational Self-Assessment for Cultural and Linguistic Competence. This brief provides an overview of organizational cultural and linguistic competence, organizational assessment, and resources.

Culture and Trauma Brief (Vol 2, No 1): Trauma Among Homeless Youth (2007) (PDF)
Find facts about trauma and homeless youth, trauma's consequences, and considerations for treatment.

Culture and Trauma Brief (Vol 1, No 4): NCTSN Resources on Culture and Trauma (2006) (PDF)
Find a comprehensive update on NCTSN's culturally informed resources on child trauma. The Network recognizes that ethnicity, gender identity and expression, spirituality, race, immigration status, and a host of other factors affect not just the experience of trauma but help-seeking behavior, treatment, and recovery.

Culture and Trauma Brief (Vol 1, No 3): Translation of English Materials to Spanish (2005) (PDF)
Find recommendations for translating materials from English to Spanish in order to develop Spanish resources that are culturally competent and capture valid and reliable information.

Culture and Trauma Brief (Vol 1, No 2): Trauma Among Lesbian, Gay, Bisexual, Transgender, and / or Questioning Youth (2006) (PDF)
Find information about risks of trauma exposure among lesbian, gay, bisexual, transgender, or openly questioning (LGBTQ) youth, statistics on trauma experienced by these youth, and consideration for treatment.

Culture and Trauma Brief (Vol 1, No 1): Promoting Culturally Competent Trauma-Informed Practices (2005) (PDF)
Find information about the impact of trauma and culture on children and adolescents, initial findings from the NCTSN Core Data Set on prevalence and treatment of trauma among diverse populations of children, and a description of the Network's broader view of culture and availability of expertise.


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Congressional Briefing on Culture and Trauma

American Psychological Association Congressional Briefing: Ethnic Minority Children Experiencing Traumatic Events: Promoting Mental Health and Resilience (November 16, 2005) (Video)
Video of a congressional briefing sponsored by APA on November 16, 2005. Barbara Bonner, Director of the Indian Country Child Trauma Center in Oklahoma and Alicia Lieberman, Director of the Child Trauma Research Project and ETTN in San Francisco, both represented the Network in a panel and presented on the impact of trauma on American Indian and young children specifically, and on ethnic minority children generally. They also discussed the impact of specific traumatic events, including Hurricane Katrina, community violence, and the impact of multiple traumatic events. Other panelists include Larke Huang, Luis Vasquez, and Portia Hunt.


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Refugee Trauma

The Network has developed resources on child and adolescent refugee trauma, including materials for educators and mental health professionals.





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Trauma-informed Interventions: Clinical Research Evidence and Culture-Specific Information Project

Trauma-Informed Interventions: Clinical Research Evidence and Culture-Specific Information Project (2008) (PDF), a collaboration between the National Crime Victims Research and Treatment Center at the Medical University of South Carolina and the National Child Traumatic Stress Network, was created to identify trauma-informed treatment interventions and to describe their level of cultural competency. The project was developed to assist mental health practitioners, policy makers, researchers, educators and clinicians in making treatment decisions that are based on clinical and research evidence.

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