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Implementing culturally responsive therapy to serve Latino male clients in mental health

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Implementing culturally responsive therapy to serve Latino male clients in mental health

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Implementing Culturally Responsive Therapy to Serve Latino Male Clients in Mental Health
by
Adrian Estrada Jr.

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2020

Copyright 2020 Adrian Estrada Jr.
ii
Acknowledgements
The process of earning a doctoral degree and writing a dissertation was long and
demanding and I did not do this alone. First and foremost, I would like to thank my wife Monica
and my daughter Hannah for taking this journey with me. Monica has been extremely supportive
right from the start without any doubts or hesitations. Without my family’s constant support,
encouragement, and understanding this would not have been possible for me to achieve my
academic goals. I would also like to thank my parents (Adrian Estrada Sr., Yolanda Estrada,
Arturo Cervantes, Arlynn Cervantes) and my siblings (Luis A. Estrada, Jacqueline Estrada,
Nicholas J. Cervantes) who have always been in my corner by supporting and encouraging me in
all of my academic goals and ventures. I wish there was room on my diploma to write the names
of my wife and daughter (Monica Ann Estrada, Hannah Ann Estrada) because without them I
could not have completed this goal.
I would like to express my deep and sincere gratitude to my dissertation committee, Dr.
Helena Seli, Dr. Jennifer Phillips, and Dr. Sourena Haj-Mohamadi who were a part of this study
from its inception. The writing of this study has been academically challenging, but with the
support, patience, and guidance of my dissertation chair, Dr. Helena Seli, this study was made
possible.
As I reflect on this accomplishment, I want to thank everyone who has provided me with
the life lessons that have influenced me to be the person that I have become. A small boy with
big dreams that grew up in a rough part of Los Angeles…is now a USC doctoral graduate. Fight
On!!!

iii
Table of Contents
Acknowledgements……………………………………………………………………………….ii
List of Tables………………………………………………………………………………………v
List of Figures……………………………………………………………………………………vii
Abstract………………………………………………………………………………………….viii
Chapter One: Introduction …………………………………………………………………….…. 1
Introduction to the Problem of Practice ………………………………………….………. 1
Organizational Context and Mission ………………………………………….…….…… 1
Organizational Goal …………………………………………………………….………...4
Related Literature …………………………………………………………………………5
Importance of the Evaluation …………………………………………………….…….....7
Description of Stakeholder Groups …………………………………………….…….……8
Stakeholder Group for the Study ……………………………………………….…………9
Purpose of the Project and Questions ………………………………………….…….…. 10
Methodological Framework ………………………………………………….......….…. 11
Definitions ………………………………………………………………………..….…. 11
Organization of the Project …….………………………………………………….……. 12

Chapter Two: Review of the Literature ……………………………………………………..……14
The Practice of Mental Health ……………………………………………………….…..14
Culturally Responsive Therapy ………………………………………………….15
Female Care Professionals Engagement Best Practices …………………………16
Latino Men in Mental Health …………………………………………………………….17
Access to Mental Health Services ………………………………………………..19
Latino Male’s Resistance to Mental Health Services ……………………………20
Challenges Latino Men Face with Mental Health Services ……………………………...21
Political Support Prioritizing Mental Health for Some ………………………….22
Accessible Community Mental Health Resources ………………………………23
Clark and Estes Gap Analysis Conceptual Framework ………………………………….24
Female Care Professionals’ Knowledge, Motivation, and Organizational Influences …..25
Knowledge and Skills ……………………………………………………………26
Motivational Influences ………………………………………………………….30
Organizational Influences ………………………………………………………..34
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation
and the Organizational Context ………………………………………………………….37
Conclusion ……………………………………………………………………………….39
Chapter Three: Methods …………………………………………………………………………40
Research Questions ...…………………………………………………………………… 40
Participating Stakeholders ……………………………………………………………….40
Interview Sampling Criterion and Rationale …………………………………….41
iv
Interview Sampling (Recruitment) Strategy and Rationale …………………...…41
Data Collection and Instrumentation ………………………………………………….…42
Interviews ………………………………………………………………………..43
Documents ……………………………………………………………………….44
Data Analysis …………………………………………………………………………… 44
Credibility and Trustworthiness …………………………………………………………45
Ethics …………………………………………………………………………………….46
Chapter Four: Results and Findings ……………………………………………………………..48
Participating Stakeholders ……………………………………………………………….48
Findings Based on CRT Training-Related Document Analysis …………………………49
Knowledge Influence Findings …………………………………………………..52
Motivation Influences’ Findings ………………………………………………... 64
Organizational Influences Findings ……………………………………………...70
Synthesis ………………………………………………………………………………... 79
Chapter Five: Recommendations ………………………………………………………………...82
Recommendations for Practice to Address KMO Influences ……………………………82
Knowledge Recommendations …………………………………………………..83
Organization Recommendations ………………………………………………...86
Integrated Implementation and Evaluation Plan …………………………………………88
Organizational Purpose, Need and Expectations ………………………………...89
Level 4: Results and Leading Indicators …………………………………………90
Level 3: Behavior ……………………………………………………………….. 91
Level 2: Learning ……………………………………………………………….. 94
Level 1: Reaction ……………………………………………………………….. 96
Evaluation Tools …………………………………………………………………97
Data Analysis Reporting …………………………………………………………98
Strengths and Limitations of the Approach ………………………………………………99
Limitations and Delimitations ………………………………………………………….100
Future Research ………………………………………………………………………...102
Conclusion ……………………………………………………………………………...103
References ……………………………………………………………………………………...106
Appendices ……………………………………………………………………………………..114
Appendix A: Interview Protocol ……………………………………………………….114
Appendix B: Document Analysis Protocol …………………………………………….117
Appendix C: Culturally Responsive Therapy Guide ……………………………………119
Appendix D: Culturally Responsive Therapy Training Participants Pre and Post-Test…121
Appendix E: Culturally Responsive Therapy Trainer Observation Evaluation ………..124
Appendix F: Culturally Responsive Therapy Training Participant Evaluation ………...125

v
List of Tables
Table 1. Organizational Mission, Global Goal, and Stakeholder Performance Goals ………...... 10
Table 2. Knowledge Influences, Types, and Assessment for Analysis ………………………..…29
Table 3. Motivational Influences and Assessment for Analysis …………………………………33
Table 4. Organizational Influences and Assessment for Analysis ……………………………….37
Table 5. Demographic Information of Participants ………………………………………………49
Table 6. Determination of Knowledge Influences ……………………………………………….53
Table 7. Participants Comments Related to Describing the Practice of Culturally
Responsive Therapy…………………………………………………………………….54
Table 8. Terms Used During Interview Related to Benefits of Culturally
Responsive Therapy…………………………………………………………………….56
Table 9. Terms Used During Interview Related to Challenges of Culturally
Responsive Therapy…………………………………………………………………….57
Table 10. Determination of Motivational Influences …………………………………………….64
Table 11. Participants Comments Related to Describing the High Value of Culturally
Responsive Therapy …………………………………………………………………..68
Table 12: Determination of Organizational Influences …………………………………………..71
Table 13. Summary of Knowledge, Motivation, and Organizational Findings of
Needs and Strengths …………………………………………………………………..81
Table 14. Summary of Knowledge Influences and Recommendations ………………………….83
Table 15. Summary of Organization Influences and Recommendations ………………………..87
Table 16. Outcomes, Metrics, and Methods for External and Internal Outcomes ………………..91
Table 17. Critical Behaviors, Metrics, Methods, and Timing for Evaluation …………………...92
Table 18. Required Drivers to Support Critical Behaviors ……………………………………….93
Table 19. Evaluation of the Components of Leaning for the Program ……………………………96
vi
Table 20. Components to Measure Reactions to the Program ……………………………………97

vii
List of Figures
Figure 1. Interaction between the Organization, Stakeholder Groups, and the
Organizational Goal …………………………………………………………………...38
Figure 2. Sample Dashboard to Report Progress Towards Meeting the Stakeholder Goal ……...99

viii
Abstract
This qualitative study examined a non-profit mid-size community mental health organization that
receives federal, state, and city contracts to provide services in the San Fernando Valley, where
the focus was female care professionals’ implementation of culturally responsive therapy (CRT)
with Latino male clients in mental health services and increase the rates of engagement in
follow-up care. The research questions explored female care professionals’ knowledge and
motivational needs as well as the organizational influences (Clark & Estes, 2008) of CHSF on
the implementation of CRT. Following the review of the literature, assumed knowledge,
motivational, and organizational influences were examined though a qualitative design. Assumed
influences were explored via interview and document analysis data. Findings demonstrated that
female care professionals had mixed levels of understanding about applying the strategies of
engagement, mixed levels of reflection about own effectiveness and frustration of not having
adequate time or being able to reflect on their effectiveness in supporting Latino male clients.
Additionally, in exploring motivation, female care professionals communicated mixed levels of
self-efficacy in implementing CRT, and though had a high value for implementing CRT, did not
highly value in in the context of supporting Latino male clients. Finally, the care professionals
perceived that the organization does not prioritize engagement of Latino male clients over
serving women and children. A comprehensive implementation and evaluation plan was
developed using the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), intended
to increase the stakeholders’ knowledge and motivation and help reduce the organizational
influence gaps.
1
Chapter One: Introduction
Introduction of the Problem of Practice
Latino male clients are 48% less inclined to schedule appointments or follow through
with mental healthcare professionals than Caucasian men (Elder et al., 2013). The stigma
associated with mental health inhibits Latino male clients from seeking appropriate mental health
care (Satcher, 2003). According to Griffin et al. (2012), this problem is important to address
because Latino male clients account for a large proportion of the reported gender and ethnic
differences in mortality globally. Latino males are more likely to have attempted suicide (10.7%)
when compared to African American males (7.3%) and Caucasian males (6.3%); Latino males
are more likely to commit suicide (23.1%) when compared to African American males (15.4%)
and Caucasian males (19.5%); and approximately 50% of all Latino male suicides occur among
ages 10-34 years of age (Rios-Ellis, 2005). Latino male clients are also susceptible to their health
needs being overlooked or being prioritized, or feeling invisible by service providers (Griffin et
al., 2012).
Organizational Context and Mission
The Community and Health of San Fernando (CHSF, pseudonym) is an organization
dedicated to supporting and advocating for communities in the San Fernando Valley. A
pseudonym has been assigned to the organization to keep its identity confidential. The mission of
CHSF is to improve social conditions in Latino communities within Los Angeles County by
empowering communities and breaking down social barriers. CHSF focuses its efforts on serving
the Latino community by prioritizing education, civic participation, health, culture, mental
health, drug, alcohol prevention and intervention services. CHSF is best known in the
community and in Los Angeles County for its environmental prevention work which includes
2
community mobilization, coalition building, and political education (local and state) against drug
related issues. CHSF is located in Northeast Los Angeles County with a satellite office located in
the North end of Los Angeles County. CHSF is currently operating on a yearly budget of $11.8
million.
At the time of the study, CHSF worked under six Los Angeles County funded contracts.
CHSF focuses on community empowerment as a key role in their mission. CHSF annually
services 250 parents and over 1,000 students at local public, charter, and private schools under
their mental health parent and youth awareness on drugs program. On average, more than 200
volunteers and community support members actively participate on a monthly basis in different
established local and state-wide coalitions, community mobilization efforts, and advocacy
towards political issues locally and state-wide. The ages of participants served by CHSF range
from 12 to 72; the average age being 42 years of age and 60% of the participants identify as
Hispanic/Latino, 10% Caucasian, 15% Black and 15% as Other. The organization as a whole has
a total of 114 full-time employees (92 females, 22 males). CHSF chain of command consists of
the executive director, executive assistant, program directors, program coordinators, and
frontline staff. Due to CHSF having different programs serving different populations, the study
focused on the adult mental health unit. The adult mental health unit consists of 61 employees;
one program director, one program coordinator, one clinical director, one clinical coordinator
and 61 therapists (53 females, 8 males).
The organizational goal of CHSF’s is that by December 2020, 100% of Latino male
clients served by CHSF will comply with their appointments and follow-up care. At the time of
the study, only 10% of Latino male clients are complying with their mental health appointments
and follow-up care. This problem was revealed after a quality assurance audit identified several
3
areas of concern that need improvements in order for CHSF to maintain compliance with
contractual obligations and achieve its goal. The contract of focus is the mental health unit of
CHSF. CHSF mental health unit provides individual and family therapy to participants that are
involved with the following county systems: Probation, Department of Children and Family
Services, or the Department of Mental Health. CHSF gets referrals from different county systems
for mental health services. According to the Department of Mental Health contract between
CHSF and the county, CHSF needs to serve men, women, children and the elderly population to
continue receiving operational funding. On a monthly average, CHSF provides mental health
services to approximately 200 individuals. Of that population, approximately 10 to 20
individuals identify as Latino male which is 10 to 20 percent of CHSF’s contractual requirement.
The majority of the participants receiving mental health services from CHSF are low-
socioeconomic status, have no education in the United Sates, speak little to no English as
Spanish is their first and primary language, and immigration status having the parents and or the
children being undocumented. All participants in CHSF mental health services have full-scope
Medical insurance, receive financial assistance from the government, and live in low-income
housing complexes. The majority of the participants have never attended regular medical or
dental check-ups, they only went to see the doctor when they were sick or something was
hurting. The majority of the participants in CHSF mental health program have never spoken
about their mental health with a professional or seek help to address their mental health. All of
the participants in CHSF mental health program were court ordered and are required to enroll in
a mental health program. Routine mental health screenings are offered on a daily basis, allowing
care professionals to assess and appropriately refer clients to a mental health program (e.g.,
outpatient, individual or family therapy, support groups, intensive programs). One challenge that
4
CHSF faces is that once the assessment is completed and the proper program has been identified,
only 10% of Latino male clients follow up with their scheduled sessions for continued services.
Latino male clients’ failure to follow through with services is evidenced by 90% failing to
complete the assessment and follow-up care as this process usually takes 30 to 60 days to
complete. CHSF sees only about 10% of Latino male clients follow through with the entire
process. As part of the corrective action plan, CHSF has created and implemented culturally
responsive therapy (CRT) training to help support female care professionals engage Latino male
clients in mental health services. CHSF provides CRT training on a monthly basis that consists
of a three-day in person training followed by four coaching sessions. At the completion of every
training and coaching session, participants receive a certificate of completion, but can continue
to attend the training and coaching sessions as many times as they like.
Organizational Goal
In order to comply with contractual obligations and engage Latino male clients, the Board
of Directors, in January 2019, identified their performance goal of having 100% of Latino male
clients served by CHSF will comply with their appointment and follow-up care. This action led
to the creation and implementation of a new best practice-based training module to implement
CRT. The CRT training module that CHSF administered to care professionals consisted of a
three-day in person training, each day consisting of six-hours of instruction combined with
activities. The training sessions are followed by four coaching sessions where care professionals
have the opportunity to discuss cases where more technical support is needed. Coaches also have
the opportunity to provide in-field direct feedback to care professionals if participants agree to
have a coach shadow the session. The achievement of CHSF’s performance goal will be
5
measured by the compliance of Latino male clients attending their appointments and completing
follow-up care.
Related Literature
In March of 2010, a comprehensive health care reform law was enacted, better known as
the Affordable Care Act, which introduced with the idea of increasing the number of people
insured and increasing the quality of care for everyone while trying to reduce costs (“What does
the affordable care act mean for you?, 2013). Low income communities have seen an increase in
clinics addressing primary and preventative care, but marketing and engagement efforts have
prioritized women and children (Meyer, 2003). Latino men continue to experience greater
barriers when accessing care and services, often receiving less intensive and poorer quality care
(Satcher, 2003). Reitmanova and Gustafson (2012) found that Latino men experience difficulties
accessing updated mental health information and face communication barriers to access adequate
mental health services. Participants identified the barriers in accessing services as not having
accurate information about mental illness, facing long wait times for appointments or to initiate
therapy, and they were unaware of professional support systems for treatment in their
communities.
Latino men who are unemployed, have lower to no education, and have a lower socio-
economic status are associated with poorer mental health care compared to Caucasian men
(Watkins et al., 2011). Watkins et al. (2011) identified that men of color with lower education
and lower socio-economic status have higher depressive symptoms and higher Non-Specific
Psychological Distress scores that went unnoticed than Caucasian men. Dupere et al. (2012)
found that when Latino men seek services, they do not always get the help they need. Latino men
often encounter negative experiences with health and social services, feeling misunderstood, or
6
feel looked down upon, judged, stigmatized, and discounted (DeFreitas et al., 2018). Latino
men’s resistance to treatment has been identified by their inability to communicate in treatment,
not scheduling or following through with treatment, and by not allowing themselves to be
vulnerable.
Each organization or program providing mental health services in the county has a
governing body that oversees the implementation of services, the accountability of professionals,
and the protection of the people receiving the service. The Board of Behavioral Sciences (BBS)
oversees and governs all interns and licensed professionals (e.g., Marriage Family Therapists
(LMFT) interns (IMF), Clinical Social Workers (LCSW) Associates (ASW), Professional
Clinical Counselors (LPCC) interns (APCC), Educational Psychologists) working with people in
mental health. The BBS conducted a survey in 2007 to better identify therapists who are licensed
in the state of California to practice therapy. The BBS mailed 64,000 surveys and received a total
of 25,909 responses, a repose rate of over 40%. The BBS found that 78.53% of the applicants
identified as female and 20.95% identified as male, 74.40% identified as non-Hispanic White
and 8.38% identified as Hispanic Latino, and only 11.83% of the participants spoke Spanish
(“Demographic Report,” 2019).
Memon et al. (2016) found that men of color were less willing and less able to discuss
their problems with female mental health professionals. Data indicated that Latino men struggle
recognizing and accepting their mental health diagnosis and are reluctant to discuss
psychological distress and seek help with female care professionals (Memon et al., 2016). Deb
and Miller (2017) presented similar findings showing that men of color are less likely to consult
with family, physicians, and female mental health providers to address their mental health issues.
African American and Hispanic men had fewer visits to health provider to address their health
7
and mental health needs than Caucasian men (Deb & Miller, 2017). Davies et al. (2010) also
found that Latino men avoid traditional mental health services due to fears of being perceived as
weak, feeling vulnerable, or incompetent. Latino men’s unwillingness to address or talk about
the problem was the root problem of men not coming into the center. Local mental health and
care systems have focused and prioritized primary and preventative care towards women and
children.
Importance of the Evaluation
It is important to evaluate the organization’s performance in relation to the performance
goal of 100% of Latino male clients served by CHSF complying with their appointments and
follow-up care for several reasons. Latino men continue to not recognize and accept their mental
health diagnosis and are reluctant to discuss psychological distress and seek help with female
care professionals (Memon et al., 2016). As CHSF looks to comply with its contractual
obligations in year 2020, they analyzed their processes and created a training curriculum on
CRT. CRT is a framework that has strict guidelines, but is flexible to allow modifications based
on the individual’s needs and identified strengths (Asnaani & Hofmann, 2012). CRT is not a
framework that fits all individuals; it is a moldable framework that can be tailored to the specific
needs of each individual. CRT was also identified as a valuable tool to serve mental health
patients and achieve the organizational goal of engaging 100% of Latino male clients served by
CHSF in mental health services and follow-up care. Understanding the relationship between
engaging Latino male clients by implementing CRT provided a framework for the leadership
team at CHSF as it seeks to achieve its organizational goal.

8
Description of Stakeholder Groups
Three stakeholder groups are important in the context of increasing Latino male clients’
engagement and participation with mental health services and follow-up care: program
administrators, care professionals, and Latino male clients. Program administrators supervise
care professionals who directly engage Latino men in mental health and have them participate on
their follow-up care. This allowed for a direct report on the approaches and strategies that are
being used to engage Latino men in mental health services and follow-up care. Program
administrators plan and coordinate the services of the organization and the program. Program
compliance, programmatic logistics (training, hiring, supervising), and the compliance of
organizational policies and procedures are responsibilities that the program administrators have
within the organization.
For the purpose of this research, care professionals are defined as those therapists and
counselors who have direct contact in engaging Latino men in mental health services and follow-
up care. The mental health unit at CHSF has a total of 61 care professionals (53 females, eight
males). Statewide data from the BBS indicates 78.53% of care professionals are female and
20.95% of care professional are male. The staff ratio data for both CHSF and statewide strongly
suggests the mental health care professional field being female dominant. Care professionals
with CHSF are individuals that are licensed or interns with the BBS under the state of California
who help clients improve their lives, develop better cognitive skills, reduce symptoms of mental
illness, and cope with challenges that they may be experiencing due to current or past trauma.
Care professionals meet with patients on a weekly basis for 60 to 90 minutes in an individual or
group setting to help support their mental health wellbeing. CHSF care professionals attend
various trainings to help support their professional growth. Continuous feedback on the
9
implementation of CRT is collected by the administrative team during supervision to further
advance future training protocols and curriculum development. Care professionals provide
detailed information to the administrative team addressing the different approaches that they are
using to better engage Latino men. Care professionals’ experiences in providing care to Latino
men are important to understand in the context of the goal of increasing follow-up care. Care
professionals work with individuals or groups to improve their mental health.
Stakeholder Group for the Study
Although the combined efforts of several stakeholders contribute to the achievement of
the overall organizational goal of having 100% of Latino male clients served by CHSF comply
with their appointments and follow-up care, this study explored the capacity of female care
professionals to implement evidence-based techniques to motivate Latino male clients to
participate in their care and follow-up appointments. Female care professionals are the identified
stakeholder group of focus because the CHSF staff is predominately female with a ratio of six
female care professionals for one male care professional. An internal audit conducted by the
County of Los Angeles Department of Mental Health (December 2019) also revealed that CHSF
female care professionals are not servicing Latino male clients well in comparison to women and
children. CHSF female care professionals are servicing women and children more often for a
longer period of time, while male clients are being serviced less frequently or services being
terminated within the first 30 days of initial contact.
The stakeholder group’s goal, supported by the Board of Directors, is that by December
2020, all care professionals implement CRT to engage 100% of Latino male clients served by
CHSF in mental health services and follow-up care. The Board of Directors is looking to comply
with contractual obligations to better engage Latino male clients in mental health services that
10
training curriculum on culturally responsive therapy was created. CRT is a framework that
allows care professionals to better understand their clients’ background, ethnicity, and belief
system by accommodating and respecting all practices, traditions, values, and opinions
(“Culturally Sensitive,” 2019). CHSF care professionals participated in a three-day training on
CRT where each day consisted of six hours of training materials. This was followed by four
coaching sessions (one a month) where assigned trainers would go in the field to observe the
implementation of CRT.
Table 1
Organizational Mission, Global Goal, and Stakeholder Performance Goals

Purpose of the Project and Questions
The purpose of this study is to explore the capacity of female care professionals in
engaging 100% of Latino male clients served by CHSF in mental health services and follow-up
care by implementing CRT. The analysis focused on knowledge, motivation, and organizational
influences that impact female care professionals’ in their practice.
Organizational Mission
The mission of the organization is to improve social conditions in Latino communities within
Los Angeles County by empowering communities and breaking down social barriers.
Organizational Performance Goal
By December 2020, 100% of Latino male clients served by Community and Health of San
Fernando will comply with their appointments and follow-up care.
Stakeholder Goal
Female Care Professionals
By December 2020, female care professionals will implement culturally responsive therapy to
engage 100% of Latino male clients in mental health services and follow-up care.
11
The questions that guide this study are the following:
1. What is the female care professionals’ knowledge and motivation related to
implementing culturally responsive therapy to engage 100% of Latino men served by
Community and Health of San Fernando in mental health and follow-up care?
2. What is the interaction between organizational culture and context and female care
professionals’ knowledge and motivation to implement culturally responsive therapy to
engage 100% of Latino male clients served by Community and Health of San Fernando
in mental health and follow-up care?
3. What are the recommendations for organizational practice in the areas of knowledge,
motivation, and organizational resources?
Methodological Framework
This study utilized a qualitative methodological approach. The data collection approach
that was utilized to gain an understanding included interviews and document analysis.
Qualitative interviews used, focusing on how people interpret their experiences, how they
construct their worlds, and the meaning one attributes to their own personal experiences
(Merriam & Tisdell, 2016). As the researcher continues to try and understand the relationship
between female care professional’s knowledge, motivation and organizational influences in
engaging Latino male clients in mental health services by implementing CRT; the use of open-
ended interview questions allowing a better understanding on the values and opinions from the
participants (Creswell, 2014).
Definitions
Board of Behavioral Sciences (BBS): The Board of Behavioral Sciences is a California
regulatory agency that is responsible for overseeing, licensing, examining, and enforcing the
12
professional standards for: Licensed Marriage and Family Therapists and Associates, Licensed
Clinical Social Workers and Associates, Licensed Professionals Clinical Counselors and
Associates, Licensed Educational Psychologists.
Care Professionals: Therapist or counselors that work with individuals or a group of individuals
that help improve mental health by talking about their emotions through their traumatic
experiences or situations.
Latino: Latino or Hispanic referring to a person of Cuban, Mexican, Puerto Rican, South
American, Central American, or other Spanish origin.
Mental Health: An individual’s emotional, psychological and social well-being; affecting how
one think, feels and acts.
Mental Health Care Provider: A person or company that is clinically authorized to practice by
the State and performing within their scope of practice defined by their Board issued License.
Non-Profit: A non-profit also known as a 501c(3) is a group or organization that is tax-exempt
formed to provide a public benefit.
Organization of the Project
Chapter One introduces the purpose of the study, the problem statement, the background
of the problem, research questions, methodological framework, and the definition of identified
terms. Chapter Two identifies the review of relevant literature that addresses the history of
Latino men accessing mental health services, current activities of Latino men resisting mental
health, challenges Latino men face with governmental and organizational community mental
health programs, and the cross-cultural therapeutic framework. The chapter also presents the
conceptual framework and the influences that guide the exploration of female care professionals’
practices. Chapter Three outlines the methodology, followed by an explanation of the tools being
13
used to gather the data. This chapter also reviews the research questions, explains the research
design, population and sample, instrumentation, data collection methods, measures of validity,
credibility and trustworthiness, the reliability of the study, and the strategies used to analyze and
interpret the data collected. Chapter Four presents the findings of the study. Finally, Chapter Five
introduces a discussion of the findings, implications for practice, conclusions, and
recommendations for future research.

14
CHAPTER TWO: REVIEW OF THE LITERATURE
The literature review will examine the importance of Latino men having access to
appropriate mental health services. This is followed by an overview of literature on the barriers
and challenges that Latino men face when seeking mental health services and the challenges that
female care professionals’ face when trying to engage Latino male clients. The review will
present an in-depth discussion on cross cultural counseling and characteristics of expert female
care professionals with best engagement practices. This section includes current research on care
professional preparation and professional development practices in engaging Latino male clients
for mental health services. Following the general research literature, the review turns to the Clark
and Estes (2008) Gap Analysis Conceptual Framework, specifically, presenting the knowledge,
motivation, and organizational influences on female care professional’s ability to engage Latino
male clients served by CHSF in mental health services and follow-up care.
The Practice of Mental Health
The BBS is a California state agency that enforces best practices, responsible for issuing
licenses to practice therapy, examines candidates for licensing, and enforces professional
standards for Marriage Family Therapists (LMFT) interns (IMF), Clinical Social Workers
(LCSW) Associates (ASW), Professional Clinical Counselors (LPCC) interns (APCC), and
Educational Psychologists (LEP) (Board of Behavioral Sciences, 2019). The BBS’s mission is to
“protect and serve Californians by setting, communicating, and enforcing standards for safe and
competent mental health practice.” The BBS makes sure that all professionals are practicing in a
safe and competent approach.
Care professionals that are implementing mental health services must first take adequate
and appropriate courses from an accredited institution. Each participant must be in good standing
15
and graduate from their program of choice. Once care professionals complete their required
coursework, an application with official transcripts must be submitted to the Board of Behavioral
Sciences (BBS) for review and approval to start practicing as an intern. An intern care
professional must complete 3,000 hours of supervised direct client care therapy supervised by
licensed therapist. Intern care professionals cannot practice therapy without the guidance and
supervision of a licensed therapist and all clients must be referred by a licensed therapist to an
intern care professional. Once an intern care professional completes 3,000 hours of direct client
care, the care professional must submit their application and completion of hours signed by the
licensed therapist to the BBS. The BBS usually takes four to six weeks to respond, granting the
applicant access to take the board exam. Care professionals need to pass 2 board exams one on
law and ethics and the second one on clinical practice. Not until all 3,000 hours have been
completed and the two board exams have been passed, then will care professional be a licensed
care professional.
Culturally Responsive Therapy
A mental health framework is a set of standards that guides the practitioner in improving
the way they care for clients with mental health challenges to provide a high-quality service
(“Culturally Sensitive,” 2019). Each practitioner uses different approaches to engage and work
with each individual. There are many different approaches that are available to use. One
approach that helps engage Latino males is CRT. Culturally responsive therapy is the care
professional knowing and having an understanding of the clients’ background, ethnicity, and
belief system (“Culturally Sensitive,” 2019). CRT allows all patients to be considered as unique
individuals; a comprehensive assessment of the patients’ problems must gather information
about how cultural beliefs are maintaining or shaping emotional symptoms (Asnaani &
16
Hofmann, 2012). According to Walck (2017), once the assessment has been completed, the care
professional should continue to engage in self-education themselves by reading the assessment.
In using the assessment as a continued engagement and treatment tool care professionals can
identify the clients’ cultural norms to better understand the client’s culture in mental health
which is important in engagement and retention (Walck, 2017). Therefore, after the assessment
phase has been completed, it is necessary to address the stigma around receiving treatment and
the impacts it may have on the individuals’ social networks (Asnaani & Hofmann, 2012).
Furthermore, care professional must continue to validate and respects client’s perspective of
treatment and by continuing to maintain hope the client will be more likely to address their
mental health and stay involved (Walck, 2017). According to Asnaani and Hofmann (2012) it is
important to explore the individual’s strengths in order to enhance treatment and bring these
culture-influenced strengths to therapy discussions. Having care professionals explore what
others in the clients’ social group would say the participant’s strengths are can enhance treatment
participation (Asnaani & Hofmann, 2012). CRT supports care professionals in providing safety
and purposeful treatment.
Female Care Professional Engagement Best Practices
Confident female care professionals who deliver appropriate interventions to engage and
support Latino male clients can achieve greater outcomes than those who do not deliver
appropriate engagement interventions (Dixon et al., 2016). The strategies and techniques for
multicultural competence frameworks for the delivery of services need to be incorporated and
implemented through a curriculum provided by a trained facilitator that can help each participant
navigate through the process. Much of cultural diversity and awareness in mental health remains
and continues to be implemented in trainings and not through clinical practice (Norcross et al.,
17
2009). Multicultural counseling competence highlights the importance of addressing racial and
ethnic awareness to better impact therapy relationships with Latino men and not harm the
participants (Chang & Berk, 2009).
In implementing CRT to better engage Latino male clients, female care professionals
have a tool that can help better engage and help Latino male clients address their mental health
needs. Female care professionals who establish a strong relationship characterized by empathy,
acceptance, and active listening without judgement were able to better support Latino men
(Norcross et al., 2009). CRT is a framework that has strict guidelines, but is flexible enough to
modifications based on the individual’s needs and identified strengths. Implementing different
modified strategies (e.g. asking probing questions, offering concrete advice, implementing skills
training, psycho-educating) are important factors for improving outcomes of engagement and
participation in Latino males’ (Chang & Berk, 2009). CRT is not a framework that fits all
individuals, it is a moldable framework that can be tailored to the specific needs of each
individual.
Latino Men and Mental Health
Mental health is a condition that is silent and most of the time overlooked that affects
ones emotional, psychological and social well-being (Men of crisis face health crisis, 2002).
Mental health affects the way a person thinks, feels, and acts during their daily function.
According to Courtney (2002), in the United States, one-half of the estimated Latino male deaths
can be prevented through education on changes in their personal practices. Latino males are
more likely than any other race to adopt unhealthy beliefs, engage in risky behavior, and are less
likely to seek healthy promoting services (Courtney, 2002). Mental health problems are common
regardless of race, ethnicity, gender, or sexual preference, but help is available and with proper
18
treatment mental health problems can get better and many can recover completely. According to
Davis and Liang (2015), cultural ideologies are defined as an individual’s internalization of
cultural belief system toward their masculinity roles that avoid certain prescribed behaviors.
Latino men are raised to be strong and express little to no emotions in their lives, these behaviors
inhibit Latino males in addressing their mental health and seeking mental health services. Latino
men with mental illness can experience disparities with treatment programs by therapist
perceiving Latino males not being compliant, not engaging, or accepting that they have a
problem (Holley et al., 2016).
Mental health funding and programs have allowed professionals to be more accessible
and available to provide services, but care professionals continue to believe that Latino men are
difficult and non-compliant with services. Latino male clients have reported that they felt
ignored, not listened to, viewed as difficult individuals, experienced a lack of respect, were
thought of lacking intelligence, and felt like their privacy was violated (Holley et al., 2016).
Historically, Latino men were and continue to be the most overlooked population that
experiences the poorest health outcomes and face the greatest barriers when trying to seek
appropriate mental health care (Satcher, 2003). It is important that public health recognizes and
addresses Latino male clients’ needs and issues; the need to address the mental health of Latino
male clients is in part due to the current sociopolitical environment which includes limited
funding to improve access, action around public policy on mental health, scaling up access to
services, improved global architecture for mental health, linkage between mental and social
development, and more health economic research on cost-effective interventions (Jenkins et al.,
2011; Satcher, 2003). While there have been considerable advances in mental health services and
programs, Latino men continue to be overlooked and underserved.
19
Access to Mental Health Services
Latino male mental health is an area that continues to be overlooked and misunderstood
by care professionals due to care professionals’ personal interpretations and biases. According to
Courtney (2002), the information known of Latino male mental health is fragmented and
diffused by individual disciplinary lenses of health educators, medical professionals, nurses,
psychiatrists, public health workers, and social workers. These individual lenses enable the
professional to better understand specific aspects of Latino men’s mental health, but these lenses
also limit in the way the professional can conceptualize their experiences. This in turn limits how
Latino male mental health is understood and perceived.
Mental health services look different depending on the agency or program, but the
engagement and comfort of the participant needs to be the same regardless of the person. Latino
males have lower rates of initiating treatment in a community-based setting, experienced shorter
episodes of treatment, and received less adequate treatment (Deb & Miller, 2017). Mental health
has a stigma attached to it that any individual is reluctant in seeking services (Wu et al., 2017).
Latino men report not trusting their mental health practitioner or decision making about their
treatment but feeling more comfortable and better trusting in traditional healers over Western
medicine approaches (Courtney, 2002).
The lack of access to mental health by Latino males is primarily related to the adverse
socioeconomic conditions, lack of appropriate health insurance, the unequal access to health care
and the lack of informative education on mental health (Jones et al., 2012). Despite the
improvements in mental health awareness, access, information, and resources, mental health has
not specifically identified low-income communities in educating its constituents in the services
or treatments that are available for mental health. Community-based organizations are immersing
20
themselves within in low-income communities but continue to struggle in appropriately
marketing their services and programs to constituents. Latino males with serious mental health
problems are more likely to go undiagnosed and untreated due to cost and not knowing where to
receive treatment (Deb & Miller, 2017). Latino men are less likely to be prescribed psychotropic
medications, have mental health conditions diagnosed, and are more likely to be denied
insurance authorization for treatment than European American men (Courtney, 2002). This is
evidence that Latino men are at risk of going undetected and overlooked of mental health
disorders in primary care settings, community-based settings, and emergency rooms (Deb &
Miller, 2017).
Latino Males’ Resistance to Mental Health Services
McKenzie et al. (2018) identified that an important factor contributing to lack of
participation in mental health care is Latino men’s resistance to medical services. This resistance
is strongly correlated with increased restriction of emotions and increased psychological distress
because seeking help or discussing their emotions goes against male role expectations
emphasizing strength and emotional restraint. Mental health has a negative stigma attached to
receiving treatment that most individuals will avoid going to seek help or getting appropriate
treatment to address the problem (Wu et al., 2017). Resistance to mental health for Latino men is
associated with the unwillingness to speak during treatment, the lack of follow through with
appointments, and not allowing themselves to be vulnerable. Latino men are less likely to talk
about their problems with family, care professionals, and other natural supports than Caucasian
men (Brown, 2005). Latino males are culturally taught and encouraged to be superior,
emotionless, and allowed to be vulnerable. Latino men are less likely to seek and engage in
mental health support due to their reluctance to accepting needing help and being seen as
21
vulnerable or weak (Brown, 2005). Family traditions and cultural beliefs play a role in the
emotional development of Latino men and their acceptance towards help and support. Latino
men believe that men should not be allowed to be cared for or nurtured, instead a man should
find their own way of dealing with things on their own and care for themselves (Strickland,
2012).
Showing and expressing one’s emotions is encouraged when receiving mental health
treatment because care professionals need to identify and address the trauma the individual has
endured. Latino men are less willing to discuss and openly accept their problems (Davies et al.,
2010). Latino men are less likely to seek and accept help for mental health and when they are in
mental health treatment, Latino men report being unsatisfied with treatment and find treatment to
not be helpful (Paz-Pruitt, 2007). Personal image and the way others perceive oneself is
important; mental health can affect one’s personal image in some cultures or social circles. Men
of Latin descent avoid mental health services due to the stigma of being portrayed as weak,
helpless, and powerless (Davies et al., 2010).
Challenges Latino Men Face with Mental Health Services
Throughout the years, mental health has seen an increase of awareness and recognition
both locally and federally. Information about mental health is more accessible and available in
communities that did not have these resources in the past. Early mental health intervention
initiatives continue to prioritize awareness of mental health starting at pre-schools for both
children and parents providing education, services, and increasing awareness on mental health
services (Gonzales-Ball & Bratton, 2019). Still, mental health continues to have a negative
stigma tied to it and communities do not know of the services and continue to be reluctant in
accepting or seeking services to address their mental health. The stigma behind mental health
22
continues to be the biggest barrier for communities to accept and seek mental health as a health
condition (Davies et al., 2010). A vast number of programs have emerged both locally and
federally across the nation.
Political Support Prioritizing Mental Health for Some
The National Alliance on Mental Illness (NAMI), a non-profit with national recognition,
continues to prioritize political efforts that include accessible and adequate mental health
services for Latino males. Local governmental bodies are promoting different programs targeting
Latino men’s mental health through different federal grants, state programs, and local initiatives
after revealing that Latino men’s health has been neglected (Meyer, 2003). Government funded
programs continue to identify and tailor their initiatives and interventions to the specific needs of
the community. Before implementing services, communities are being assessed and specific
implementation plans based on the needs of the community are being designed to better serve
and support its constituents (Holley et al., 2016). National mental health education committees
are prioritizing mental health education in the participant’s native language (Meyer, 2003).
Continued positive assessments, engagement, and education practices have allowed low socio-
economic communities and Latino men to address their mental health.
The stigma surrounding mental health is improving as services are more accessible, but
political agendas continue to prioritize women and children mental health initiatives and
continue to dismiss mental health initiatives towards Latino men. Latino male mental health has
received little to no political support in prioritizing and identifying solutions to improving Latino
males’ mental health (Holley et al., 2016). Different political initiatives continue to support
women’s and children’s mental health by increasing the services that their insurance provider
can cover and making it easier for them to apply and get services. One in four Latino men do not
23
have insurance; out of those who are insured, mental health is not a service that is covered
(Meyer, 2003). The lack of support for mental health services for Latino men in policy agendas
continue to be a barrier in the political sector allowing easier access to mental health (Holley et
al., 2016).
Accessible Community Mental Health Resources
Governmental grants and resources have been allocated at the community level allowing
local community organizations the opportunity to use these financial resources to address mental
health in underserved communities. In fiscal year 2018-2019, The Los Angeles County
Department of Mental Health (LACDMH) a budget of over $2.8 billion which is the largest
county-operated mental health department in the United States (Los Angeles County Department
of Mental Health, 2019). The $2.8 billion budget included over $500 million for distribution to
different community organizations through grants and resources to better help address mental
health throughout Los Angeles County. The $500 million fund over 85 directly operated sites,
300 co-located sites, over 1,000 contracted organizations, and service over 250,000 residents
within Los Angeles County (Los Angeles County Department of Mental Health, 2019). Using
monies from the grants, community organizations are able to target Latino males by engaging
and shaping a better message to talk about mental health services (Satcher, 2003). With the
support of local grants and resources, community organizations are targeting communities of
Latino men that lack awareness and education on mental health (Memon et al., 2016). With more
resources available to them, different community organizations and networks are coming
together in developing programs that address the community and Latino men’s mental health
(Satcher, 2013).
24
Despite the help of grants and resources funneling to local community organizations,
Latino men’s mental health continues to not be a priority and being overlooked by community
mental health organizations. Local community organizations continue to be restricted by the
contracts’ objectives, timelines, and quantity of participants that are set by governmental entities
with no direct fieldwork experience. Local organizations face challenges in positively engaging
Latino males, providing preventative information about mental health, and implementing early
detection programs to address mental health due to timeline expectations set by the county
(Memon et al., 2016). Community organizations are often notified of their awarded contract with
short notice from the start date, where budgets, contract negotiations, and hiring needs to happen
quickly.
Clark and Estes Gap Analytic Conceptual Framework
In order to understand stakeholder performance in support of organizational goals, Clark
and Estes (2008) provided an analytic framework referred to as gap analysis. The purpose of this
gap analysis is to identify and understand stakeholders’ knowledge, motivation, and
organizational support towards achieving their work performance goals. Knowledge influences
are divided into four knowledge types: factual knowledge, conceptual knowledge, procedural
knowledge, and metacognitive knowledge (Krathwohl, 2002). Motivation is a process where
goal directed activities are sustained (Rueda, 2011). Motivational principles such as self-efficacy,
attributions, values, and goals can be measured when analyzing the organizational and
stakeholder performance (Rueda, 2011). Lastly, the gap analysis explores the organizational
influences: cultural models and cultural settings. A cultural model is the normative
understanding of how the world works or ought to work and cultural settings is seen as the who,
what, where, when, where, why, and how through daily routines (Rueda, 2011).
25
Each of the elements from the Clark and Estes (2008) gap analysis are addressed in this
study focusing on female care professionals’ knowledge, motivation and organizational needs for
them to implement culturally responsive therapy to engage 100% of Latino male clients served
by Community Health of San Fernando in mental health services and follow-up care. The first
section will identify presumed influences on the stakeholder performance goal through the
different knowledge influences. The knowledge influences governing this study include
knowledge of CRT in relationship to working with Latino men as a female care professional,
applying the strategies with specific focus on Latino male clients, and actively reflecting on their
effectiveness with the process being used. Thereafter, identified motivational influences through
attainment and intrinsic value of the stakeholder goal will be further explored. The motivational
theories will explain their motivational influences of feeling confident in implementing effective
strategies and seeing the value of using appropriate engagement strategies. Finally,
organizational influences on achievement will be further discussed. The organizational
influences will develop the cultural model of accountability by prioritizing the needs of the client
above the needs of the organization. Cultural setting influences of ensuring that training transfers
into practice and the organization needing to avail effective resources related to both role models
and shadowing opportunities. Each stakeholder knowledge, motivation and organizational
influence on performance will be furthered examined through the methodology section discussed
in Chapter Three.
Female Mental Health Care Professionals’ Knowledge, Motivation and Organizational
Influences
This portion of Chapter Two focuses on the knowledge, motivation, and organizational
influences that are required for female care professionals at CHSF to achieve their stakeholder
26
performance goal. The performance goal for the organization is that by December 2020, 100% of
Latino male clients served by CHSF will comply with their appointments and follow-up care.
The stakeholder goal addresses all care professionals implementing CRT to engage 100% of
Latino male clients served by CHSF in mental health services and follow-up care.
Knowledge and Skills
The purpose of individual and team gap analysis is to pinpoint if all employees have the
appropriate knowledge, motivation, and organizational support (Clark & Estes, 2008). Female
care professionals need to have specific knowledge and skills to engage 100% of Latino male
clients served by CHSF in mental health services and follow-up care. The specific knowledge
explored in this study is the implementation of CRT to better engage Latino males in mental
health services. The four knowledge types within the structure of the knowledge dimension of
the revised taxonomy include factual knowledge, conceptual knowledge, procedural knowledge,
and metacognitive knowledge (Krathwohl, 2002). Factual knowledge consists of the discrete,
basic elements that individuals must know to be familiar with the identified discipline.
Conceptual knowledge is complex, focusing on the interrelationships within the basic elements
and with the larger structure that allows them to function. Procedural knowledge is referred to as
how to do something, addressing the different methods, techniques, or systems. Finally,
metacognitive knowledge is the awareness of and the knowledge of one’s own cognition. The
following sections will address three knowledge influences critical for female care professionals
to implement CRT.

27
Care Professionals’ Knowledge of Culturally Responsive Therapy in Relationship to Working
with Latino Men as Female Care Professionals’
The first knowledge influence that CHSF female care professionals need is knowing how
to engage and communicate effectively with Latino men. Before any female care professional
engages in services, a basic understanding of the background and barriers that Latino men are
faced with through completing the assessment and focusing on their cultural beliefs must be
identified. Griffith et al., (2012) further support the importance of gaining a better understanding
to better serve Latino men. As such, female care professionals need to understand the
relationship between masculinities and health requires a framework such as CRT that accounts
for the individuals in making positive health choices that shape the individual’s behavior and
health practices. Female care professionals must be able to implement different interventions and
strategies to properly distinguish between cultural and pathological aspects of Latino men’s
coping responses when delivering competent interventions (Whaley, 2004). Training programs
must address cultural biases and the racial stereotypes that care professionals may have against
Latino men (Whaley, 2004). Background knowledge about Latino men’s cultural beliefs is
important to better support Latino men. Female care professionals need to be familiar with
appropriate cultural coping response styles to engage and when providing care to Latino men
without causing more harm (Whaley, 2004). Cultural coping responses specific to Latino male
including gender and culturally specific roles, protectors and providers of the family, taking an
individualistic approach in dealing with problems, and allowing them to vent without providing
answers (Gloria et al., 2009). It is important for female care professionals to recognize when
they are making generic statements about their trauma and should reframe from assumptions
about how a specific cultural belief informs the patients distress (Asnaani & Hofmann, 2012).
28
Efforts must be made to build a culturally competent care professionals’ workforce that are able
to communicate effectively with Latino male clients to deliver appropriate treatment (Satcher,
2003).
Female Care Professionals’ Knowledge about Applying Strategies of Engagement with
Specific Focus on Latino Male Clients when Introducing the Importance of Follow-up Care
The second knowledge influence that CHSF female care professionals need to achieve
the identified performance goal is knowing how to apply strategies of engagement with a specific
focus on Latino male clients when introducing the importance of follow-up care and completing
the assessment. For Latino male clients, having health female care professionals that understand
their cultural beliefs, can relate to their experiences, and who can incorporate best practices that
are sensitive to their masculinity will improve their willingness to continue care (Satcher, 2003).
Female Care Professionals’ Reflection about own Effectiveness in the Context of Supporting
Latino Men to seek Resources and Completing the Assessment and Continued Care Services
The third knowledge influence that CHSF female care professionals need in order to
achieve the identified performance goal is knowing the importance of reflecting on their own
effectiveness in serving Latino male clients in the context of supporting them to seek resources
and completing the assessment for continued care services. Female care professionals must be
willing to embrace the process of analyzing their approach and strategies of engagement to see if
any modifications are needed to better serve Latino men (Suite et al., 2007). Satcher (2003)
supports this argument and adds that for improving the care for Latino men, continued
collaboration between similar organizations to assess and implement solutions will need to be
addressed on an ongoing basis. According to Griffith et al., (2012) female care professionals
should continue to assess and identify the process which helps determine how well Latino male
29
clients have been captured and engaged. Table 2 categorizes the above mentioned three
knowledge influences by knowledge type and explains different possible assessment methods
and identifies CHSF mission, organizational global goal, and the stakeholder goal.
Table 2
Knowledge Influences, Types, and Assessment for Analysis
Stakeholder Goal

By December 2020, female care professionals will implement culturally responsive
therapy to engage 100% of Latino male clients served by Community and Health of San
Fernando in mental health services and follow-up care.

Knowledge Influence Knowledge Type Knowledge Influence
Assessment
Care professionals’ knowledge
of culturally responsive therapy
in relationship to working with
Latino men as a female care
professional

Declarative
Conceptual
Interviews asking stakeholders
what knowledge stakeholders
have about culturally
responsive therapy.
Female care professionals need
to know how to incorporate and
apply strategies of engagement
with a specific focus on Latino
male clients when introducing
the importance of follow-up
care.

Procedural

Interviews asking stakeholders
to provide examples on how
they engage and treat Latino
male clients for
encouragement in receiving
primary services and follow-up
care.
Female care professionals need
to actively reflect on their own
effectiveness in serving Latino
male clients in the context of
supporting them to seek
resources and completing the
assessment for continued care
services.

Metacognitive Using interviews stakeholders
were asked to look at different
scenarios and explain how they
either have approached the
situation or would approach
the situation and engage in a
conversation with the client.

30
Motivational Influences
Motivation-associated influences are the second dimension that will be explored in the
context of female care professionals’ feeling confident in implementing CRT with Latino male
clients. Motivation is mirrored by the amount of effort an individual exerts to better understand
the information and engaging in the appropriate cognitive process (Mayer, 2011). Rueda (2011)
described motivation as a process where goal directed activities are sustained. There are four
critical components to motivation: it is personal to the individual, it activates a behavior, it
energizes by fostering persistence, and it is directed at accomplishing a specific goal (Rueda,
2011). Clark and Estes (2008) introduced motivation as an internal, psychological process that
gets individuals going, keeps them moving, and helps them accomplish the task. The three
critical motivational influences are choosing to work towards a goal, persisting until it is
achieved, and investing the necessary amount of mental effort to accomplish the task (Clark &
Estes, 2008).
Female care professionals need to be motivated to implement CRT to engage Latino male
clients served by CHSF in mental health services and follow-up care. The five motivational
variables underlying choice, persistence and mental effort are interest, beliefs, attributions, goals,
and efficacy (Mayer, 2011). Motivation based on interest is the idea that individuals work harder
when the information has personal value or interest to them (Mayer, 2011). Motivation based on
beliefs is when individuals work harder to learn when they know that their hard work will pay
off (Mayer, 2011). Motivation centered on attributions defines individuals working harder when
they attribute their success and failures to their effort rather than their ability (Mayer, 2011).
Motivation through mastery orientation refers to individuals working harder when their goal is to
perform well or master the material rather than performing well in comparison to others (Mayer,
31
2011). Lastly, motivation based on efficacy is the idea of individuals believing that they can be
successful implementing the task at hand (Mayer, 2011). The following section will focus on
self-efficacy and expectancy value theory motivational influences, as both are critical to female
care professionals in engaging Latino male clients served by CHSF in mental health services and
follow-up care.
Female Care Professionals’ Self-Efficacy in Implementing Culturally Responsive Therapy
with Latino Male Clients
In order for female care professionals in mental health to implement CRT, they need to
feel confident in their ability to do so. Rueda (2011) stated that self-efficacy is people’s
judgements on their own capability to organize and complete the plan of action needed to
achieve desired levels of performance. Individuals form their self-efficacy beliefs by deciphering
information from four primary sources: mastery experience, vicarious experience, social
persuasion, and physiological reaction (Pajares, 2006). Mastery experience is when individuals
measure their actions and their interpretations of these actions create their self-efficacy beliefs;
vicarious experience refers to people forming their efficacy beliefs by seeing relevant others
perform tasks and by peer modeling; social persuasion is influenced by verbal messages one
receives from others intentionally or accidentally; physiological reaction refers to someone who
is optimistic or positive having enhanced self-efficacy, whereas someone who is depressed
having diminished self-efficacy (Pajares, 2006). Individuals with high self-efficacy, greater
belief in their ability, and with higher expectations for positive results will be more motivated to
be engaged, be persistent, and work harder at the task (Rueda, 2011).
To achieve their stakeholder goal, care professionals from CHSF need to be efficacious
about their ability to support Latino male clients in mental health services and follow-up care.
32
Confident care professional who deliver proper interventions like storytelling are known to
achieve greater impact in engaging and supporting men than traditional educational approaches
like lectures or presentations (Wheeler et al., 2018). Harding (2013) expands on care
professionals who actively participated in training and followed up with questions and further
support from the training department felt more confident and had more positive outcomes with
engaging Latino men than those individuals who did not seek extra support from the training.
Female care professionals must believe in their ability to confidently implement the appropriate
interventions to better engage Latino men. Female care professionals who received and were
motivated to implement the different motivational interventions from training forums had an
increase in group attendance and higher completion rates with assessments (Harding, 2013).
Female Care Professionals’ Value for Implementing Culturally Responsive Therapy in their
work with Latino Male Clients
Eccles (2006) defines expectancy value as the individual’s expectation of success and the
value that one attaches to the different options perceived by the person. Expectancy-value model
contains two fundamentally motivational-oriented questions: “Can I do the task?” and “Do I
want to do the task?” (Eccles, 2006). The first question addresses one’s expectation of
completing the task, while the second question looks at one’s perceived value associated with the
task (Eccles, 2006). Rueda (2011) refers to value or task value as the importance that each person
attaches to the task. The four separate dimensions of task value are attainment value, intrinsic
value, utility value, and cost value (Rueda, 2011). Attainment value refers to the importance that
a person attaches to doing the task well; intrinsic value outlines the enjoyment that a person
experiences during the identified activity; utility value proposes the usefulness a person believes
33
the task is for reaching a future goal; cost value is the perceived cost of the task through time,
effort, or other dimensions (Rueda, 2011).
To achieve their stakeholder goal, female care professionals from CHSF must value the
use of engagement strategies appropriate for Latino male clients. When female care professionals
see the importance of putting into practice interventions learned such as CRT, legitimate barriers
like retention and participation could be more easily resolved (Harding, 2013). With female care
professionals seeing the value of Latino male clients’ seeking mental health services and follow-
up, female care professionals will have less negative views about Latino men and for different
ways to provide support (Grella et al., 2004).
Table 3 categorizes the above mentioned two motivational influences by type and
explains different possible assessment methods and identifies CHSF’s mission, organizational
global goal, and the stakeholder goal.
Table 3
Motivational Influences and Assessment for Analysis
Stakeholder Goal

By December 2020, female care professionals will implement culturally responsive therapy to
engage 100% of Latino male clients served by Community and Health of San Fernando in
mental health services and follow-up care.

Motivation Influences Motivation Type Motivational Influence
Assessment
Female care professionals need to
feel confident in implementing
culturally responsive therapy with
Latino male clients.
Self-Efficacy

Interviews asking
stakeholders how confident
they are in implementing
culturally responsive
therapy.
Female care professionals must see
the value of using culturally
responsive therapy for Latino male
clients.

Expectancy Value

Interviews asking
stakeholders if they see the
value of using culturally
responsive therapy.
34
Organizational Influences
Organization-associated influences are the third dimension that impacts female care
professionals in implementing CRT with their Latino male clients. Organizational features
include how different settings are structured and organized, the policies and procedures that
define the organization, and how individuals interact with one another within the organization
(Rueda, 2011). Organizations can have different cultures and are developed overtime. Culture is
a way that describes core values, goals, beliefs, emotions, and processes that are learned as
individuals over time through different family and work environments (Clark & Estes, 2008).
Culture is not static, but rather be a dynamic process that is created and formed by individuals
that are in the course of negotiating everyday life (Rueda, 2011).
The following section will focus on cultural models and cultural setting-related
organizational influences as both are critical to female care professionals in implementing
Cultural models by prioritizing the needs of the clients over the needs of the organization and
cultural settings by making sure training transfers into practice and the organization availing
effective resources for shadowing and role modeling opportunities are not mechanistic and static
in nature, but rather they are dynamic and interactional processes (Rueda, 2011).
Organization Needs to Engage Latino Male Clients Rather than Focusing all Efforts on
Servicing Women and Children for Contractual Billing Purposes
The first organizational influence that CHSF female care professionals need to achieve
their stakeholder goal is the organization must prioritize Latino male clients through CRT rather
than focusing efforts to utilize contractual funds servicing women and children who are more
responsive than Latino males. Rueda (2011) defines cultural models as a shared mental schema
of how the world works or should work. Cultural models can be used to characterize
35
organizations, different business settings, and classrooms (Rueda, 2011). Cultural models are
dynamic instead of being static traits, and are expressed through cultural practices (Rueda, 2011).
To achieve their stakeholder goal, the organization’s culture needs to prioritize the needs of the
clients above the needs of the organization. Client’s needs are numerous and equally important,
but given limited time and limited resources available to address all of their needs, organizations
need to remove the organization’s opinion of what should be prioritized and allow the clients to
identify the needs they want to prioritized (Alio, 2017). Addressing the needs and allowing the
individual to feel ownership of their treatment builds on meaning that is a shared connection
between client and professional which can lead to a healthy sense of self (Frey, 2013). It is
important to respect the client’s prioritized needs first, even if it is not the organizations needs or
goals, this will help build trust, and will also increase the client’s sense of autonomy and
engagement in the process (Alio, 2017).
Organization Needs to Ensure that Training Transfers into Practice
The second organizational influence that CHSF female care professionals need in order to
effectively implement CRT is the organization ensuring that the training transfers into practice.
Rueda (2011) defines cultural settings as being who, what, when, where, why, and how of the
routines of everyday life; the more concrete version of a social context. Cultural setting impacts
behaviors and impacts the actions of the people who inhibit them (Rueda, 2011). Individuals who
are attentive and engaged in trainings are better equipped to confidently implement strategies and
better adapt to the new way of conducting business (Norcross et al., 2009). Organizations that
support their employees with the most current forms of implementing new effective practices
have better performance outcomes and more satisfied employees that can confidently engage
clients in mental health. Grella et al. (2004) stated that organizations who invest in the most
36
updated and effective training curriculums see an increase in performance goals and more
confident and effective employees. To assess female care professional’s cultural models a survey
or interview questions about willingness to implement new engagement strategies, having the
motivation to adapt to new changes, about their trainings, how they feel about them, and what
they want to get out of these trainings will be administered.
Organization Needs to Avail Effective Resources Related to Both Role Models and Shadowing
Opportunities for Female Care Professionals in Addressing the Needs of Latino Male Clients
Organizations that support their employees through continued training, shadowing
opportunities, and supervised role-playing scenarios are shown to have increased performance
outcomes when implemented in the field with their clients (Wheeler et al., 2018). Communities
and organizations with updated educational and training efforts can be more aware about the
barriers and challenges that Latino men face and are able to better support their staff with more
effective strategies on engagement and implementation. Pro-active professionals seeking and
implementing the support of the organizations in the community and working together are better
equipped and able to share resources to support community members through different forums
and town halls with more educated staff and constituents (Memon et al., 2016). This study will
the explore the organization prioritizing the needs of clients over the needs of the organization,
the organization ensuring that training transfers into practice, and the organization availing
effective resource related to both role models and shadowing opportunities in addressing the
needs of Latino male clients.

37
Table 4
Organizational Influences and Assessment for Analysis
Stakeholder Goal
By December 2020, female care professionals will implement culturally responsive therapy
to engage 100% of Latino male clients served by Community and Health of San Fernando in
mental health services and follow-up care.

Organizational Influences Organization Influence Assessment
Cultural Model Influence 1:
The organization needs to engage Latino
male clients rather than focusing all efforts
on servicing women and children for
contractual billing purposes.

Interview questions about how the
organization is prioritizing the clients and not
the organization’s budget or contract
Cultural Setting Influence 1:
The organization needs to ensure that
training transfers into practice.
Interview questions about how the female
care professionals perceive that training
material is being put into practice
Cultural Setting Influence 2:
The organization needs to avail effective
resources related to both role models and
shadowing opportunities for female care
professionals in addressing the needs of
Latino male clients.
Interview questions about if role models or
shadowing opportunities identified by the
organization.

Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation and
the Organizational Context
A conceptual framework is a visual or written product that explains graphically or
narratively the main points of the study, key factors, concepts, or variables and the relationship
that they have with each other (Maxwell, 2013). The knowledge, motivation, and organizational
influences for female care professionals’ engagement with best practices in providing care to
Latino males are presented through Clark and Estes (2008) Analytical Framework. Figure 1
below illustrates the conceptual framework.

38
Figure 1
Interaction Between the Organization, Stakeholder Groups, and the Organizational Goal

Female Care Professionals
Knowledge Motivational
Declarative Conceptual: Self-Efficacy:
Implement the confident in implementing
fundamental principles culturally responsive therapy
of culturally responsive
therapy

Procedural: Expectancy Value:
Apply strategies of Seeing the value of using
engagement culturally responsive therapy

Metacognitive:
Reflecting on their
effectiveness

Community and Health of San
Fernando (CHSF)
Cultural Models Cultural Settings
Engaging Latino male Training transfers
male clients through into practice
culturally responsive
therapy rather than Avail effective
focusing all efforts on resources related to
servicing women and role models and
children to bill down shadowing
all contracts
Stakeholder Goal
By December 2020, all care professionals will implement culturally
responsive therapy to engage 100% of Latino male clients served by
Community and Health of San Fernando in mental health services and
follow-up care.
KEY

Stakeholder Goal

Organization

Stakeholder Influences

Simultaneous Interaction

Interaction leads to
39
Conclusion
This evaluative study seeks to understand the effectiveness of female care professionals
engaging Latino male clients served by CHSF in mental health services and follow-up care. To
inform this study, this chapter reviewed the literature associated with the history of Latino male
and mental health, challenges Latino male clients face with mental health, and approaches for
Latino men and mental health. This review explored the history of Latino men in accessing
mental health services, challenges Latino men face with mental health services, and approaches
in engaging Latino men and mental health. This literature review process led to identifying the
assumed knowledge, motivational, and organizational influences in Clark and Estes (2008) Gap
Analytic Conceptual Framework that are related to the stakeholder goal of all female care
professionals implementing CRT to engage 100% of Latino male clients served by CHSF in
mental health services and follow-up care. The knowledge influences include conceptual
knowledge on how to engage and communicate with Latino male clients, procedural knowledge
in applying strategies of engagement, and metacognitive knowledge in reflecting on their
effectiveness as female care professionals serving male clientele. The motivational influences
include self-efficacy in the ability to confidently implement culturally responsive therapy and
expectancy value of seeing the value of using CRT for Latino male clients. The organizational
influences include cultural models of the organization needing to engage Latino male clients
through CRT rather than focusing all efforts on servicing women and children to bill down the
contracts. The organizational influences of cultural settings of the organization needing to ensure
that training transfers into practice and the organization needing to avail effective resources
related to both role models and shadowing opportunities. Chapter three will present the study’s
methodological approach applied in this study.
40
CHAPTER THREE: METHODS
The purpose of this study is to examine female care professionals’ knowledge,
motivation, and organizational influences in their capacity to implement CRT to engage Latino
male clients served by CHSF in mental health services and follow-up care. This chapter will
present the research design and the methods for collecting data and data analysis. The section
that follows will introduce the research questions and the methodology for the study. Data
collection and instrumentation approaches will be addressed, followed by concluding the chapter
with a discussion on data analysis applied in this study.
Research Questions
1. What is the female care professionals’ knowledge and motivation related to implementing
culturally responsive therapy to engage 100% of Latino men served by Community and
Health of San Fernando in mental health and follow-up care?
2. What is the interaction between organizational culture and context and female care
professionals’ knowledge and motivation to implement culturally responsive therapy to
engage 100% of Latino male clients served by Community and Health of San Fernando in
mental health and follow-up care?
3. What are the recommendations for organizational practice in the areas of knowledge,
motivation, and organizational resources?
Participating Stakeholders
The stakeholders for this research study are licensed female care professionals
implementing CRT to engage Latino male clients served by CHSF in mental health services and
follow-up care. The care professional levels include licensed care professionals, intern care
professionals, and practicum care professional students. For this research, licensed care
41
professionals are defined as persons who completed 3,000 hours of supervised therapy, passed
the two BBS board exams, and BBS has certified the individual to be a licensed care
professional. Intern care professionals are defined as persons who are working on completing
their 3,000 hours of service delivery and have not yet passed or taken the two BBS board exams.
Practicum care professional students are defined as persons who have completed their first year
of graduate school and need to complete 150 hours before graduating.
Interview Sampling Criteria and Rationale
Criterion 1
Female care professionals include licensed female care professionals working at CHSF.
However, intern female care professionals and practicum female care professional students were
excluded given their lack of experience and formal training received in a permanent capacity.
Interview Sampling (Recruitment) Strategy and Rationale
Stakeholders were notified of the study through informative brochures and flyers send
through electronic mail. Interested stakeholders were contacted by phone, email, or in-person
that solicited interest in participating in this research study. A spreadsheet of interested female
care professionals was created and identified by female care professionals’ licensed BBS
number. The BBS number was intended to be used for random selection if more than 10
individuals volunteer to be interviewed. A sample of 10 licensed female care professionals was
selected from the list of interest. None of the participants were subordinate to the researcher. No
participants interviewed were directly or indirectly supervised, or otherwise managed, by the
researcher.
Qualitative interview serves as an effective data collection method when the researcher is
on-site and can develop a relationship with the identified participants of the study (Johnson,
42
Christensen, 2015). For this study, the researcher was off-site conducting virtual interviews
through ZOOM. The researcher scheduled times and dates with the identified participants meet
individually via ZOOM. The interview process recognizes and validates the value of the
participants perspective as well as the meaning on the topic of focus (Patton, 2002). A critical
part of this study is to understand the female care professionals’ perspective of engaging Latino
male clients by implementing CRT. By conducting interviews, the researcher gained better
insight and a broader perspective in female care professionals engaging Latino male clients with
CRT.
Data Collection and Instrumentation
The research questions in this study guided the researcher and the strategies on what data
collection processes to utilize as well as the development of the instruments that were used.
Analysis of documents is necessary as there is already information produced and gathered from
CHSF regarding CRT training. These documents were reviewed after the interviews were
completed with female care professionals to compare the CRT training records and curriculum to
with female care professionals’ responses. Qualitative interviews were utilized and
administered. Qualitative research is a way of gathering information techniques through
interviews, observations, or document analysis (McEwan & McEwan, 2003). An approach that
explores and understands a deeper meaning individual ascribe to the greater problem by the data
being collected in the participants setting with the researcher making interpretations on the
meaning of the data (Creswell, 2014). The study includes qualitative data gathered through
interviews. The interviews were conducted with female care professionals who are licensed and
that provide direct mental health services to Latino male clients to gather meaningful data
43
regarding their knowledge, motivation, and organizational experiences in engaging Latino male
clients in mental health services by implementing CRT.
Interviews
One-hour interviews were conducted with 10 licensed female care professionals from
CHSF. All interview participants volunteered to participate in the study by expressing interest
from the informational flyer sent through electronic mail. Interviewees were asked to identify
best available times and dates for the interview to take place so that the felt more willingly to
participate and engage in the interview process.
Interview Protocol
The interview protocol for this study is based on a semi-structural approached. The
interview process through a qualitative approach is less formalized, is more flexible, and is a
more organic interview which allows for easier probing and follow-up questions for richer data
(Merriam & Tisdell, 2016). The stakeholder group of focus being female care professionals
implementing CRT by providing direct mental health services to Latino male clients and
gathering information on successes and barriers on engaging Latino male clients, the flexibility
of probing and follow-up questions is important.
Interview Procedures
CHSF mental health unit has 61 full-time care professionals (53 females, eight males).
All female care professionals were invited and informed about participation in the study. If more
than 10 female care professionals show interest of participating in the study, a random sample of
10 participants are to be selected from a random number table using their BBS license number
and randomly select 10 participants without having any identifying information. Ten participants
showed interest in participating in the study, the researcher interviewed all 10 participants. The
44
researcher offered a $20.00 gift card as an incentive for participating in the study. Thirty-two
female care professionals in the CHSF mental health unit are licensed by the state of California
BBS. All participants who are to be selected to be interviewed will have expressed to voluntarily
participate as an interviewee participant. No interview participant selected directly reports to the
researcher nor does the researcher have any work-related direct influence over the participant
being interviewed. Interviewees were asked to choose their preferred interview dates and times
to enhance their willingness in participating in the interview process. The questions are open-
ended, neutral, singular, and clear (Patton, 2002). To avoid making participants feel pressured or
uncomfortable in responding a certain way, singular response questions must be avoided during
the interview (Patton, 2002).
Documents
Documents give an understanding of why CHSF female care professionals need to
implement CRT to engage Latino male clients. Two documents were reviewed for this study: (a)
CRT training curriculum and (b) CRT training records. These documents are public records and
were obtained with permission from the administrative staff and human resources department.
Merriam and Tisdell (2016) stated that the researcher is not altering any data when conducting a
document analysis, which is beneficial to the research process. Data was used from fiscal year
July 1, 2018 to June 30, 2019. The documents were reviewed and analyzed after the interviews
were completed with female care professionals’ participants to provide further understanding of
the responses or reveal any discrepancies in response to female care professionals’ interviews.
Data Analysis
Data analysis is a process that provides meaning to the data that was previously collected
(Merriam & Tisdell, 2016). For the study, the researcher utilized a qualitative data analysis. The
45
results from the qualitative interviews offered a deeper insight for this study. After qualitative
interviews are conducted, the researcher transcribed each individual interview. Once all of the
interviews are transcribed, the researcher identified analytic codes supporting the conceptual
framework. Using the conceptual framework as the guide to the study, interviews were coded
and emergent themes were identified, focusing on the knowledge and motivation of female care
professionals implementing CRT to engage Latino male clients and organizational culture. The
identified themes from the interviews were used to understand the gaps as well as the assets in
the study.
Credibility and Trustworthiness
The researcher is the primary and key instrument while conducting a qualitative research
study (Creswell, 2014). With any research study, it is important that the researcher provides a
purposeful contribution to the identified field with data that is believable and trustworthy
(Meriam & Tisdell, 2016). The strategies used to make sure that this study upheld credibility and
trustworthiness relied solely on the researcher’s efforts to maintain them. Ensuring adequate
rigor, paying careful attention to detail, and providing the highest ethical conduct possible were
given the highest priority and importance throughout this research study (Merriam & Tisdell,
2016). The strategies used in this research study to guarantee credibility and trustworthiness were
the use of rich data and respondent validation ((Merriam & Tisdell, 2016). The researcher being
the primary instrument of the data collection process, the researcher ensured that the data was
rich, by capturing detailed field notes during each interview and having detailed transcripts
attached with the field notes of every interview. During each individual, interview the researcher
kept a journal to capture specific tones and body language to offer further information to each
interview (Merriam & Tisdell, 2016). The strategy of taking detailed field notes, transcribing the
46
interviews, and keeping a journal allowed the researcher to guarantee credibility and the data are
perceived as trustworthy. The researcher reviewed documents by CHSF on CRT Training
curriculum and CRT training records to support or dispute what female care professionals
reported during the interviews.
Ethics
Interviews allow researchers to gain access to different experiences and interpretations
from a different perspective. Interviewing individuals with knowledge on the topic gives access
to their observations of others (Weiss, 1994). Understanding and gathering the different
perspectives and opinions of others is crucial for this study because it gives the researcher the
ability to analyze real life experienced data and observations through other perspectives and
point of view. Being allowed to interview and obtain another’s persons perceptive and opinion
on the matter is a responsibility and a privilege. When gathering any type of data for the study,
the researcher needs to go through proper protocols to make sure that the information and
participation is both voluntary and appropriate for the study. Individuals participating in the
study need to be informed of the purpose, rewards, and risks of the study as well as their
participation being completely voluntary throughout the process (Krueger & Casey, 2009). Via
an IRB-template based Information Sheet, the researcher provided each participant with a
summary of the study identifying the research questions, purpose, and a list of sample interview
questions. This Information Sheet stated that participation in this study is completely voluntary
to participate, being recorded, understanding their confidentiality, and being aware of the safety
protocols that are taken in storing the data. The requirement for consent continues throughout the
project; if a participant decides to retract something that they said or deny the use of their
interview in the project, the participant owns the information and is able to block its data use in
47
the project (Rubin & Rubin, 2012).
The organization of focus is CHSF. CHSF is a non-profit organization that is located in
the Northeast San Fernando Valley. The organization focuses on alcohol and drug prevention,
adult mental health, parenting classes, and advocacy work. The researcher is a program director
of mental health program within CHSF. The study of female care professionals engaging Latino
men served by CHSF in mental health services and follow-up care is important to address so that
the organization can continue to seek further adult mental health funding and not loose existing
contracts due to the lack of participation from Latino men. The researcher will not interview
individuals within his unit as the researcher directly supervises those individuals. The researcher
interviewed individuals from a different unit where there is no supervisory influence or direct
contact with on a daily basis. The researcher explained in detail the summary of the study that
outlined the purpose, research questions, consent forms, and interview questions. The first ethical
obligation to interviewees is to do no harm and keep all promises that you discussed with them
(Rubin & Rubin, 2012). The researcher needs to take into account the different assumptions and
biases that they are faced with. This is an important note to consider as the researcher needs to
disconnect from program director duties and only focus on being a researcher and gathering the
data necessary for the purpose of the study and not to reprimand individuals.

48
CHAPTER FOUR: RESULTS AND FINDINGS
The purpose of this research study is to explore female care professionals’ knowledge,
motivation, and organizational influences related to their capacity for care professionals
implementing CRT to engage Latino male clients in mental health services and follow-up care.
This would support the accomplishment of the suggested organizational performance goal of
100% of Latino male clients served by CHSF complying with their appointments and follow-up
care by December 2020. This study utilized a modified gap analysis framework with the primary
focus on a qualitative design. This chapter outlines the following elements of the research study:
interview and document analysis findings. The questions guiding this study were the following:
1. What is the female care professionals’ knowledge and motivation related to implementing
culturally responsive therapy to engage 100% of Latino men served by Community and
Health of San Fernando in mental health and follow-up care?
2. What is the interaction between organizational culture and context and female care
professionals’ knowledge and motivation?
3. What are the recommendations for organizational practice in the areas of knowledge,
motivation, and organizational resources?
Participating Stakeholders
A total of 10 female care professionals from CHSF participated in this research study. All
10 participants were licensed therapists with the Board of Behavioral Sciences (BBS) with the
State of California. The experience of all of the participants ranged from two years to 30 years
with eight years as the mean years of therapist experience as a licensed therapist. The age of the
participants ranged from 33 years old to 62 years old with 40 years old as the mean years of age.
The participants identified ethnicity included three (30%) participants identifying as
49
White/Caucasian and seven (70%) participants identifying as Latina/Hispanic. Table 5 identifies
the participant’s age, years of being licensed with BBS in the State of California, and the
participants identified ethnicity.
Table 5
Demographic Information of Participants
ID Years of being Licensed
with BBS in California
Age Ethnicity Gender
W001 21 years 45+ years old White/Caucasian Female
W002 30 years 45+ years old White/Caucasian Female
W003 8 years 35-45 years old White/Caucasian Female
L001 2 years -35 years old Latina/Hispanic Female
L002 2 years 35-45 years old Latina/Hispanic Female
L003 2 years -35 years old Latina/Hispanic Female
L004 6 years 35-45 years old Latina/Hispanic Female
L005 5 years 35-45 years old Latina/Hispanic Female
L006 6 years 35-45 years old Latina/Hispanic Female
L007 4 years -35 years old Latina/Hispanic Female

Findings Based on CRT Training-Related Document Analysis
In order to set the context for discussion of data related to knowledge influences, findings
based on the CRT training-related document analysis will be presented first and later also
discussed in the context of organizational influences. Based on the document analysis review of
CRT training records, the purpose of CRT is clearly stated in the trainers’ curriculum as well as
in the PowerPoint presentation training as a framework that allows care professionals to better
understand their clients’ background, ethnicity, and belief system by accommodating and
respecting all practices, traditions, values, and opinions (“Culturally Sensitive,” 2019). CHSF has
trained 100% of the care professionals as the training is part of the 90-day on-boarding packet to
complete. CHSF keeps a record of all trainings implemented with a copy of the agenda,
curriculum, sign-in sheet, pre and post-test, and certificates of completion for audit purposes.
50
CRT training is a three-day in person training where each training day consists of six
hours of instruction. The CRT training has changed to adhere to COVID-19 guidelines set by the
Center for Disease Control and Prevention. All CRT trainings are currently being conducted
through Zoom meetings where a maximum of 10 care professionals can participate per training.
The training has been modified slightly to focus more on engagement through tele-health.
Tele-health is a remote service delivery where care professionals and clients log-in to a
secure website and conduct their session through an online portal as opposed to in-person. Care
professionals are expected to continue to provide services to their clients and CRT training has
included engagement strategies and methods via tele-health. CRT trainers and coaches continue
to provide support via tele-health by conducting trainings via Zoom as well as coaching sessions.
During in-person day to day operations at the organization, CRT PowerPoint training is
accessible to all CHSF staff through an online shared folder and each supervisor has a copy of
the curriculum in their office to utilize and reference if needed. CHSF care professionals all
receive a copy of the training both in hard copy and electronically when registered for CRT
training.
A guide with steps (presented in Appendix C) is made available to all care professionals
detailing the steps that need to be implemented in CRT. The guide illustrates the five steps of
CRT: Step 1: engagement, Step 2: record review, Step 3: assessment and safety planning, Step 4:
collateral session (formal and informal supports), Step 5: tracking and adapting underlying
needs. CRT’s steps are guided by the following principles, Consistency: an essential component
in service delivery, Responsiveness: mutual respect for values and norms with an openness to
learning and understanding diverse perspectives, Collaboration: a collaborative process with
formal and informal support systems, and Teaming: promotion of team-based approaches with
51
formal and informal supports built by trust. CRT is a continuous process where every step can
and should be addressed multiple times in treatment in addressing the underlying needs of the
identified clients.
CHSF has identified six coaches within their department to provide shadowing, role -
modeling, and technical assistance. Each coach has specified office hours and an online public
calendar where care professionals can sign themselves up to receive technical assistance, role-
modeling, and shadowing opportunities. During CHSF staff meeting agendas coaches address
their calendar availability and upcoming training dates scheduled. CHSF keeps electronic records
and paper printouts of all of the appointments that are scheduled with coaches as well as sign in
sheets and summary of the event. On average, for the months of May, June, and July of year
2020, coaches’ schedules were over 50% filled with technical assistance, role-modeling, or
shadowing-related activities with care professionals. The training records show that on average,
CHSF care professionals attend or seek support from the coaches two times a month.
After each training and coaching session is completed, each participant must complete an
evaluation on the training. Training participants can choose to keep their evaluation anonymous
or can provide their name to be contacted if more clarification is needed about their comments
for further improving the training. CHSF training department gathers pre and post-tests as well
as questionnaires to gather the participants feedback and generate quarterly reports that focus on
the presumed effectiveness of the training, participants’ understanding of the training, and their
level of comfort in implementing CRT after taking the training. The CRT training records do not
contain any evidence of care professionals reflecting upon their practice or interpretation of the
training in an individual or group supervision setting. Participants completing CRT training must
complete four coaching sessions which are designed for participants to discuss and reflect on
52
their practice. There is no standard curriculum for how the coaching sessions must be conducted
or evaluated, the coaching sessions are designed to be individualized based on the needs of each
individual participant. For example, there are no specific reflection-oriented prompts that the
coaches are expected to use. The coaches instead provide what they refer to as an “individualized
approach,” where every session is unique based on their identified focus and coaches provide
support and re-assurance of techniques of engagement. The curriculum does not include
examples or vignettes of real-life scenarios, it is designed to be only an introduction to CRT.
Knowledge Influences’ Findings
Numerous interview questions were asked to assess the knowledge influences affecting
female care professionals’ in implementing the fundamental principles of culturally responsive
therapy, incorporating and applying strategies of engagement on Latino male clients, and female
care professionals reflecting on their own effectiveness in serving Latino male clients in the
context of supporting them to seek resources and completing the assessment for continued care
services. The findings suggest that female care professionals comprehend the concepts of
culturally responsive therapy. Female care professionals described culturally responsive therapy
as a universal framework throughout the organization to engage and support Latino male clients.
Table 6 identifies the assumed knowledge influences and the summary of findings for each
assumed influence.

53
Table 6
Determination of Knowledge Influences
Assumed
Knowledge
Influence
Findings Gap Asset
Declarative:
Conceptual
Female care professionals’ comprehensive knowledge of
culturally responsive therapy
X
Procedural Female care professionals’ mixed levels of understanding
about applying strategies of engagement with a specific
focus on Latino male clients
X
Metacognitive Female care professionals’ mixed levels of reflection
about own effectiveness in the context of supporting
Latino men to seek resources and completing the
assessment and continued care services
X

Finding 1: Female Care Professionals’ Comprehensive Knowledge of Culturally Responsive
Therapy
For female care professionals to understand the influence culturally responsive therapy
has on Latino male clients, they must understand the concept of what CRT is. As part of the
interviews, female care professionals were asked to describe the practice of CRT, state the
strengths and challenges of implementing culturally responsive therapy, and to discuss their
experiences in implementing culturally responsive therapy. According to the literature, culturally
responsive therapy is a framework that allows care professionals to better understand their
clients’ background, ethnicity, and belief system by accommodating and respecting all practices,
traditions, values, and opinions (“Culturally Sensitive,” 2019).
When asked during the interview to describe their knowledge on culturally responsive
therapy, the data indicates that female care professionals’ knowledge on culturally responsive
54
therapy is aligned with the literature. W001 described culturally responsive therapy as a tool to
“support Latino male clients’ in engaging in mental health services by understanding their past
and respecting their values and different beliefs.” W003 said, “For me, culturally responsive
therapy is a way to engage Latino men by getting to know them and adjusting my practice to
better fit their needs.” Overall, all 10 participants communicated the core concepts of culturally
responsive therapy. No one cited the exact definition from the training curriculum, but all 10
interviewees had a general understanding on the purpose of culturally responsive therapy. Table
7 identifies comments from respondents that demonstrate this knowledge and the bolded portions
on the comments identify the core, foundational concepts of CRT.
Table 7
Participants Comments Related to Describing the Practice of Culturally Responsive Therapy
Participant Response
W001 “Culturally responsive therapy is a model that I use to support Latino male
clients’ in engaging in mental health services by understanding their past and
respecting their values and different beliefs.”

W002 “CRT is a tool that allows us to engage Latino male clients by building rapport
with them, getting to know them, and revolving the practice upon their
experiences.”

W003 “For me, culturally responsive therapy is a way to engage Latino men by getting
to know them and adjusting my practice to better fit their needs.”

L001 “CRT is a model we were trained to engage men in mental health services that
focuses on their background and takes into account where they come from,
their beliefs, their culture.”

L002 “CRT is a framework that helps CHS care professionals engage people in services
focusing primarily on their culture and beliefs.”

L003 “CRT is an EBP that helps therapists engage individuals in services by taking into
account their culture, race, and what they believe in.”

L004 “We use a framework called culturally responsive therapy which we can use to
engage men in services by discussing their background and culture and having
55
treatment revolve around them.”

L005 “CRT is a model that we use to engage clients in therapy where the focus is for us
to build rapport and tailor the therapy based on their culture and background.”

L006 “I use culturally responsive therapy as a tool to engage men in therapy by getting
to know them, where they come from, what their traditions are, who they
want to become, and how their life was before the trauma.”

L007 “CRT is a framework that is being used by us to engage Latinos in therapy that
focuses on getting to know them and implementing their culture and beliefs in
therapy. Everyone is different so every treatment plan is individualized.”

Perceptions of Benefits Related to Culturally Responsive Therapy. In addition to
describing the practice of CRT, female care professionals were asked how they would describe
the benefits and any challenges of CRT to a colleague. Female care professionals described
multiple benefits and challenges implementing CRT. The most common benefits included the
following: better engagement, individualized care, and an easy guide to follow. The most
common challenges included the following: time consuming, repetitive, and too structured.
According to L002:
The benefits of CRT are having a framework that allows me to engage Latino men in
services and is a framework that is straight forward with easy steps to follow. You cannot
skip steps and if done correctly all the steps can gather the necessary information to
maintain participation and build rapport with client.
All participants stated benefits with CRT. W003 said, “CRT is a great framework that I have
used for a number of years. It allows me to get to know my clients based on their background
and create an individualized plan to engage and retain participation in services.” W001 stated:
I use CRT consistently and I have found that I am able to better engage with my clients
when I implement CRT. CRT allows me the time to get to know them and have rich
56
information during the assessment phase that I can later use to better understand their
trauma and have a better connection.
W001 felt that CRT was a framework that allowed for better engagement between therapist and
client than…. and provided more meaningful information for the assessment that was used later
to provide better services to the clients. L005 stated, “CRT is a framework that I am comfortable
using and allows me to engage my clients to participate in services.” L005 felt that CRT was a
framework that she was comfortable using and really helped her with engaging her client to
participate in mental health services. Table 8 identifies terms used from respondents about the
benefits of CRT.
Table 8
Terms Used During Interview Related to Benefits of Culturally Responsive Therapy
Terms Respondent

Better engagement W001, W002, W003, L001, L002, L003, L004, L005, L006, L007

Individualized W001, W003, L004, L007

Focused framework W001, W002, W003, L001, L002, L003, L004, L005, L006, L007

Easy to use L002, L004, L005, L006,

Better assessment W001, W003, L002, L003, L005, L006, L007

Building rapport effectively L002, L003, L005, L007

Active participation W003, L001, L002, L004, L005, L007

Perceptions of Challenges Related to Culturally Responsive Therapy. Interviewees
were asked to describe the challenges faced when implementing CRT. L007 said, “CRT is a
framework that takes a lot of time and does not allow itself to skip the activities as we need to
follow the framework to the T.” All participants expressed their challenges with implementing
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CRT. According to L003, “CRT is to rigid and time consuming. We work with a difficult
population and the framework takes too much time to complete and it becomes repetitive.” Table
9 identifies terms used from respondents on the challenges of CRT.
Table 9
Terms Used During Interview Related to Challenges of Culturally Responsive Therapy
Terms Respondent

Time consuming W001, W002, L001, L003, L004, L005, L007

Too long W003, L003, L004, L007

Repetitive W001, L003, L005,

Rigid W003, L003, L005, L007

Too many meetings with clients L001, L002, L003, L007

The findings indicate that female care professionals comprehend the general purpose of
CRT. No one female care professional was able to provide the exact definition that the training
uses, but all care professionals were able to identify the main points of CRT and its purpose.
Female care professionals were able to identify the benefits and challenges in using CRT to
engage Latino male clients. All female care professionals interviewed identified the different
benefits and challenges that they have seen in implementing CRT.
Finding 2: Female Care Professionals’ Mixed Levels of Understanding about Applying
Strategies of Engagement with a Specific Focus on Latino Male Clients
Procedural knowledge is the “how to” (Rueda, 2011), a knowledge influence necessary for
female care professionals to effectively implement culturally responsive therapy to engage Latino
male clients in mental health services and follow-up care. The procedural knowledge influence of
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care professionals applying the strategies of engagement with a specific focus on Latino male
clients when introducing the importance of follow-up care was analyzed further through key
interview questions. The responses from the interviews indicated that female care professionals
know how to incorporate and apply the strategies of engagement by using CRT, but not all
interviewees felt comfortable implementing it with Latino male clients. Six out of the 10
participants stated applying strategies of engagement focusing on Latino male clients when
introducing the importance of follow-up care.
W003 felt that she has implemented CRT in order to engage Latino male clients in
mental health services. Specifically, W003 referenced the use of CRT:
I am trained in CRT and have used it to engage Latino men. What I like about CRT is
that I am able to use the assessment as a principal reference to provide the necessary
services to address their needs. I first start with gathering information for the assessment
at the initial meeting, then I go through the documents that I receive from the court and
their social worker. I go through all of the documents to get a better idea of their history
and trauma. I spend a lot of time in the document review phase, because I feel that this
gives me all of the tools and information so that I know what the client has experienced
and not have to focus on them telling me their story because I have a good idea on what
happened and can focus on building rapport.
W003’s response demonstrates how engaging with the client as well as reviewing the documents
can support care professionals in understanding their clients based on their story and their
history. L002 stated that she does not focus on one step over the others, instead she focuses on all
of the core steps equally. L002 stated, “I like using CRT and go through the curriculum the way
it was designed. I don’t spend more or less time on any individual step.” L002 stated that she
59
spends approximately one to two hours on each step and does not focus more on one over the
other. L007 and L004 did not clearly identify a preferred step that they focus on over the other
when implementing CRT. L007 stated, “I think the steps are important to follow in CRT. I don’t
care much for them, but I follow them.” L004 stated, “CRT has steps to follow to hold validity, I
don’t agree with a lot of them, but do implement them as best as I can.” W002 and W001
expressed that she likes CRT and spends more time in the initial assessment phase when getting
to know the client. W002 stated, “I follow the steps, but spend the majority of my time getting to
know the person and hearing their story and what they have to say.” W001 felt that spending
more time in record review, she will be reading and gathering information based on someone
else’s interpretation or assessment. Instead, W001 felt it was more important to focus on the
individual client to gather their story and make her own assumptions and interpretations based on
the information she was gathering firsthand. W001 responded:
When I am implementing CRT, I focus on making sure that I am implementing all of the
steps of CRT. I spend the most time in talking to the client as I want to hear their story
and get to know them in a more personal level. I don’t spend too much time on document
review because this is the interpretation of the system in order to open a case. A lot of the
time that information is formulated to substantiate an allegation. I want to hear as close to
the real story as possible by interviewing and talking to the individual client and building
rapport from the first day.
W002 and W001 both felt that spending more time working with the client and getting
the information from the client is more beneficial than looking through the records. W001 clearly
felt that she wanted to make her own interpretations based on conducting true in-person therapy
with the client rather than taking the documents submitted as a way to see the client.
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W003, L002, L007, L004, W002, and W001 all showed and expressed knowledge of
applying strategies of engagement focusing on Latino male clients. Six out of the 10 participants
identified implementing CRT, with some focusing on certain steps while others are following the
curriculum without preferencing one step over the other. The curriculum is being implemented
differently based on what each individual professional think works best for them and their style
of choice in providing mental health services.
Four out of the 10 participants indicated that they are not implementing the strategies of
CRT to engage Latino male clients. L003 felt that CRT is too repetitive and time consuming if
the male client is not going to comply with continuing to come to services. In explaining why
CRT was not always implemented at the initial meeting when first meeting the client, L003
responded:
CRT is a good framework to follow if the client is going to continue and take advantage
of the services being provided to him. I have implemented CRT four times and all four
times the clients only come for a month and then stop coming. CRT is too time
consuming and repetitive with always trying to engage formal and informal supports in
the clients’ treatment.
L001 and L005 felt that CRT is too rigid and does not allow them to explore different avenues
within treatment with their clients. L001 stated, “CRT is a framework that can work for some,
but not all. CRT needs to be more flexible.” L005 stated, “I like CRT as a framework, but not as
the framework to implement with all Latino male clients in my caseload.” L006 felt that CRT is
an effective framework, but she utilizes different principles from different frameworks to better
meet the needs of the clients she is serving. Specifically, L006 stated, “There isn’t one
framework that will fit all of the men clients we have. I choose strategies from different
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evidence-based programs that make the most sense for the individual client and create a specific
program for them to follow.”
L001, L003, L005, and L006 expressed not being completely satisfied with CRT and not
implementing CRT all the time, L006 stated, “I am not always happy with implementing CRT
every single time.” Six out of the 10 participants indicated that they are happy and implement the
strategies of CRT, W003 stated, “I am happy with CRT and how I better engage clients through
hearing their story.” Four out of the 10 participants indicated that they “do not care” (L001) for
CRT as they choose to not implement the strategies, L001 stated, “I do not care much for CRT as
it is not a framework that can work or benefit on everyone.”
The data did show that all 10 participants did in fact know how to incorporate and apply
the strategies of engagement with Latino male clients. Participants expressed not implementing
the strategies of CRT to engage Latino male clients due to CRT being repetitive, rigid, time
consuming and not allowing exploration of different approaches or techniques outside of CRT.
Finding 3: Female Care Professionals’ Mixed Levels of Reflection About Own Effectiveness
in the Context of Supporting Latino Men to Seek Resources and Completing the Assessment
and Continued Care Services
Metacognitive knowledge is the learners’ awareness of how they learn and how they
control their own learning and performance (Mayer, 2011). With the goal of effectively
supporting Latino male clients to seek resources and completing the assessment for continuing
services, female care professionals need to actively reflect on their own effectiveness. Female
care professionals need to self-reflect to determine their best strategies and activities to use when
engaging Latino male clients in mental health services and follow-up care. When asked how they
felt CRT has supported their clients’ needs, seven out of 10 female care professionals
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interviewed described positive outcomes with using CRT to support their Latino male clients.
W001 stated, “CRT has allowed my male clients to feel comfortable with me, therefore
allowing me to provide them with the necessary services they need.” W002 explained why she
felt that CRT was supporting her clients,’ “before CRT, I didn’t have a model to use to engage
them in therapy, now I am able to relate to them and seek the necessary services they need to
continue with therapy.” W003 further supported the implementation of CRT by identifying how
engagement is a process that continues to revolve because she is always in the engagement phase
with her clients. Specifically, W003 stated:
With CRT I am able to engage and build rapport with my clients, but can always come
back to engagement as this is a cycle that we can go from engagement, to planning, to
implementation, and come back to engagement if we need to.
L001 addressed different resources that she has been able to provide her clients because of the
engagement and rapport she was able to build early on. L001 stated:
By engaging my male clients, I have been able to implement CRT and early on
identifying their needs and having the clients own their treatment plan. We have been
able to identify that they need parenting classes, anger management, drug counseling,
family therapy, or marriage counseling and focusing on those efforts instead of just
having the client start programs that they do not need or are ready to take.
Participants identified their awareness in identifying the underlying needs early on when
engaging male participation in mental health services and mentioned by L007, L001, L003,
W001, and W002. L007 stated, “As a female therapist, it’s important for me to identify what best
strategies are working to engage the client by focusing on their underlying needs while in
treatment.” L001 said that for her to see the effectiveness of her practice is by looking at
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focusing at the clients’ underlying needs so that the client can feel like they own treatment. L003
had similar feelings towards the importance of identifying the underlying needs to better engage
and support the client, “I have to consistently make sure that I am checking on myself and not let
my opinions steer their treatment, instead I need to make sure I am listening and identifying their
underlying needs.” L001 also added being able to “pull yourself aside from treatment to make
sure you have truly identified their underlying needs and not their wants or desires.” W001
knows that in order to engage the client in services, “underlying needs are important to identify
early on and continue to revisit consistently to make sure we together come to the core of the
issue for treatment to work.” W002 knows that treatment goes both ways, “the client as well as I
need to continue discuss engagement efforts and discuss the identified underlying needs.”
Throughout the interview, participants discussed activities of self-reflecting on their
effectiveness in serving Latino male clients’ but felt that they are not spending enough time self-
reflecting on their implementation and wished they did more of it. W002 stated, “During
supervision I would like to discuss each individual client more, but I don’t always talk about
them or my approach because of my high caseload.” W002 also added having more opportunities
and the ability to “discuss my cases with supervisors and colleagues to improve practice.” L005
reflected on desiring more time to discuss cases and hearing different perspectives, “I would like
to be able to have more time to discuss challenging cases to hear how others might deal with this
issue.” L001 said, “As an intern, I spent three to four hours a week reflecting on my practice with
my supervisor, now that I am licensed, I’m lucky if I can do that once a week.”
The data showed that while female care professionals understand the importance of self-
reflecting on their own effectiveness, they feel they do not spend enough time self-reflecting on
their implementation. Female care professionals discussed the support they were provided as
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interns, but as licensed care professionals, lack the same support and often feel alone with no
guidance.
Motivation Influences’ Findings
Understanding the motivation of CHSF female care professionals is critical in
implementing CRT to engage Latino male clients in mental health services and follow-up care.
Motivation is described as choosing to engage, persisting, and implementing the necessary
amount of mental effort to succeed (Clark & Estes, 2008). Table 10 identifies the assumed
motivational influences and the summary of findings for each assumed influence.
Table 10
Determination of Motivational Influences
Assumed
Motivational
Influence
Finding Gap Asset
Self-Efficacy Female care professionals’ mixed levels of self-
efficacy in implementing culturally responsive
therapy with Latino male clients
X
Expectancy
Value
Female care professionals have high value for
implementing culturally responsive therapy, but not
with Latino male clients
X

Finding 4: Female Care Professionals’ High Levels of Self-Efficacy in Implementing
Culturally Responsive Therapy with Latino Male Clients
During the interviews, CHSF female care professionals were asked about their
confidence in implementing CRT engage Latino male clients in mental health services and
follow-up care. Female care professionals were asked to describe an experience in implementing
CRT with their clients and how they felt. Six out of 10 female care professionals described
experiences of feeling confident in implementing CRT to engage Latino male clients. W001
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stated that she feels comfortable and confident when implementing CRT which she finds benefits
her as the well as the client in the treatment process.
W001 stated, “In implementing, CRT I feel comfortable because I have been
implementing CRT for a number of months now and see the impact it has been making in
engaging my clients in treatment.” L002 and L005’s comments echoed feeling “confident when
it comes to implementing CRT to engage clients in treatment.” L006 and L003 expressed feeling
“comfortable during the engagement phase and implementing CRT. Participants gave CRT
training credit for providing them with the tools and techniques to support Latino male clients.
W001 stated, “CRT training has prepared me to support my Latino men clients and have been
able to engage them in services when they participate.” L004 stated feeling grateful in having a
framework to work under to engage Latino male clients, “I am grateful for all of the trainings I
attend. The trainings have definitely supported me in engaging Latino men in therapy. I have
better participation because of it.” L002 stated, “I never liked working with Latino men because
they are a difficult population to work with, but CRT has allowed me to feel comfortable in the
services I am providing.” L005 stated:
I am not always the first to admit that something is working, but culturally responsive
therapy has made me a better therapist especially when it comes with working with
Latino men. I am no longer scared or reluctant in providing services to them. I am able to
go in there and provide a service.
L006 expressed how she is implementing CRT across the board with all of her clients, “I know
we were told to use CRT to help us engage Latino male clients, but I implement CRT with all my
clients.” L003 further echoed this statement by stating, “I use CRT with men and women
regardless of their race, ethnicity, or gender.”
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All of the CHSF female care professionals interviewed were able to express a high level
of confidence. Based on interview data, what contributed to the participants feeling confident in
implementing CRT was the quality of the mandatory training offered as well as the quantity of
training sessions that were made available. They also discussed what contributes to their
confidence in implementing or using CRT to engage Latino male clients in mental health
services and follow-up care.
All of the CHSF female care professionals expressed the importance of the training and
how the training and trainers are engaging and effective in their delivery and structuring of the
curriculum. W001 and W002 shared about attending many trainings throughout their career and
being trained in different evidence-based practices and feeling “a clear view of how CRT needs
to be implemented.” L001 and L003 expressed feeling like they continuously attend trainings on
CRT when new staff are hired. Because L001 and L003 are the assigned staff who are
responsible in having new staff shadow and continuously check-in on their progress, they
provide support to all new hires and often attend trainings with them to answer any questions
they may have. L001 stated feeling burnout since she has been through CRT training three times
this year, “I hear so much about CRT in attending three trainings this year, that when I need to or
want to implement CRT, I don’t feel like I have the energy to do so, I may just be burned out.”
L003 expressed concern about her attending CRT training multiple times this year while
everyone else only attends once a month, “Just because I’m the newly licensed therapist, I
shouldn’t have to babysit new staff and sit through the same training multiple times.” All the
CHSF female care professionals except for L001 and L003 stated attending CRT training once a
month with having booster refresher training three-months after the initial training and utilizing
technical assistance if needed.
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When asked what additional resources can be implemented to increase their confidence,
W001 and W003 stated that they would like to talk to other colleagues about how they are
implementing CRT. W001 stated, “I would like to see and talk to other organizations to see how
they are implementing CRT and how they are overcoming certain challenges.” L001 stated that
she would like to share her experiences about using CRT and hear others’ experiences in using
CRT. L007 stated, “attending different CRT trainings throughout the county to see if I can learn
new ways of doing the steps that can work for my style.”
The data indicates that female care professionals have high self-efficacy in implementing
CRT with Latino male clients. Female care professionals indicated feeling confident in
implementing CRT, seeing the benefits of implementing CRT with their clients, and the quality
of CRT training offered contributing to their confidence in implementing CRT with their clients.
Finding 5: Female Care Professionals’ Have High Value for Implementing Culturally
Responsive Therapy, but not with Latino Male Clients
During the interviews, CHSF female care professionals were asked to voice the value
they believe CRT brings when working with Latino male clients. Seven out of 10 female care
professionals made comments that indicated the high level of importance they assign to
implementing CRT in engaging Latino male clients in mental health services and follow-up care.
W003 stated the importance of using CRT to engage clients in mental health services:
CRT is an important tool that I need to use because it has been proven to work with
different agencies and I have seen it work first-hand. CRT provides the client and I with a
framework to follow and work off of that allows me to identify the underlying needs and
really get to know the client during the assessment phase.
L001 and L003 comments indicated CRT is “a tool that is important and helps us better engage
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Latino men in services.” L004 stated that she is able to see the benefit of using CRT in engaging
Latino men as she has used the model and seen better engagement efforts. L004 stated, “In
implementing CRT, I have seen better engagement efforts with Latino men in therapy.” W001
stated that because she is not Spanish speaking, she is happy to have and use a model that can
help her connect with Latino men and get to know them better. Specifically, W001 stated, “As a
non-Spanish woman, I appreciate having CRT as a model I can refer to and use to better engage
and get to know my clients.” W002 and W003 stated being able to use a model that “has shown
to be effective with engagement and retention in services.”
Table 11
Participants Comments Related to Describing the High Value of Culturally Responsive Therapy
Participant Response
W001 “As a non-Spanish speaking woman I appreciate having CRT as a model I can
refer to and use to better engage and get to know my clients.”

W002 “CRT has shown to be effective with engagement and retention in services.”

W003 “CRT is an important tool that I need to use because it has been proven to work
with different agencies and I have seen it work firsthand specifically with
engagement and treatment compliance”

L001 “CRT is a tool that helps us better engage Latino men in services.”

L002 “I use CRT to engage and retain male clients as I have seen if implemented
correctly, clients are then more engaged and participate in treatment.”

L003 “CRT has allowed me to engage my clients and provide a provide them with
personalized treatment.”

L004 “In implementing CRT I have seen better engagement efforts with Latino men in
therapy.”

L005 “When implementing CRT and doing all of the work and research that is done
before hand and with the client to better understand where they are coming from.”

L006 “I use CRT as a way to engage Latino men in treatment and connect with them so
that they can see the benefit of therapy.”
69

L007 “CRT is a good framework that has allowed me to engage my male clients in
treatment and have personally seen an increase in retention rates.”

Despite seeing the value of implementing CRT to engage Latino male clients in mental
health services and follow-up care, all of the female care professionals with the exception of
W001 verbalized frustrations and at times not wanting to implement CRT with Latino male
clients. W002 and L004 stated that they often do not want to start with implementing CRT, “the
preparation and research that goes in implementing CRT for the male client not come or continue
to attend sessions is pointless.” L006 stated that she often starts her assessment with client within
the first week, “I then gage to see if the client shows interest in participating to then implement
CRT.” L003 stated:
I often don’t start with CRT because of the time and preparation one needs to do when
implementing CRT. A lot of the times the client is not ready for treatment that I have
found myself doing a lot of work and the client not wanting to participate or show up to
treatment and all that work is wasted time.
L001 and L005 reinforced this statement by stating, “Waiting after the client has participated to
implement CRT.” W001 stated:
For the most part, therapists try to engage and provide services to Latino male clients, but
we often fall short due to their unwillingness to participate or continue in the program.
The therapists by default need to focus their efforts on those who do want the help and
support and that is often women and children. The agency continues to support us as best
they can, but if the men do not want the help, we can’t force them even court can’t force
them to participate.
Female care professionals at CHSF expressed their frustration when implementing CRT
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right from the start of being assigned a case and then their work not counting because of the
client not continuing services or not wanting to participate in treatment. Interview data
demonstrated that female care professionals are able to see the value of implementing CRT, but
do not want to implement CRT until they know and are sure that the client will be committed to
participating and completing the program. Despite feeling frustrated with CRT, the data
indicates female care professionals have high value for implementing CRT. Female care
professionals indicated CRT being an important tool that helps with engagement, a model that
has shown to be effective, and CRT retaining male clients in treatment.
Organizational Influences’ Findings
Organizational culture impacts employee performance within the organization (Clark &
Estes, 2008). The organization as a whole speaks to the values and beliefs of the organization by
building a foundation of what the norm is and what employees must do and follow. The goals,
policies, and procedures of the organization must align with the current culture that the
organization has (Clark & Estes, 2008). The interview questions pursued the female care
professionals’ perceptions about the organization’s ability to support their implementation of
culturally responsive therapy. In order for female care professionals to engage with, persist and
invest the necessary mental effort to effectively implement CRT, they need the organization’s
support. It is important to understand CHS female care professionals’ organizational influences
of cultural model and cultural setting in implementing CRT to engage Latino male clients served
by CHSF in mental health services and follow-up care. Table 12 identifies the assumed
organizational influences and the summary of findings for each assumed influence.

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Table 12
Determination of Organizational Influences
Assumed
Organizational
Influence
Finding Gap Asset
Cultural Model Organization lack of prioritization of Latino male
clients’ engagement
X
Cultural Setting Organization has ensured effective training
transferring into practice
X
Cultural Setting Organization’s robust resources related to role
model and shadowing opportunities for female
care professionals in addressing the needs of
Latino male clients
X

Finding #6: Organization’s Lack of Prioritization of Latino Male Clients’ Engagement
The CHSF female care professionals interviewed were asked whether they felt CHSF is
prioritizing Latino male clients’ needs in comparison to the other clientele. The findings suggest
that while the organization offers incentives for billing Latino male clients, other accountability
mechanisms are lacking. Female care professionals described different supportive measures that
the organization has put in place to further support Latino male engagement. W001 and L004
described the different incentive programs that the organization has implemented to encourage
Latino male participation. Specifically, W001 stated, “The agency provides us with a monthly
bonus of $300.00 if we bill 10-12 hours a week specifically with our Latino male clients.”
Through the interviews, participants expressed how each female care professional has a billing
expectation of 24 hours a week to be billed and CHSF is requesting that half of their billing
expectation is focused on Latino male clients. L004 further supported this statement by stating,
“If I or any therapist bills 10-12 hours a week with our Latino men clients, we get an extra
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$300.00 a month on top of our paycheck.”
Monetary incentives seemed to motivate the female care professionals to try to engage
Latino male clients in services, but other interviewees expressed taking advantage of acquiring
extra time off. W002, L005, and L007 addressed how CHSF “provides you with a monthly
bonus or one day off without using acquired paid time-off if you meet the billing expectation
with your Latino male clients.” Overall, the female care professionals addressed the different
efforts that CHSF is implementing to try to support the engagement of Latino male clients by
providing monetary and time-off incentives. Through the interviews, participants expressed that
mental health service organizations will always have in place a contractual billing expectation
for care professionals through weekly or monthly billing expectations. Incentivizing care
professionals to meet their billing expectations is common in non-profit mental health agencies
in trying to comply with all contract requirements.
According to W003, “The organization continues to support us with providing us with
on-going support and assistance with implementing CRT to engage our Latino male clients.”
Comments by several participants pointed to an experience of continued organizational support
related to engagement efforts with Latino male clients. L001 stated, “During staff meetings,
admin provides the staff with reports on how we are billing, and male participation and
engagement is always a topic on the agenda.” L006’s comments further supported this statement,
“We meet as a team and individually one time a week and during these meetings we talk about
different ways we can engage Latino men in treatment.” W001, W002, and L004’s comments
reinforced this statement by stating that “weekly meetings are being held to discuss challenges
and best practices in engaging Latino men in session.”
According to the participants interviewed, CHSF has in place different incentive
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mechanisms to further support focusing on Latino male engagement, but female care
professionals expressed concerns regarding Latino male engagement. All of the female care
professionals interviewed expressed a level of frustration with care professionals focusing
treatment on women and children for contractual billing purposes. According to L001, “The
organization as a whole provided us with CRT as a tool to engage Latino male clients, but due to
their resistance, women and children continue to be the focus for billing purposes.” CHS works
on a fee for service delivery. For every therapeutic session or service they provide, the
organization is able to bill accordingly. L001 continued:
I haven’t been here long with the organization, but everywhere I work, it has been the
same. The organization has a billing expectation and if clients continue to cancel sessions
or not participate in treatment, like most male clients do, that’s just money out of the
hands of the organization. So, we as therapists work harder and provide more support to
those clients who do participate and by default, those are female and children clients.
L003’s comments further supported L001’s experience, “Due to the lack of male participation,
we focus more on women and children. During staff meetings, we are reminded to focus on our
men clients, but we aren’t reprimanded if we don’t.”
According to the data gathered from the interviews, the organization has no overall
consequences if female care professionals do not meet or focus their engagement efforts with
Latino male clients. The agency overall looks at service delivery as a whole in case load not by
gender or age. L003 continued, “The organization is able to see that women and children are the
focus of service delivery, but because we are still billing and meeting our quota not a big deal is
made.” L007 reinforced this statement by stating, “Regardless of who we bill for, as long as we
bill what’s expected of us, we don’t get in trouble.”
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The findings indicated that the organization has implemented incentives and reward
programs to help encourage female care professionals in engaging and focusing services on
Latino male clients. CHSF provides continued support and reports on the organization’s
engagement efforts with Latino male clients, but lacks accountability mechanisms in engaging
Latino male clients in mental health services. Female care professionals expressed the
organization not prioritizing Latino male participation if the organization is financially being
compensated for focusing its services on women and children.
Finding #7: Organization Has Ensured the Effective Transfer of Training into Practice
Throughout the interviews, the CHSF female care professionals expressed the different
ways in which CHSF ensures that training related to implementing culturally responsive therapy
to engage Latino male clients transfers into practice. All 10 responded that in their experience,
CHSF provides adequate CRT training. The different types of training identified were initial
CRT training, coaching sessions, and refresher training on CRT. Additionally, according to the
document analysis, CHSF provides multiple trainings a month and care professionals are able to
attend however many trainings they want. Coaching sessions are offered as well with continued
support by the identified coaches.
Regarding training, W001 stated, “CHSF provides the initial training and continued
training on a regular basis. Anyone can attend any training as long as your supervisor approves
it.” W002 stated to personally having and attending “a lot of trainings” as she stated enjoying
participating in trainings to improving her delivery. L002 stated, “Every therapist working for
CHSF must attend CRT training within the first 90 days of being hired.” L006 expressed in
different occasions CHSF administration providing “mini training” regarding the implementation
of CRT during their monthly staff meetings.
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All of the CHSF participants interviewed identified CRT training being available
throughout the year, but they went more into detail on how they feel CHSF is ensuring that
training transfers into practice. L004 stated, “The agency supports its staff by training us on CRT
and then continued to support us with coaching sessions and having discussion in supervision
about our implementation.” W002 further supported this statement by stating, “The agency as a
whole continues to remind us and supporting us throughout the year in the importance of
implementing CRT.” W002 explained that CHSF “conducts random quarterly reviews for ….
about…. The review consists of a questionnaire being randomly distributed to families about
their experience with the agency and the services being provided.” L001 stated, “Supervisors
make calls throughout the year and ask families how they like services and how services are
being implemented.” L001 felt that the organization calls families for their opinion to ensure the
implementation is effective and find ways to better support and help its employees. L007
expressed “learning from the quarterly reviews” as the results are anonymous and are delivered
as an agency-wide strength or challenge instead of singling out specific staff. L007 stated:
I take the findings and use them as ways for me to improve my practice because this is
how families are taking it, they may not be talking about me, but I make sure to address
their concerns the best I can.
Some of the participants expressed recommendations that can continue to ensure that
training transfers into practice within different capacities. L005 expressed wanting to “see and
hear how other agencies are implementing CRT.” L005 stated:
I believe in working collaborate with everyone and would like to see and hear how other
agencies are implanting CRT so that we can support one another. We can discuss the
different successes and challenges we are all facing and learn from each other. Maybe
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another agency has a better way of implementing CRT that is more effective than what
we are doing here.
L007 continued to identify the importance of partnering with different organizations to “learn
from one another and support the implementation of CRT.” L006’s comments further supported
this statement, “I would like to talk and engage with other agencies and staff and see how others
are implementing CRT. The agency needs to make this available to further support our growth
and continue to learn.”
During the document analysis review of CRT training records, all CHSF care
professionals had attended their initial CRT training, with the exception of new oncoming staff.
All of the currently employed care professionals had participated in the three-day training and
had participated in the additional four coaching sessions. This was verified by certificates of
completion, sign-in sheets of participation, and the copies of the pre and post-tests. Additionally,
CHSF provided agendas of staff meetings to the researcher that identified the focus of the
meeting was discussing the importance of CRT implementation, successes and challenges of
CRT, and how CRT helps with client engagement.
The responses from the interviews and the document analysis review of CRT training
records as well as staff meeting agendas demonstrate that CHSF is ensuring that training
transfers into practice. Female care professionals expressed that CHSF provides adequate
training of CRT, CRT coaching sessions, CRT refresher trainings, and CHSF making CRT
training available multiple times a month. The participants interviewed expressed that CHSF
provides continued support and reports on the organization’s engagement efforts with Latino
male clients.

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Finding #8: Organization’s Robust Resources Related to Role Models and Shadowing
Opportunities for Female Care Professionals in Addressing the Needs of Latino Male Clients
The CHSF female care professionals commented that there are role models or people
identified as coaches who can provide extra support and guidance to staff via shadowing
opportunities or mock trainings. W001 stated that CHSF has “individuals who are the identified
experts who provide coaching and technical assistance” and named the identified staff who
provide the coaching and technical assistance. L004 expressed the importance of being able to
have both role models and shadowing opportunities to support staff. Specifically, L004 stated, “I
enjoy reaching out to the coaches as they provide me with alternative strategies to better do my
job. I usually go to the coaches for support one time a month.” L003 stated that having the ability
to reach out to the coaches for support “in my first year as a licensed clinician shadowing
opportunity allowed me to better my clinical skills to better engage my Latino clients.” L007
explained how coaching has helped care professionals better support Latino male clients with
engagement, “The organization provides us with the support we need to better engage Latino
male clients by providing coaching and shadowing opportunities.” Female care professionals
interviewed were able to identify the coaches that can further support them with shadowing
opportunities and who are designated role models.
Female care professionals explained in detail how they have received personal shadowing
or role modeling opportunities. The identified coaches by CHSF are care professionals that carry
smaller caseloads and who provide trainings and technical assistance multiple times a month.
L005 stated:
I have made appointments with the coaches to help me with CRT implementation and
they often want to know what challenges I am facing in order to best help me. Once I
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explain the situation, they often offer guidance or I they can come into my session and
provide direct support.
W001 and W002 discussed the openness that the coaches have with care professionals and the
“quick response and availability to come out and support us or for us to go and shadow how they
implement CRT.” W003 explained that she has not participated in any role model trainings but
has had the coaches shadow her to provide direct support. W003 explained, “I prefer the coaches
coming into my sessions and shadowing me so they can help me with my problems in engaging
or implementation.” W003 explained that her attending role modeling sessions is what she
already did with attending the training and she wants direct support with the challenges she is
facing.
The CHSF female care professionals expressed the importance of having coaches and
allowing them opportunities of shadowing and role modeling to better engage Latino male
clients. L004 expressed how shadowing opportunities have benefitted her service delivery and
how she has shifted her approach with specific clients. L004 explained:
By taking advantage of shadowing and role modeling I have been able to improve my
delivery of services with Latino men. I have participated in role modeling sessions where
I go and see how the coach implements certain strategies in their sessions and they have
shadowed me and offered support and technical assistance. I feel that my engagement and
approach has improved greatly.
L006 expressed how the coaches are open to help and how the organization encourages care
professionals to participate in role modeling and shadowing opportunities. L006 stated, “the
organization always reminds us of the support coaches can give us, I think I have grown because
of the support I have gotten from the coaches.” L002 and L007 stated “being more comfortable
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in implementing CRT” after had attended a coaching session. All of the female care
professionals interviewed expressed the importance of having coaching support and how it has
positively impacted their engagement and approach with Latino male clients.
Synthesis
The findings from interviews with the CHSF female care professionals and the document
analysis of the culturally responsive therapy training records and training curriculum
demonstrate the complex relationship that CHSF female care professionals have with the
implementation of CRT with Latino male clients. While little research has been conducted about
female care professionals implementing CRT to engage Latino male clients in mental health
services and follow-up care, the findings from this study reveal a disconnect between how
female care professionals perceive the implementation of CRT and how female care
professionals are actually implementing CRT with Latino male clients.
The interview findings combined with the document analysis indicated that female care
professionals have conceptual knowledge necessary to implement the fundamental principles of
CRT. Female care professionals interviewed were able to identify the fundamental principles of
CRT and have implemented the principles. Female care professionals also communicated their
knowledge of skills related to applying strategies of engagement with a specific focus on Latino
male clients when introducing the importance of follow-up care. Female care professionals
expressed knowing how to incorporate and apply the principles of CRT, but not always doing it
due to the length of the process or the repetitive nature of the process. The female care
professionals communicated metacognitive knowledge of actively reflecting on their
effectiveness in serving Latino male clients in the context of supporting them to seek resources
and completing the assessment for continued care services. However, they did not feel they had
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enough time allocated to reflect on their effectiveness. The interviews exposed that CHSF female
care professionals had mixed levels of procedural and metacognitive knowledge in implementing
CRT to engage Latino male clients.
Female care professionals of CHSF indicated that they have high levels of self-efficacy in
feeling confident in implementing CRT with Latino male clients. Interviewed participants
expressed feeling confidence in implementing CRT with Latino male clients, but would like to
collaborate with other colleagues and programs outside of CHSF to see how CRT is
implemented. Female care professionals see the value of using CRT to engage and service Latino
male clients, but in some cases chose not to use CRT because they perceived Latino males as not
committing to the program.
Interviews with the CHSF female care professionals indicated that the organization does
not have a cultural model of engaging Latino male clients but rather focuses efforts on servicing
women and children for contractual billing purposes. The participants felt that CHSF supports in
the importance of engaging Latino male clients, but if contractual billing is being fulfilled by
serving women and children, they experienced that CHSF does not encourage the importance of
targeting Latino male clients for services. CHSF female care professionals recognized the
organization ensuring that training transfers into practice and the organization avails resources
related to both role models and shadowing opportunities. Table 13 restates the needs of the
knowledge, motivation, and organizational findings. Chapter Five provides recommendations for
practice that will address the gaps on the knowledge, motivational, and organizational influences
which were presented in this section.

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Table 13
Summary of Knowledge, Motivation, and Organizational Findings of Gaps and Assets
Knowledge Influence Finding Gap Asset
Conceptual Knowledge Female care professionals’ comprehensive
knowledge of culturally responsive therapy.

X
Procedural Knowledge Female care professionals’ mixed levels of
understanding about applying strategies of
engagements with a specific focus on
Latino male clients.

X
Metacognitive Knowledge Female care professionals’ mixed levels of
reflection about own effectiveness in the
context of supporting Latino men to seek
resources and completing the assessment
and continued care services.

X
Motivational Influence Finding Gap Asset
Self-Efficacy Female care professionals’ high levels of
self-efficacy in implementing culturally
responsive therapy with Latino male
clients.

X
Expectancy-Value Female care professionals’ have high value
for implementing culturally responsive
therapy, but not with Latino male clients.

X

Organizational Influence Finding Gap Asset
Cultural Model Organization’s lack of prioritization of
Latino male client’ engagement.

X
Cultural Setting Organization has ensured the effective
transfer of training into practice.

X
Cultural Setting Organization’s robust resources related to
role models and shadowing opportunities
for female care professionals in addressing
the needs of Latino male clients.

X

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CHAPTER FIVE: RECOMMENDATIONS
Chapter 4 presented the results and findings from the data gathered through interviews
and document analysis to answer the study’s research questions identifying knowledge,
motivation, and organizational influences related to care professionals implementing culturally
responsive therapy to engage Latino male clients in mental health services and follow-up care.
Each influence was categorized as a validated gap or a validated asset. The knowledge,
motivational, and organizational influence was determined to be a gap if more than 25% of
participants indicated low levels of knowledge, motivation or negative perceptions regarding the
organization.
The recommendations discussed in this chapter are based on data related to the
knowledge, motivational, and organizational influences obtained via interviews and document
analysis. The recommendations are first organized and presented in the categories of knowledge,
motivation, and organizational influences. The following integrated implementation and
evaluation recommendations are presented using the New World Kirkpatrick Model framework
(Kirkpatrick & Kirkpatrick, 2016). The recommendations, implementation, and evaluation plans
are designed to work to reduce or eliminate the knowledge, motivational, and organizational
influence gaps. This chapter will also discuss the limitations and delimitations of the study and
provide recommendations for future research.
Recommendations for Practice to Address KMO Influences
Two knowledge influences related to procedural and metacognitive influences were
validated to be gaps during the data collection. The data indicated that female care professionals
demonstrated mixed levels of knowing how to incorporate and apply strategies of engagement
and further, that female care professionals engaged in mixed levels of reflection about own
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effectiveness in the context of supporting Latino men to seek resources and completing the
assessment and continued care services. Additionally, one organizational influence related to
cultural model, the organization not prioritizing engagement of Latino male clients was validated
to be a gap during the data collection.
Knowledge Recommendations
The assumed knowledge influences for CHSF female care professionals and their needs
are listed in Table 14 based on the data gathered and analyzed through interviews and document
analysis. Using the Clark and Estes Gap Analysis Framework (2008) to guide this study, the
conceptual and metacognitive influences were identified and validated as a gap. The knowledge
influences in Table 14 represent the complete list of assumed knowledge influences that are
validated as gaps, the theoretical principles, and recommendations that would best meet the
needs of the female care professionals of CHSF.
Table 14
Summary of Knowledge Influences and Recommendations
Influence Finding

Principle and Citation Context-Specific
Recommendation

Female care professionals’
mixed levels of understanding
about applying strategies of
engagement with specific focus
on Latino male clients.
(Procedural)
To develop mastery,
individuals must acquire
component skills, practice
integrating them, and
know when to apply what
they have learned (Schraw
& McCrudden, 2006).

Provide information through staff
meeting and coaching sessions on
applying strategies of engagement on
Latino male clients.
Female care professionals’
mixed levels of reflection about
own effectiveness in the context
of supporting Latino men to
seek resources and completing
the assessment and continued
care services. (Metacognitive)

Effective observational
learning is achieved by
first organizing and
rehearsing modeled
behaviors, then enacting
them overtly (Mayer,
2011).
During training, provide opportunities
for care professionals (learners) to
self-reflect on their effectiveness.
During weekly supervision, provide
care professionals (learners) with
adequate time for self-reflection on
their effectiveness.

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Enhance Female Care Professionals’ Procedural Knowledge about Culturally Responsive
Therapy Strategies
The results and findings of this study indicate that female care professionals have mixed
levels of understanding and applying the strategies of CRT. The responses from female care
professionals’ interviews indicated that female care professionals know how to apply the
strategies of CRT, but do not feel comfortable implementing CRT with Latino male clients.
Female care professionals identified the steps of CRT and provided examples and different
scenarios of how CRT and each step is to be implemented. There was a preference on what steps
female care professionals preferred implementing and spending more time on such as record
review in the assessment phase. Female care professionals expressed CRT being too repetitive,
rigid, and time consuming as reasons why CRT is often not being implemented with Latino male
clients. Additionally, female care professionals expressed frustration implementing CRT right
away with Latino male clients due to Latino male clients’ lack of motivation to commit to
participate in services. A recommendation rooted in information processing theory has been
selected to close this procedural knowledge gap. Schraw and McCrudden (2006) found that in
order to develop mastery, female care professionals must first acquire the skills, then practice
implementing the skills learned, and know when and where to apply their new knowledge. This
would suggest that providing female care professionals with information through staff meetings
and coaching sessions on applying the strategies of CRT to engage Latino male clients would
support their learning. CHSF is providing all care professionals with a robust CRT training
multiple times a year. The recommendation is to provide information during staff meetings and
coaching sessions on the importance of learning from each other and applying the strategies of
CRT to engage Latino male clients in a less repetitive, rigid, and time-consuming approach.
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Providing consistent updated information on engagements strategies that are less rigid, repetitive,
and time-consuming, can support the understanding and application of strategies of engagement
with Latino male clients.
Female care professionals need to feel that the information being presented is important,
relevant, and authentic for learning to take place (Hunzicker, 2011). The information on applying
strategies of engagement needs to be consistent and meaningful for female care professionals to
see the importance of applying CRT strategies of engagement for Latino male clients. According
to Schraw and McCrudden (2006), information can be more quickly learned and remembered
when the information learned is meaningful and a connection is made from prior knowledge. The
evidence shows that female care professionals need to have meaningful information present
before making a connection in implementing the CRT strategies of engagement with Latino male
clients.
Increase Female Care Professionals’ Reflection About Own Effectiveness in Implementing
CRT
The results and findings of this study indicate that female care professionals engage in
mixed levels of reflection about their own effectiveness. The responses from female care
professionals’ interviews indicated that female care professionals do not have adequate time to
self -reflect on their effectiveness in the context of supporting Latino male clients seeking
resources and completing the assessment and continued care services. Female care professionals
provided information on how CRT has provided female care professionals to more effectively
engage Latino male clients. Interview participants expressed the consistent frustration of not
having adequate time or being able to reflect on their effectiveness in supporting Latino male
clients. A recommendation rooted in information processing theory has been selected to close
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this metacognitive knowledge gap. Mayer (2011) found that effective observational learning is
achieved by organizing and practicing modeled behaviors and by implementing the modeled
behavior clearly. The recommendation is to provide female care professionals to self-monitor
and self-assess their own effectiveness during training, coaching sessions, and in supervision
with their supervisors. As an example, during training or coaching sessions, female care
professionals can practice engagement efforts in a group setting and can reflect on their
effectiveness in implementing CRT. During supervision, female care professionals will be
provided with 30 minutes to review cases and reflect on their effectiveness.
Female care professionals must be willing to embrace the process of analyzing their
approach and strategies of engagement to see if any modifications are needed to better serve
Latino men (Suite et al., 2007). The practice of self-reflection on one’s own effectiveness allows
care professionals to identify any flaws in their implementation of CRT by modifying their
approach to increased desired outcomes. According to Griffith et al. (2012), female care
professionals should continue to assess and identify the process which helps determine how well
Latino male clients have been captured and engaged. The evidence shows that female care
professionals need to have adequate time and more opportunities during CRT training, coaching
sessions, and supervision in reflecting on their own effectiveness to better support Latino male
clients seek resources and completing the assessment and continued care services.
Organization Recommendations
The assumed organizational influences for CHSF female care professionals and their
needs are listed in Table 16 based on the data gathered and analyzed through interviews and
document analysis. Using the Clark and Estes Gap Analysis Framework (2008) to guide this
study, the cultural model influences were validated as a gap and determined to affect the
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stakeholder goal of female care professionals implementing CRT to engage Latino male clients
in mental health services and follow-up care. The organizational influences in Table 15 represent
the complete list of assumed organizational influences that are validated, the theoretical
principles, and recommendations that would best meet the needs of the female care professionals
of CHSF.
Table 15
Summary of Organization Influences and Recommendations
Organization
Influence

Principle and
Citation

Context-Specific Recommendation
Organization does
not prioritize
engagement of
Latino male clients
(Cultural Model)
Build a momentum
of change by
involving as many
people as possible
(Moran &
Brightman, 2000).
CHSF can create a committee that oversees Latino
male clients’ participation in mental health
services. Committee will strategize effective
outreach and engagement efforts and events in the
community. CHSF will provide reports on a
monthly basis to all staff on the percentage of
Latino males in services and provide incentives
and enforce policies when not meeting Latino
male clients.

Prioritize Engagement of Latino Male Clients
The findings of this study indicate that the organization does not prioritize engagement of
Latino male clients. The response from female care professionals’ interviews indicated that the
organization has implemented and has in place different incentive mechanisms and supportive
measures to help female care professionals prioritize Latino male clients. CHS has monetary
incentives of $300.00 a month if billed 10-12 hours a week with Latino male clients or paid time
off without using accrued time off. Female care professionals provided information on CHSF
reminding them on the importance of engaging Latino male clients, but not having any
consequences or repercussions for not engaging Latino male clients. Interview participants
expressed that Latino male clients still not being engaged by CHSF female care professionals
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and CHSF does not prioritize Latino male clients as long as CHSF continues to draw down their
financial budget. A recommendation rooted in cultural model theory has been selected to close
this organizational gap. Moran and Brightman (2000) stated, build a momentum of change by
involving as many people as possible. The recommendation is for the organization to create a
committee of management and care professionals that will oversee the engagement and service
delivery to Latino male clients in mental health services. Committee will develop a plan of
action, provide all staff with monthly reports, continue to provide incentives, and enforce
policies created when female care professionals refuse to engage or serve Latino male clients in
mental health.
Organization’s usually have limited time and limited resources to address all of their
needs, organizations need to use the resources they have and create internal committees to
brainstorm new ideas or oversee projects (Alio, 2017). The practice of creating committees with
employees allows the organization to use the resources they already have to oversee prioritizing
Latino male clients in mental health services and follow-up care. The evidence shows that the
organization needs to have a committee in place to oversee that services and engagement efforts
to Latino male clients are prioritized.
Integrated Implementation and Evaluation Plan
The integrated implementation and evaluation plan are based on the New World
Kirkpatrick Model. Kirkpatrick and Kirkpatrick (2016), stated that there are three reasons to
evaluate improvement programs which include the following: program improvement,
demonstration of value, and maximizing the conversation of learning into employee behavior
changes that contribute to the facilitating of achieving organizational goals. The New Kirkpatrick
Model consists of four levels of both training and evaluation: (Level 4) Results, (Level 3)
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Behavior, (Level 2) Learning, and (Level 1) Reaction (Kirkpatrick & Kirkpatrick, 2016). Level 4
is defined as the results of the identified program through their desired outcomes of an initiative
and to the degree in which the objectives are met. Level 3 defines critical and required behaviors
which must be performed by individuals to achieve the desired outcomes. Critical and required
behaviors must be monitored and ensure consistent performance and reinforcement of the
continued use of the new behavior. Level 2 assesses the individuals’ new learned behavior by
measuring knowledge, skills, attitudes, self-efficacy, and commitment towards the desired
outcomes. Level 1 evaluates the individual’s reaction to the identified behavior including
engagement and satisfaction. Using the New World Kirkpatrick Model as a framework for the
implementation and evaluation plan will allow CHSF to measure the success of their desired
outcomes while continuing to provide opportunities for further improvements during the
implementation and evaluation phase.
Organizational Purpose, Need and Expectations
The purpose of this study is to evaluate the knowledge, motivation, and organizational
influences affecting CHSF ability for female care professionals to implement CRT to engage
Latino male clients in mental health services and follow-up care. Through a review of both the
literature review and the interviews conducted with female care professionals in the organization,
five assumed influences were determined as areas for continued improvement. The identified
influences include the following: the need for female care professionals to know how to apply
strategies of engagement with a specific focus on Latino male clients, the need for female care
professionals to reflect on their own effectiveness in serving Latino male clients, the need for
female care professionals to feel confident in implementing culturally responsive therapy, the
need for female care professionals to see the value of using culturally responsive therapy, and the
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organization needing to engage Latino male clients rather than focusing all efforts on servicing
women and children for contractual billing purposes. The proposed solutions to mitigate these
gaps include the following: providing information at staff meeting and coaching sessions on
applying strategies of engagement, providing adequate time during trainings and supervisions for
reflection, providing updated CRT training through vignettes or activities and collaborating with
other agencies to cross-train, role models or coaches providing new approaches and problem
solve, and CHSF creating a committee to oversee the delivery and engagement of Latino male
clients. The desired outcome of these proposed solutions is to increase the number of Latino
male clients complying with their appointments and follow-up care.
Level 4: Results and Leading Indicators
Table 16 identifies the desired outcomes including both internal and external outcomes,
the metric which is being used to measure success, and the method for collecting data which will
evaluate the Level 4 results of implementation and evaluation. There are four desired outcomes:
two internal outcomes and two external outcomes that will result from culturally responsive
therapy training. It is intended that if the outcomes are met, the stakeholder goal of all care
professionals will implement CRT to engage 100% of Latino male clients in mental health
services and follow-up care.

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Table 16
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Increased number of Latino male
clients complying with their
appointment and follow-up care.
The number of completed
assessment and follow-up care notes.
Data from
Electronic
Health Records
Increased audit compliance by
engaging Latino male clients in
services.
The number of corrective action
items needing to address
Data from
corrective action
plan
Increased number of Latino male
clients complying with female care
professionals.
The number of Latino male clients
reporting they are comfortable with
female care professional.
Quarterly
Survey
Internal Outcomes
Increased number of female care
professionals feeling confident
implementing CRT with Latino
male clients.
The number of female care
professionals reporting they feel
confident implementing CRT with
Latino male clients.
Quarterly
Survey

Level 3: Behavior
Critical Behaviors
The stakeholders of focus are female care professionals in Community and Health of San
Fernando. Critical behaviors are described as actions that individuals must consistently
demonstrate to facilitate Level 4 targeted outcomes (Kirkpatrick & Kirkpatrick, 2016). The first
critical behavior is female care professionals needing to be able to implement the fundamental
principles of culturally responsive therapy. The second critical behavior is female care
professionals needing to know how to incorporate and apply strategies of engagement with a
specific focus on Latino male clients when introducing the importance of follow-up care. The
third critical behavior is female care professionals needing to actively reflect on their own
effectiveness in servicing Latino male clients in the context of supporting them to seek resources
and completing the assessment for continued care services.
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Table 17

Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s) Method(s) Timing
Demonstrate the ability to
implement the fundamental
principles of culturally
responsive therapy
Randomly picked
cases will be observed
by peer and coach.
Female care
professionals will self-
assess.
Female care
professional will be
observed by peer and
coach. They will
provide feedback.
By
December
2020.
Demonstrate how to
incorporate and apply
strategies of engagement
with a specific focus on
Latino male clients when
introducing the importance
of follow-up care
Observations and
informal
conversations
Female care
professionals will self-
assess.
Female care
professional will be
observed by peer and
coach. They will
provide feedback.
By
December
2020.
Demonstrate active
reflection on own
effectiveness in servicing
Latino male clients in the
context of supporting them
to seek resources and
completing the assessment
for continued care services.
Number of times
female care
professionals reflect on
their effectiveness
during training and in
supervision.
Female care
professionals will be
given time during
trainings and
supervision to reflect on
their effectiveness.
By
December
2020.

Required Drivers
Required drivers provide an extra level of support and accountability that ensures the
implementation of the proposed solutions through reinforcement, monitoring, and
encouragement (Kirkpatrick & Kirkpatrick, 2016). The four categories for critical drivers are the
following: reinforcing, encouraging, rewarding, and monitoring. The identified required drivers
will provide support to female care professionals and reinforce knowledge gained during training
and encourage them to apply the strategies learned. Multiple required drivers will be used to
support female care professionals including job aids, monthly check-ins, and coaching. Table 18
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shows the recommended drivers to support the critical behaviors of CHSF female care
professionals.
Table 18
Required Drivers to Support Critical Behaviors
Method(s) Timing Critical
Behaviors
Supported
1, 2, 3 Etc.
Reinforcing

Conduct consistent monthly training for staff to gain new
implementation skills.
Monthly 1, 2
During training, the instructors model the importance and
effectiveness of using culturally responsive therapy to engage
Latino male clients.
On-
going
1, 2
Provide well respected peer models during training to
demonstrate the effectiveness of using culturally responsive
therapy to engage Latino male clients.
On-
going
2
Encouraging

Conduct team meetings with all employees including new and
experienced staff in collaboration with Administration to
establish a clear plan on how to engage Latino males.
Weekly 2
Conduct whole organization meetings to communicate resource
priorities and provide role model and shadowing opportunities
to staff on a monthly basis.
Monthly 1, 2
Rewarding

Recognition of female care professionals meeting their
productivity expectation in engaging Latino male clients in
mental health services and follow-up care.
On-
going
1, 2
Recognition of female care professionals whose Latino male
clients express looking forward to meeting for mental health
services on a weekly basis.
On-
going
1, 2
Monitoring

Observations of female care professionals implementing CRT Monthly 1, 2

Organizational Support
The organization must provide female care professionals with the necessary resources
and support to continue to increase the chance of success. First, the organization must engage
Latino male clients rather than focusing all of their efforts on servicing women and children for
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contractual billing purposes. This expectation must be established at the highest level of
leadership in the organization and expected of all care professionals. Second, the organization
needs to ensure that female care professionals reflect on their own effectiveness in serving Latino
male clients. Third, the organization must ensure that female care professionals feel confident in
implementing CRT with Latino male clients.
Level 2: Learning
Learning Goals
Female care professionals need to possess specific knowledge, skills, and attitude to support
their Level 3 performance critical behaviors listed in Table 17. Following the implementation of
the recommended solutions, female care professionals will be able to:
1. Implement the fundamental principles of CRT. (Procedural)
2. Articulate the strategies of engagement with Latino male clients. (Conceptual)
3. Articulate the value of using CRT for Latino male clients. (Expectancy Value)
4. Articulate confidence in their ability to implement CRT with Latino male clients. (Self-
Efficacy)
Program
The identified learning goals will increase the knowledge and motivation of female care
professionals and can be achieved through training on culturally responsive therapy. To further
develop and support female care professionals’ knowledge and skills, female care professionals
will be provided with cross training with other organizations and coaches, job aids, modeling
opportunities during weekly supervision, and coaching sessions. Since female care professionals’
turnover rate is high and the hiring of new female care professionals is frequent, the training will
be on-going. Female care professionals will participate in annual refresher training courses on
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CRT as well as on-going coaching and modeling opportunities. On an annual basis, all female
care professionals will participate in a training providing information of principles, strategies,
and the effectiveness of using culturally responsive therapy in engaging Latino male clients.
Female care professionals will also have the opportunity to participate in cross-training. Cross
training will consist of female care professionals attending other agencies training on CRT an
participating in their coaching and shadowing opportunities. Aside from the in-person annual
training, female care professionals will receive on-going modeling and coaching to better support
the implementation of culturally responsive therapy to engage Latino male clients in mental
health services and follow-up care.
Evaluation of the Components of Learning
According to the New World Kirkpatrick Model (2016), the five components of learning
are: knowledge, skills, attitude, confidence, and commitment. Female care professionals need to
demonstrate the proper knowledge to engage Latino male clients after participating in the
training and the procedural knowledge to implement the principles of culturally responsive
therapy. Female care professionals need to see the value and feel confident in performing and
their ability to implement culturally responsive therapy to engage Latino male clients in mental
health services and follow-up care. Table 19 identifies the recommended evaluation method and
time for each component of learning.

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Table 19
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”

Knowledge and activity reinforcements (exercises) throughout the
training
During in-person
training
Administer pre and post Test Before and after
training
Procedural Skills “I can do it right now.”

Demonstrate proficiency in implementing culturally responsive
therapy
During in-person
training
Administer pre and post Test Before and after
training
Attitude “I believe this is worthwhile.”

Instructor and role model observations During in-person
training
Administer pre and post Test Before and after
training
Confidence “I think I can do it on the job.”

Break-out group discussions During in-person
training
Open Team meeting Monthly
Commitment “I will do it on the job.”

Individual implementation plan During in-person
training
Administer pre and post Test Before and after
training

Level 1: Reaction
Measuring the reaction of female care professionals related to culturally responsive
therapy training is important. Assessing the reaction of female care professionals is important in
determining the female care professionals’ engagement during the training, perception of value
on the training, and if the training is relevant to their role as a care professional. Reactions can be
measured by observations from the leader, from an identified observer, or surveys (Kirkpatrick
& Kirkpatrick, 2016). Table 20 identifies the different methods used to identify the reactions by
female care professionals’ and their level of engagement.
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Table 20

Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement

Completion of training, participation in breakouts and exercises. On-going
Instructor observation After training
Training evaluation After training
Pre and post test After training
Relevance

Training evaluation After training
Customer Satisfaction

Training evaluation After training

Evaluation Tools
Immediately Following the Program Implementation
While attending the in-person training events, all participants will be asked to complete a
Pre and Post-test (included as Appendix D). The pre and post-test will indicate the participant’s
knowledge prior to receiving CRT training, the knowledge gained after receiving the training,
the participants’ commitment, attitude, the degree to which the participant valued the training,
and the participant’s level of confidence in applying the principles learned during the training.
Additionally, the trainer and co-trainers will complete a checklist following the in-person
training (included as Appendix E). The observers will record the observations of all the
participant’s attitude and level of engagement during the in-person training. Finally,
administrative staff will complete a checklist following the monthly discussions and check-ins
with female care professionals (included as Appendix F). The administrative staff will report the
female care professionals’ level of satisfaction, commitment, attitude, and mastery of what has
been learned through their implementation.

98
Delayed for a Period After the Program Implementation
The organization will administer a survey approximately 90-days after each learning
session has occurred with care professionals. The survey includes a series of nominal, interval,
and ratio questions that assess the following criteria: care professionals satisfaction and relevance
of culturally responsive therapy training to better engage Latino male clients (Level 1); female
care professionals’ knowledge, skills, confidence, attitude, value, and commitment of applying
the trainings knowledge (Level 2); female care professionals’ application of the learning event in
implementing the principles and strategies of culturally responsive therapy (Level 3); and female
care professionals’ confidently incorporating and applying the strategies of engagement with a
specific focus on Latino male clients when introducing the importance of follow-up care (Level
4).
Data Analysis and Reporting
The Level 4 goal of the implementation plan is to provide female care professionals in
Community Health of San Fernando the knowledge, motivation, and organizational support to
effectively implement culturally responsive therapy to Latino male clients in mental health
services and follow-up care. Each week, the reviewer will track the number of times female care
professionals discussed implementing CRT principles and strategies to engage Latino male clients
in mental health services and follow-up care. The data will be reported to the administrative team
to record progress and to continue brainstorming on ways to support and reinforce the
implementation of CRT. Figure 2 demonstrates an example of how the dashboard can present the
data for staff and administration regarding training. Similar dashboards can be created for Levels
1 and 3 by the administrative team.

99
Figure 2
Sample Dashboard to Report Progress Towards Meeting the Stakeholder Goal

Strengths and Limitations of the Approach
The Clark and Estes (2008) Gap Analysis model in collaboration with the Kirkpatrick
and Kirkpatrick (2016) New World Kirkpatrick Model provided a comprehensive method to
identify, organize and validate the knowledge, motivational, and organizational influence gaps as
well as implementing and evaluating recommendations to mitigate the validated gaps. However,
the structure of the Gap Analysis model did prove to be difficult in organizing influences when
the assumed influences were related in combination to the knowledge, motivational, and
organizational influences. Furthermore, the Gap Analysis did not allow for external influences
outside of the knowledge, motivational, and organizational influences. One external influence
that could have been considered is how is the community of San Fernando is being affected by
100
Latino male clients not being prioritized in mental health services by CHSF or other mental
organizations in the community.
Limitations and Delimitations
There were several limitations to this study, many of the limitations were made aware
before the start of this study, while the other limitations were identified over the progress of this
study. One major limitation of this study is the study being conducted in a limited amount of
time with limited resources that prevented the study from reaching a larger sample size. An
additional limitation of this study was the period in which data was collected. In applying for
approval from the institutional review board, the country had declared a state of emergency due
to being in a pandemic from COVID-19, causing shelter in place orders, organizations shutting
down, and organizations having to learn virtual platforms as everything was to be conducted
through virtual platforms as opposed to in person meetings.
All of the interviews and data gathering for this study needed to be collected through
Zoom a virtual platform that allows two-way video conferencing. Video conferencing (Zoom)
made it difficult for the participants to feel comfortable and the interviewer to create a safe
environment. This added another limitation to the study having respondents not being truthful
when providing answers to the interview questions.
The study only included members of one department and office and may lack
generalizability beyond the department and the office. If replicated, the study could improve by
using additional organizations within the community of San Fernando that offer mental health
services and implement CRT. If additional organizations are included, the study can gather data
to determine if the organizations culture affected the stakeholder’s response to CRT. Another
addition to the study would be the implementation of mixed methods research to enhance the
101
understanding of the training and the organization by conducting interviews with stakeholders,
observations on service delivery, and an anonymous questionnaire.
The stakeholder group of this study, female care professionals working in Community
Health of San Fernando, were selected based on their expressed interest in participating in this
study. This study may have been affected by participation bias as a result of voluntary
participation in this study. The study focused on female care professionals who provide direct
service to Latino male clients within CHSF. Furthermore, this study did not seek to identify
Latino male clients’ experience with engagement efforts and their level of commitment to
treatment. Overall, the participants interviewed seemed truthful and honest when providing
insight into their level of knowledge, motivational, and organizational influences. Some of the
participants interviewed at first did not want to speak freely and with confidence about the
organizational influences as they did not want to disclose anything that could negatively affect
the organization. Additionally, administrative staff could have provided a deeper history of or the
organizational influences. Delimitation, boundaries established by the researcher for this study,
may have affected this study. The study only included care professionals that were licensed with
the state of California Board of Behavioral Sciences and did not include care professionals who
are still in school or in training as an intern or an associate. All female care professionals
interviewed had a caseload of 16 clients and had an expectation of providing direct mental health
services to their identified client caseload. The stakeholder were female care professionals that
did not influence the decision-making process for the organization to make adjustments or
recommendations to the training or implementation of CRT.

102
Future Research
This study evaluated eight assumed influences contributing to the organizational goal of
Latino male clients served by CHSF will complying with their appointments and follow-up care.
The stakeholder goal of female care professionals explored was implementation of CRT to
engage Latino male clients in mental health services and follow-up care. Ten female care
professionals in Community Health of San Fernando, representing 16% of the organizations
direct care professional’s population in the organization, were interviewed during this study to
identify knowledge, motivational, and organizational influences affecting the organization and
stakeholders in reaching their respective goals.
Interviews with male care professionals, administrative staff, and direct active clients
could be conducted in future research to further explore the assumed knowledge, motional, and
organizational influences identified in this study. Male care professionals’ perspective on CRT
and Latino male engagement will be important to gather and see if Latino male clients are more
comfortable and willing to participate in services with a male care professional. Administrative
staff interviews can look deeper into the decision-making process and the conversations
regarding prioritizing Latino male clients’ mental health and the financial conversations
regarding contract compliance. By interviewing direct active Latino male clients, more
information regarding their level of comfort with female versus male staff and the barriers and
challenges in seeking mental health services and follow-up care can be identified.
Additionally, this study did not interview care professionals not affiliated with CHSF
who are also implementing CRT. Further research should identify the perspective of other care
professionals implementing CRT. This research study was confined to one organization within
Community Health of San Fernando, which impacts the generalizability of the findings beyond
103
the organization. Expanding the scope of this research to include additional organizations who
are also implementing CRT may provide a better understanding of how CRT is supporting
female care professionals engage Latino male clients, how the organization is supporting female
care professionals in engaging Latino male clients, and female care professionals’ knowledge
and motivation of using CRT to engage Latino male clients in mental health and follow-up care.
Conclusion
The purpose of this study was to focus on CHSF and evaluate the knowledge,
motivational, and organizational influences affecting the organization’s goal of Latino male
clients complying with their appointments and follow-up care. Using the Clark and Estes (2008)
Gap Analysis framework, the female care professionals’ knowledge, motivational, and
organizational influences were studied and evaluated through interviews and document analysis.
Based on the findings gathered through data collection and analysis, recommendations were
proposed to close the knowledge, motivational, and organizational gaps affecting the
stakeholders and organization’s ability in meeting their identified goals. The Kirkpatrick and
Kirkpatrick (2016) New World Model was used to identify an implementation and evaluation
plan to incorporate proposed recommendations in this study successfully.
The key takeaways from this research study is that female care professionals have a
comprehensive knowledge of CRT, female care professionals have high self-efficacy in applying
strategies of engagement, female care professionals have high value of implementing CRT,
CHSF ensures effective training, and CHSF availed robust resources related to both role models
and shadowing opportunities for female care professionals. This is due to CHFS making CRT
training available and accessible to female care professionals multiple times a year. CHSF
female care professionals have a clear understanding of CRT and the fundamental principles and
104
steps of CRT. CHSF female care professionals expressed being confident in their ability to
implement CRT. Female care professionals see the value of implementing CRT as a way of
being able to successfully engage Latino male clients in mental health services. Female care
professionals expressed feeling supported and participating in coaching sessions through role-
modeling and shadowing activities in supporting engagement strategies with Latino male clients.
The following findings revealed validated gaps. The first finding of this study was CHSF
female care professionals having mixed levels of understanding about applying the strategies of
engagement. Female care professionals expressed CRT being too repetitive, rigid, and time
consuming as reasons why CRT is often not being implemented with Latino male clients.
Additionally, female care professionals expressed frustration implementing CRT right away with
Latino male clients due to Latino male client’s lack of motivation to commit to participate in
services. Female care professionals have mixed levels of reflection about their own effectiveness
and identified by expressing frustration of not having adequate time or being able to reflect on
their effectiveness in supporting Latino male clients. Finally, the care professionals’ experience
indicated that CHSF did not prioritize the engagement of Latino male clients’ engagement and
continued to focus their efforts on servicing women and children for contractual obligations.
CHS has monetary incentives of $300.00 a month if billed 10-12 hours a week with Latino male
clients or paid time off without using accrued time off. Female care professionals provided
information on CHSF reminding them on the importance of engaging Latino male clients, but
not having any consequences or repercussions for not engaging Latino male clients. Interview
participants expressed Latino male clients still not being engaged by CHSF female care
professionals and CHSF not prioritizing Latino male clients as long as CHSF continues to draw
down their financial budget.
105
Successfully implementing the recommendations discussed in this study is but only one
small component contributing to the attainment of the organizational goal. Failure to incorporate
these recommendations discussed in this study can lead to the failure of closing the knowledge,
motivation, and organizational gaps. This can hinder the organizations ability to achieve its
organizational goal of having 100% of Latino male clients served by Community and Health of
San Fernando complying with their appointments and follow-up care and the stakeholder goal of
care professionals implementing CRT to engage 100% of Latino male clients in mental health
services and follow-up care.

106
References
Alio, P.A. (2017). Identifying, prioritizing, and addressing client needs: Strategies for home
visitors. University of Rochester Medical Center, NYS Maternal & Infant Health Center
of Excellence. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/finger-
lakes-regional-perinatal/documents/Prioritization-Report_April2017.pdf
Alkin, M. C. (2011). Evaluation essentials: From a to z. Guilford Press.
Asnaani, A., & Hofmann, S. G. (2012). Collaboration in multicultural therapy: Establishing a
strong therapeutic alliance across cultural lines. Journal of Clinical Psychology, 68(2),
187–197.
Board of Behavioral Sciences. (2019, December). California government board of behavioral
sciences. Retrieved from https://www.bbs.ca.gov/about/board_info.html
Brown, J. R. (2005). Community health strategies to improve the life options of young men of
color. Washington: Poverty & Race Research Action Council. Retrieved from
http://libproxy.usc.edu/login?url=https://search-proquest-
com.libproxy1.usc.edu/docview/210365542?accountid=14749
Chang, D. F., & Berk, A. (2009). Making cross-racial therapy work: A phenomenological study
of clients’ experiences of cross-racial therapy. Journal of Counseling Psychology, 56(4),
521-536. http://dx.doi.org.libproxy1.usc.edu/10.1037/a0016905
Clark, R. E. & Estes, F. (2008). Turning research into results: A guide to selecting the right
performance solutions. Information Age Publishing, Inc.
Courtenay, W. (2002). A global perspective on the field of men's health: An editorial.
International Journal of Men's Health, (1),
http://dx.doi.org.libproxy1.usc.edu/10.3149/jmh.0101.1
107
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods
approaches. Sage Publications.
Culturally Sensitive Therapy, (2019, November/December). Psychology Today. Retrieved from
https://www.psychologytoday.com/us/therapy-types/culturally-sensitive-therapy
Davis, J.M., & Liang, C.H (2015). A test of mediating role of gender role conflict: Latino
masculinities and help-seeking attitudes. Psychology of Men & Masculinity, 16(1), 23-32.
https://dx.doi.org/10.1037/a0035320.
Davies, J. A., Shen-Miller, D., & Isacco, A. (2010). The men's center approach to addressing the
health crisis of college men. Professional Psychology: Research and Practice, 41(4),
347-354. http://dx.doi.org/10.1037/a0020308
Deb, S., & Miller, N. A. (2017). Relations among race/ethnicity, gender, and mental health status
in primary care use. Psychiatric Rehabilitation Journal, 40(2), 233-243.
http://dx.doi.org/10.1037/prj0000230
DeFreitas, S. C., Crone, T., DeLeon, M., & Ajayi, A. (2018). Perceived and personal mental
health stigma in Latino and African American college students. Frontiers in public
health, 6, 49. https://dx.doi.org/10.3389/fpubh.2018.00049
Demographic Report on Licensees and Registrants-Summary- December 2007. (2019,
December) Board of Behavioral Sciences. Retrieved from
https://www.bbs.ca.gov/pdf/publications/demo_survey_2007.pdf
Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals
experiencing mental illness: review and update. World psychiatry: official journal of the
World Psychiatric Association (WPA), 15(1), 13–20. https://doi.org/10.1002/wps.20306
108
Dupéré, S., O'Neill, M., & De Koninck, M., (2012). Why men experiencing deep poverty in
montréal avoid using health and social services in times of crisis. Journal of Health Care
for the Poor and Underserved, 23(2), 781-796. Retrieved from
http://libproxy.usc.edu/login?url=https://search-proquest
com.libproxy2.usc.edu/docview/1037997245?accountid=14749
Eccles, J. (2006). Expectancy value motivational theory. Education.com. http://www.
education.com/reference/article/expectancy-value-motivational-theory/.
Elder, K., Meret-Hanke, L., Dean, C., Wiltshire, J., Gilbert, K., Wang, J., . . . Moore, T. (2013).
Men’s health: Disparities in confidence to manage health. International Journal of Men's
Health, 12(3), 260-275.
Frey, L. L. (2013). Relational-cultural therapy: Theory, research, and application to counseling
competencies. Professional Psychology: Research and Practice, 44(3), 177-185.
http://dx.doi.org/ 10.1037/a0033121
Gonzales-Ball, T., & Bratton, S. C. (2019). Child–teacher relationship training as a head start
early mental health intervention for children exhibiting disruptive behavior. International
Journal of Play Therapy, 28(1), 44-56. http://dx.doi.org/10.1037/pla0000081
Grella, C. E., Gil-Rivas, V., & Cooper, L. (2004). Perceptions of mental health and substance
abuse program administrators and staff on service delivery to persons with co-occurring
substance abuse and mental disorders. The Journal of Behavioral Health Services &
Research, 31(1), 38-49.
Griffith, D. M., Gunter, K., & Watkins, D. C. (2012). Measuring masculinity in research on men
of color: Findings and future directions. American Journal of Public Health, 102, 187-
194.
109
Harding, S. (2013). Direct care staff perspectives related to physical activity in mental health
group homes. Journal of Psychosocial Nursing & Mental Health Services, 51(12), 38-43.
http://dx.doi.org/10.3928/02793695-20130827-01
Holley, L. C., Tavassoli, K. Y., & Stromwall, L. K. (2016). Mental illness discrimination in
mental health treatment programs: Intersections of race, ethnicity, and sexual
orientation. Community Mental Health Journal, 52(3), 311-322.
doi:http://dx.doi.org.libproxy1.usc.edu/10.1007/s10597-016-9990-9
Hunzicker, J. (2011). Effective professional development for teachers: A checklist. Professional
Development in Education, 37(2), 177-179.
https://doi.org/10.1080/19415257.2010.523955
Irwin, C. W., & Stafford E. T. (2016). Survey methods for educators: Collaborative survey
development. U.S. Department of Education, Institute of Education Sciences, National
Center for education Evaluation and Regional Assistance, Regional Educational
Laboratory Northeast & Islands. http://ies.ed.gov/ncee/edlabs.
Jenkins, R., Baingana, F., Ahmad, R., McDaid, D., & Atun, R. (2011). Social, economic, human
rights and political challenges to global mental health. Mental Health in Family
Medicine, 8(2), 87–96.
Johnson, R. B., & Christensen, L. B. (2015). Educational research: Quantitative, qualitative,
and mixed approaches (5
th
ed.). Sage Publishers
Jones, D. J., Crump, A. D., & Lloyd, J. J. (2012). Health disparities in boys and men of
color. American Journal of Public Health, 102, S170-S172.
Kirkpatrick, J.D., & Kirkpatrick, W. (2016). Kirkpatrick’ four levels of training evaluation.
Association for Talent Development
110
Krathwohl, D. R. (2002). A revision of Bloom’s Taxonomy: An overview. Theory into practice,
41, 212–218. https://doi.org/10.1207/s15430421tip4104_2
Krueger, R. A., & Casey, M. A. (2009). Chapter 2: Planning the focus group study. In focus
groups: A practical guide for applied research (4th ed.) (pp. 29-31). SAGE Publications.
Los Angeles County Department of Mental Health Fiscal Year 2018-2019 Budget Summary.
(2019, December) lacounty.gov. Retrieved from
http://file.lacounty.gov/SDSInter/dmh/1050928_FY2018-19BudgetSummary.pdf
Malloy, C. (2011). Moving beyond data: Practitioner-led inquiry fosters change. Phi Delta
Kappa International, 6(4), 1-20.
Maxwell, J. A. (2013). Qualitative research design: An interactive approach. SAGE.
Mayer, R. E. (2011). Applying the science of learning. Pearson Education.
McEwan, E. K., & McEwan, P. J. (2003). Making sense of research. Sage Publications.
McKenzie, S. K., Collings, S., Jenkin, G., & River, J. (2018). Masculinity, social connectedness,
and mental health: Men's diverse patterns of practice. American Journal of Men's
Health, 12(5), 1247–1261. https://doi.org/10.1177/1557988318772732
Mayer, R. E. (2011). Applying the science of learning. Pearson Education.
Memon, A., Taylor, K., Mohebati, L. M., Sundin, J., Cooper, M., Scanlon, T., & de Visser, R.
(2016). Perceived barriers to accessing mental health services among black and minority
ethnic (BME) communities: A qualitative study in southeast England. BMJ Open, 6(11)
Men of color face health crisis. (2002, Mar 13). New Voice of New York, Inc.
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and
implementation (4
th
ed.). Jossey-Bass.
111
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Meyer J. A. (2003). Improving men's health: developing a long-term strategy. American Journal
of Public Health, 93(5), 709–711. https://doi.org/10.2105/ajph.93.5.709
Moran, J., & Brightman, B. (2000). Leading organizational change, Journal of Workplace
Learning: Employee Counseling Today, 12(2), 66-74.
Norcross, J. C., Bike, D. H., & Evans, K. L. (2009). The therapist's therapist: A replication and
extension 20 years later. Psychotherapy, 46(1), 32-41.
https://dx.doi.org/10.1037/a0015140
Pajares, F. (2006). Self-efficacy theory. Education.com.
http://www.education.com/reference/article/self-efficacy-theory/
Patton, M. Q. (2002). Qualitative interviewing. In Qualitative research & evaluation methods
(3
rd
ed.). SAGE Publications.
Paz-Pruittr, I. T. (2007). Family treatment approaches for depression in adolescent males.
American Journal of Family Therapy, 35(1), 69-81.
Pintrich, P. R. (2003). A motivational science perspective on the role of student motivation in
learning and teaching contexts. Journal of Educational Psychology, 95, 667–686.
https://doi.org/10.1037/0022-0663.95.4.667
Reitmanova, S., & Gustafson, D. L. (2009). Mental health needs of visible minority immigrants
in a Johnson-Lawrencesmall urban center: Recommendations for policy makers and
service providers. Journal of Immigrant and Minority Health, 11(1), 46-56.
https://dx.doi.org/10.1007/s10903-008-9122-x
112
Rios-Ellis, B. (2005). Critical Disparities in Latino Male Mental Health: Transforming Research
into Action. National Council of La Raza: Institute for Hispanic Health, 1-33.
Robinson, S.B. & Firth Leonard, K. (2019). Designing quality survey questions. SAGE
Rubin, H. J., & Rubin, I. S. (2012). Chapter 6: Conversational partnerships. In Qualitative
interviewing: The art of hearing data (3
rd
ed.) (pp. 85-92). SAGE Publications.
Rueda, R. (2011). The 3 dimensions of improving student performance. Teachers College Press.
Pajares, F. (2006). Self-efficacy theory. Education.com
http://www.education.com/reference/article/self-efficacy-theory/.
Salkind, N. J. (2017). Statistics for people who (think they) hate statistics: Using Microsoft Excel
2016 (4th ed.). SAGE.
Satcher, D. (2003). Overlooked and underserved: Improving the health of men of
color. American Journal of Public Health, 93(5), 707-9.
Schraw, G., & McCrudden, M. (2006). Information processing theory. Education.com.
http://www.education.com/reference/article/information-processing-theory/
Smith, A. L. (2003). Health policy and the coloring of an American male crisis: A perspective on
community-based health services. American Journal of Public Health, 93(5), 749-52.
Strickland, A. (2012). Defining the New Male Ideal – CNN.com.
http://www.cnn.com/2012/03/23/living/male-ideal-body-image/
Stringer, E. T. (2014). Action Research. (4
th
ed.). SAGE.
Suite, D. H., Bril, R. L., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis,
misunderstanding and mistrust: Relevance of the historical perspective in the medical and
mental health treatment of people of color. Journal of the National Medical
Association, 99(8), 879-85.
113
Walck, D. (2017). Enhancing clients’ perspectives and the therapeutic process by expanding our
view of cultural wealth. International Journal for the Advancement of Counselling, 39(4),
395-404. https://dx.doi.org/10.1007/s10447-017-9305-z
Watkins, D. C., Johnson-lawrence, V., & Griffith, D. M. (2011). Men and their father figures:
Exploring racial and ethnic differences in mental health outcomes. Race and Social
Problems, 3(3), 197-211. https://dx.doi.org/10.1007/s12552-011-9051-5
Weiss, R. S. (1994). Chapter 1: Introduction. In Learning from strangers: The art and method of
qualitative interview studies (pp. 1-14). The Free Press.
Whaley, A. L. (2004). Ethnicity/Race, paranoia, and hospitalization for mental health problems
among men. American Journal of Public Health, 94(1), 78-81.
What does the affordable care act mean for you? (2013). Clinical Journal of Oncology
Nursing, 17(1), 13.
Wheeler, A. J., Mey, A., Fowler, J. L., Gabor, G.C., & Kelly, F. (2018). A web-based mental
health promotion intervention for pharmacy staff to reduce stigmatizing and
discriminating attitudes. Health Promotion Journal of Australia, 29(3), 328.
https://dx.doi.org/10.1002/hpja.33
Wu, I. H. C., Bathje, G. J., Kalibatseva, Z., Sung, D., Leong, F. T. L., & Collins-Eaglin, J.
(2017). Stigma, mental health, and counseling service use: A person-centered approach to
mental health stigma profiles. Psychological Services, 14(4), 490-501.
https://dx.doi.org/10.1037/ser0000165

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Appendix A
Interview Protocol
The interview will begin with introducing and reviewing the purpose of the study,
participation consent forms, confidentiality, and data collection method during the interview. The
following text will be read at the beginning of each individual interview.
“Thank you for taking the time and agreeing to speak with me today. Before we begin with our
interview, I would like to go over a few things about the information being shared today and its
purpose to this study. To start, I am conducting this interview to learn more about your
experience as a female care professional in engaging Latino male clients in mental health
services and follow-up care. Data shows us that only 10% of Latino male clients are currently
complying with their mental health appointments and follow-up care.
This interview will be recorded with multiple digital recorders to ensure a safeguard in
case one malfunctions. I will be asking you a series of questions, which you have had the
opportunity to look over and read. Are you ready to start the interview and start the recording? (If
answer is yes, recording will start).
Please keep in mind that there are no right or wrong answers, I would like to hear your
perspective based on your experiences and what you have seen first-hand. This interview is
completely voluntary, and you can choose to stop answering any questions, stop the recording of
this interview at any time, or retrieve the recording files at any time during or after this
interview. You can choose to skip any questions that you may not want to answer. Once the
interview concludes, you may request to that certain or all responses be removed and not used in
this study. You will not be penalized in any way for stopping the interview or refusing to
continue with the interview. After the interview has finished and you are pleased with your
115
answers and would like to continue to participate in this study, the recording file will be
transcribed by a third-party service. Once I receive the transcript, any and all identifiable
information you may share will be substituted with pseudonyms to protect your identity as an
active participant in this study as well as any other identities. All of the recording files and
transcripts will be kept secured in a password protected computer that will not be used to access
the internet. Once the study has concluded and the study has been published, any and all
recording files and transcribed documents will be safely and correctly deleted.
All of the information that I have just provided to you was also included in the original
email scheduling this meeting and is also included in this Information Sheet. Do you have any
questions that might need further clarification? (i.e., data collection, data storage, confidentiality,
interview questions, purpose, participants) If there are no more questions, are you ok if we start
with the interview?”
1. Why did you become a mental health care professional?
2. Why did you choose to work at Community Health of San Fernando?
3. What do you enjoy most about being a mental health care professional?
4. How would you describe the practice of culturally responsive therapy (CRT)?
a. How would you describe the benefits or challenges of culturally responsive
therapy to a colleague?
5. Describe an experience in the last 4 months when you implemented culturally responsive
therapy.
a. What do you feel contributed to the experience being either a positive or negative
one?
b. How often would you say you as care professional reflect on your practice?
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6. Tell me how you feel CHSF is prioritizing Latino male clients’ needs, if at all.
7. Tell me about how you feel CHSF is creating a trusting and supportive environment to
engage Latino male clients, if at all.
8. Tell me how you feel about CHSF is supporting you in implementing culturally
responsive therapy.
9. Tell me what additional resources do you think will help you with engaging Latino men.
10. What are your thoughts about shadowing or role modeling as a way to continue to
support your implementation of culturally responsive therapy?
11. Is there anything else you would like to add in the context of supporting Latino male
clients in engaging them in mental health and follow-up care using culturally responsive
therapy?

117
Appendix B
Document Analysis Protocol
Culturally Responsive Therapy (CRT) Training Records
1. Is the purpose of the organization’s training on CRT stated? What is the stated purpose?
2. Does the organization have a record of what percent of staff attended the full-day
training?
3. Do the training records have a record of completion of the four coaching sessions?
4. Does the training culminate with a certificate of completion for CRT?
5. Do the training records include feedback from participants?
6. Do the training records have follow-up supervision feedback from female care
professionals on the implementation of culturally responsive therapy?
Culturally Responsive Therapy (CRT) Training Curriculum
1. Where is CRT curriculum located within the agency?
2. Is CRT training curriculum accessible to staff for reference?
3. What is the purpose of CRT curriculum?
4. Does the training manual include participants practicing CRT skills as part of training? If
so, how is that done – role play?
5. Does the CRT curriculum focus on engaging Latino male clients?
6. Does the CRT curriculum clearly address the steps to take during implementation?
7. What specific guidelines does CRT curriculum give to female care professionals in
engaging Latino male clients?
8. Are the objectives clearly stated and addressed in the CRT curriculum?
9. Is the organizations performance goal addressed in CRT curriculum?
118
10. Does the CRT curriculum address the knowledge, motivation, or organizational impact
on female care professionals implementing culturally responsive therapy?
11. Does the CRT curriculum address how to problem solve with difficulty in engaging
Latino male clients?

119
•Assessment and
Understanding
•Individualized
•Outcome Driven
•Culturally Respectful
•Persistent
•Prevention/Transition
•Planning
•Strengths based
•Communnity based
•Trust
•Team based
•Collaboration and
Integration
Engagement Record Review
Assessment/Safety
Planning
Collateral Sessions
(Formal /Informal
Supports)
Appendix C
Culturally Responsive Therapy Guide

Tracking and Adapting
120
Step 1: Engagement
• Creating a safe environment.
• Exploring past achievements.
• Develop rapport by staying in touch, being persistent, and modeling mutual participation.

Step 2: Record Review.
• Understanding past relationships.
• Perceptions of behaviors and past trauma.
• Identify history of trauma and past problems.

Step 3: Assessment and Safety Planning.
• Evaluating patterns of attachments
• Being kind and empathetic.
• Choosing intervention according to the clients underlying needs.

Step 4: Collateral Sessions (Informal/Formal Supports).
• Collection of information without being too pushy.
• Being sensitive
• Providing incentives.

Step 5: Tracking and Adapting
• A continuous conversation how treatment is working and appropriate.
• Evaluation of the effectiveness of the plan.
• Adapting to new challenges that arise.
• Making adjustments as needed.

This is a process and not an event. The diagram illustrates how in the process affect one another
and it is an integrated process. These practice behaviors help to create a partnership within hopes
for the individual to successfully terminate treatment.

121
Appendix D
CRT Training Participants Pre-Test
1. To help us identify your key learning expectations, please complete the following
statements:
I want to learn more about ...
I want to understand how to ...
I want to develop my ...
2. In your own experience, what do you consider are the challenges with engaging Latino
male clients in mental health services?
3. What do you feel are your strengths and weaknesses in engaging Latino male clients in
mental health services?
4. Using the 12 statements below, how do you rate your present ability to engage Latino
male clients in mental health services?

Strongly
Disagree (1)
Disagree
(2)
Neutral
(3)
Agree
(4)
Strongly
Agree (5)
I feel well prepared

I feel supported

I have the skills

I feel confident to go
ahead

I feel comfortable

I am committed

I feel overwhelmed

I feel alone

122
I am inexperienced

I am unsure what to
do

I feel uncomfortable

I feel skeptical

CRT Training Participants Post-Test
1. Please identify 5 of the most important learning points from the training course:
2. Explain how the training addressed some of the challenges you faced with in engaging
Latino male clients?
3. After this training, what do you feel are your strengths in relation to engaging Latino
male clients in mental health services?
4. Using the 12 statements below, how do you rate your present ability to engage Latino
male clients in mental health services?

Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
I feel well prepared (1) (2) (3) (4) (5)
I feel supported (1) (2) (3) (4) (5)
I have the skills (1) (2) (3) (4) (5)
I feel confident to go
ahead
(1) (2) (3) (4) (5)
I feel comfortable (1) (2) (3) (4) (5)
I am committed (1) (2) (3) (4) (5)
I feel overwhelmed (1) (2) (3) (4) (5)
I feel alone (1) (2) (3) (4) (5)
123
I am inexperienced (1) (2) (3) (4) (5)
I am unsure what to do (1) (2) (3) (4) (5)
I feel uncomfortable (1) (2) (3) (4) (5)
I feel skeptical (1) (2) (3) (4) (5)

124
Appendix E
Culturally Responsive Therapy Trainer Observation Evaluation
The following checklist will be completed by the leading and co-leading trainers following the
in-person training.

Rating Scale
1 = Effective use of target behavior
2 = Moderately effective use of targeted behavior
3 = Ineffective use of targeted behavior

Comments may include specific observations that will support the rating, as well as feedback to
help female care professionals be more effective when engaging Latino male clients in mental
health services.

Target Behavior Rating Comments
Trainer connected with participants by listening and validating
participants feedback

Trainer asked open-ended questions and encourages discussions with
participants

Trainer clarified knowledge with follow-up questions after receiving
feedback

Trainer recommended appropriate resources based on participant
feedback

Trainer worked collaboratively with participants to engage participants
and enhance their learning environment

Trainer satisfactorily answered participants questions

125
Appendix F
Culturally Responsive Therapy Training Participant Evaluation
For each of the questions below, circle the response that best characterizes how you feel about
the statement:

Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
I have the opportunity to use what
I learned in my job?
(1) (2) (3) (4) (5)
I believe CRT Training was a good
use of my time?
(1) (2) (3) (4) (5)
After CRT Training, I have
successfully applied what I
learned on the job?
(1) (2) (3) (4) (5)
I have received support from my
supervisor to apply what I have
learned on the job?
(1) (2) (3) (4) (5)
I am seeing positive results from
the CRT Training.
(1) (2) (3) (4) (5)

Please provide feedback for the following questions:

1. Describe any challenges you are facing in implementing culturally responsive therapy.
2. Describe possible solutions to overcome the challenges described.
3. How could CRT Training be improved?

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Asset Metadata

Creator Estrada, Adrian Jr. (author)

Core Title Implementing culturally responsive therapy to serve Latino male clients in mental health

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/29/2020

Defense Date 10/29/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Latino male,Mental Health,OAI-PMH Harvest,therapy

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Seli, Helena (committee chair), Haj-Mohamadi, Sourena (committee member), Phillips, Jennifer (committee member)

Creator Email adrianes@usc.edu,adrianjr3357@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-396877

Unique identifier UC11666711

Identifier etd-EstradaAdr-9157.pdf (filename),usctheses-c89-396877 (legacy record id)

Legacy Identifier etd-EstradaAdr-9157.pdf

Dmrecord 396877

Document Type Dissertation

Rights Estrada, Adrian Jr.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA