Special Article
Diversity Initiatives in Academic Psychiatry:
Applying Cultural Competence
Russell F. Lim, M.D., John S. Luo, M.D., Shannon Suo, M.D.
Robert E. Hales, M.D., M.B.A.
Objective: This article describes the process of change in an
academic department of psychiatry that has led to the develop-
ment of a diversity initiative in teaching, research, recruitment,
and services.
Methods: The authors performed a literature review of diversity
initiatives using PubMed. The authors then wrote a case study
of the development of a diversity initiative at UC Davis.
Results: Some articles on diversity initiatives were found, but
none that detailed the administrative process, funding, or sus-
tainability of such initiatives. In 1999, the UC Davis Department
of Psychiatry and Behavioral Sciences recognized the importance
of issues of diversity and established the Diversity Advisory Com-
mittee, a group of department faculty and residents that explores
and addresses the diversity needs of the department. In our ob-
servations, there are at least three requirements for a successful
diversity initiative: a diverse patient population, a “critical mass”
of interested faculty, and support of the administration. With
these three factors in place, the Diversity Advisory Committee
produced four Continuing Medical Education symposia focused
on diversity topics, developed a 4-year cultural psychiatry curric-
ulum and a 4-year religion and spirituality curriculum within the
residency, and supported nine residents who received awards
from the APA’s Minority Fellowships in 8 years. Future plans
include department-wide and medical school faculty-wide diver-
sity training, educational research, and a postgraduate fellowship
in cultural psychiatry.
Conclusion: This article shows that a diversity initiative can be
undertaken with interested minority and nonminority faculty, ad-
Received June 17, 2006; revised November 22, 2006; accepted De-
cember 15, 2006. Drs. Lim, Suo, and Hales are affiliated with the
Department of Psychiatry and Behavioral Science at the University
of California, Davis School of Medicine, in Sacramento, Calif. Dr.
Luo is affiliated with the Department of Psychiatry at the University
of California in Los Angeles. Address correspondence to Russell F.
Lim, M.D., Psychiatry and Behavioral Sciences, UC Davis School of
Medicine, 2230 Stockton Blvd., Sacramento, CA 95817; rflim@
ucdavis.edu (e-mail).
Copyright 䊚 2008 Academic Psychiatry
Academic Psychiatry, 32:4, July-August 2008
ministrative support, and a diverse patient population. The au-
thors hope this article will provide assistance to other academic
departments in developing diversity initiatives.
Academic Psychiatry 2008; 32:283–290
T he mandate for cultural competence in academic cen-
ters is rooted in the civil rights movement of the early
sixties and stems from the desire to interpret the Decla-
ration of Independence to extend basic rights to all citi-
zens. More immediately at hand, the diversity in the popu-
lation of the United States is increasing at a nearly
exponential rate; from 1980 to 2000, the number of Asians
in the United States increased by 240%, Hispanics by
125%, American Indians by 45% and African Americans
by 14%, while the number of Caucasians increased only by
7% (1). The gap between the ethnic make-up of the U.S.
population and physicians/medical students, reflected by
data from the American Association of Medical Colleges
(AAMC) (2), underscores the necessity for clinicians and
researchers to understand how cultural differences affect
diagnosis and treatment (Table 1).
There is a burgeoning literature supporting the incor-
poration of cultural competence and diversity initiatives in
mental health services and academic training, yet there are
only a few articles in the medical journals to date that de-
scribe the development of a comprehensive diversity pro-
gram. There have been examples of one-time interven-
tions, such as a cultural awareness workshop at the
University of Michigan (3), short-term postgraduate year
5 (PGY-5) fellowships, such as seen at UCLA in the late
80’s (4), a cultural curriculum in a forensics fellowship at
the University of Wisconsin (5), and a 4-year curriculum
at Baylor that evolved to encompass religion and spiritu-
ality (6). Of all of these models, the Baylor curriculum is
the closest to ours, but is not as comprehensive as it lacks
a medical student, community, or faculty component, and
http://ap.psychiatryonline.org 283
DIVERSITY INITIATIVES
the article does not give a detailed explanation of how to
sustain the initiative through administrative infrastructure,
support, and funding. One similarity is that the Baylor pro-
gram has continued APA Minority Fellowship participa-
tion (Lomax JW: personal communication, 2006).
The supplement to the Surgeon General’s Report on
Mental Health, entitled “Mental Health: Culture, Race,
and Ethnicity,” states that for African Americans, Asian
Americans, Latino Americans, and Native Americans,
“culture counts.” The report goes on to conclude that all
four groups could benefit from tailoring mental health ser-
vices to their specific needs, which would in turn increase
access to services (7). The Institute of Medicine’s report,
“Unequal Treatment,” (8) indicates that ethnic minority
patients have less access to services and receive a lower
quality of medical and psychiatric treatment, even when
controlling for socioeconomic status. Not to be left out of
the consideration of diversity is the need to address gen-
der, sexual orientation, and spirituality issues. In other
words, to be culturally competent all aspects of cultural
identity formation must be considered (9). The U.S.
Health and Human Services’ National Standards for Cul-
turally and Linguistically Appropriate Services (CLAS) in
Health Care (10), the California Endowment’s three re-
ports on principles and recommended standards (11), re-
sources (12), and a manager’s guide to cultural compe-
tence (13), and the Commonwealth Report (14) all suggest
ways to train mental health professionals and design ser-
vices that are appropriate for underrepresented patients.
Finally, the Institute of Medicine’s report, “In the Nation’s
Compelling Interest: Ensuring Diversity in the Health
Care Workforce” (15), states that diversity of providers is
a crucial element in providing quality health care for all
Americans. Medical education is not ignoring the chal-
lenge: the AAMC (16), along with the Accreditation
Council of Graduate Medical Education (ACGME) (17),
TABLE 1. United States Ethnic Population and Ethnic Academic Faculty in Medical School and in Psychiatry
General population (2000)
African Americans 12.3% (36 million)
Asian 3.6% (10.2 million)
Hispanic 12.5% (35 million)
Native American 0.9% (2 million)
Caucasian 75.1% (211 million)
Male 49.1% (138 million)
Female 50.9% (143 million)
Association of American Medical Colleges: Minorities in Medical Education: Facts and Figures 2005. Available at https://
services.aamc.org/Publications/showfile.cfm?file⳱version42.pdf&prd_id⳱133&prv_id⳱154&pdf_id⳱42
284 http://ap.psychiatryonline.org
and the residency review committee all mandate that cul-
tural competence be included in medical school and psy-
chiatric residency curriculum.
Initial steps in achieving these objectives include the re-
cruitment and retention of ethnic minority faculty mem-
bers, especially those who are interested in teaching all
aspects of cultural competence, as well as encouraging
nonminority faculty to embrace cultural competence
through diversity training and personal exploration. The
ethnic minority faculty members serve as role models and
mentors for ethnic minority medical students who may
then be more likely to be inspired to pursue a career in
psychiatry. Further mentoring by ethnic minority supervi-
sors could encourage ethnic minority psychiatry residents
to become academic faculty and continue the training of
the next generation of psychiatrists. There have been many
articles documenting the importance of mentoring for the
success of minority faculty (18–23). As mentioned previ-
ously in Table 1, data collected by the AAMC suggests that
while academic departments of psychiatry have made some
progress in having their faculty’s ethnic composition match
that of community providers and patients, there is still a
large disparity (2).
Beginnings: A Brief History of the Diversity
Advisory Committee
The UC Davis Department of Psychiatry and Behav-
ioral Sciences (heretofore referred to as the department)
was established in 1969 and is a program that is dynamic
and growing. Since 1995, the department has more than
doubled in size from 25 faculty members to over 80 at the
present time. Sacramento has also grown and diversified
over the last 20 years; it was described as “America’s most
integrated city” by Time magazine in 2002 (24). A diverse
patient population made Sacramento a good candidate for
a diversity initiative. The department has a historically
Medical school faculty (2004) Psychiatry faculty (2004)
3.1% (3,552) 3.1% (113)
12.6% (14,401) 7.2% (186)
3.9% (4,568) 4.0% (88)
0.1% (117) 0.1% (13)
72.2% (82,656) 75.4% (5,916)
69% (77,947) 63% (4,745)
31% (35,471) 37% (2,729)
Academic Psychiatry, 32:4, July-August 2008
 LIM ET AL.

close relationship with Sacramento County, placing mental
health professionals in inpatient and outpatient settings
throughout the county system. Currently, the Medical Di-
rector of the county is the departmental chair (REH). As
the department and the county grew, it became increas-
ingly apparent that more attention should be given to is-
sues of diversity in order to address the needs of the pa-
tient population. In recognition of these diverse needs, the
department recruited many psychiatrists and psychologists
of minority/cultural backgrounds for core teaching roles
and today ethnic minority faculty members represent a
third of the total faculty. This is the second requirement
for a diversity initiative: a broad foundation for the Diver-
sity Advisory Committee (DAC)—a “critical mass” of in-
terested parties. Without this “critical mass” little work can
be done because the tasks of teaching and coordinating
cultural psychiatry fall on one or two minority faculty.
Likewise, the quality of the cultural education is dimin-
ished if the faculty does not include representatives from
each of the four major federally recognized ethnic groups.
Finally, the DAC has three important functions: it works
together and brainstorms about ideas, provides support for
its members, and represents the DAC in important com-
mittees of the department, such as the Training Executive
Committee.
The DAC consists of faculty and trainees interested in
diversity issues related to training, clinical services, and
research who meet regularly to address these needs in the
department. The first incarnation of the DAC came into
being at the 1999 Psychiatry Department Faculty Strategic
Retreat, where the absence of diversity issues in reports by
the various departmental groups was noted. At that meet-
ing, the department chair authorized the creation of a
workgroup whose charge was to examine diversity issues
in the department. This represents the third and final re-
quirement for a successful diversity initiative: administra-
tive support. Interested minority and nonminority faculty
members were eager to join the workgroup, which met
over the summer of 1999, and developed a document
called “Recommendations for the Strategic Report and a
Proposal for a Diversity Workgroup,” which was reviewed
and approved by the Departmental Executive Committee
(Table 2). In response to the recommendations, the Di-
versity Advisory Workgroup was formed, and began to
meet monthly in February 2000. In June 2000, the name
of the workgroup was changed to the DAC to reflect the
ongoing process of development and recognize its integra-
tion into the department administrative structure. The de-
partment chair also gave the DAC a yearly budget to invite
nationally recognized experts in cultural psychiatry to
come to UC Davis and present culturally oriented topics
at Grand Rounds (Table 3). These speakers raised the
DAC’s profile in the department and academic commu-
nity, enlarged the DAC’s network of collaborators, and
facilitated our committee’s academic work with thoughtful
consultations.
Paving the Way for a Diversity Committee
Before discussing other projects that the Diversity Ad-
visory Committee has initiated, we will discuss some of the
barriers to a diversity initiative, and how the DAC at UC
Davis has overcome them. Because of the growing size of
our department, our faculty has become spread out over

TABLE 2. Diversity Advisory Committee Statement of Purpose

To pool the resources available for interested faculty and trainees, to coordinate efforts to teach diversity issues, research ethnic
minority treatment issues, deliver culturally appropriate care, and to focus efforts on increasing diversity within the Department of
Psychiatry.

OBJECTIVES
1. To encourage the development of scholarly work, such as research, innovative services and training, and publications in the area of
cultural competence.
2. To extend the scope of training by producing CME conferences, books, articles, Grand Rounds talks, etc., that will include
collaboration with other academic departments of psychiatry.
3. To promote the dissemination and implementation of cultural competence mandates, and to advise the chairman, the Department
Executive Committee, the Training Advisory Committee (now known as the Training Executive Committee), the Grand Rounds
Committee, and any other clinical, training, or research-oriented group on how these mandates affect them.
4. To develop a reputation for the Department of Psychiatry as a leader in the field of cultural psychiatry; to be a model program in
training, services, and research.
5. To encourage liaisons with interested individuals and parties, such as the Department of Family Practice, the National Research
Center for Asian American Mental Health, and other disciplines, such as psychology, anthropology, social work, nursing, etc.
6. To locate and recruit local experts in cultural psychiatry in the Sacramento Valley area to create a referral network for use by
clinicians, trainees, and researchers.

Academic Psychiatry, 32:4, July-August 2008 http://ap.psychiatryonline.org 285

DIVERSITY INITIATIVES
the Sacramento area to approximately 22 different sites.
Most of the minority faculty are relatively junior and thus
are not well established in the formal infrastructure of the
department. A new mentoring initiative led by our faculty
development director partnered junior and senior faculty,
but there was a need for a forum to discuss issues of cul-
tural competence in training, services, and research, and
the DAC fulfilled that need. In addition, the DAC also
performs a support function—creating a safe environment
for faculty and residents to explore similar values and in-
terests, as well as giving them helpful advice about pro-
motion and jobs after residency.
Funding is always a major barrier to new initiatives, but
since most of the teaching done by the DAC is part of the
core curriculum and the faculty members are the instruc-
tors, there are few costs involved. Our teaching faculty and
committee chair receive credit in the faculty compensation
plan for the time and energy spent on the DAC (25). In
addition, funding from the department has been received
to develop annual retreats, to invite consultants with na-
tional reputations for advice and grand rounds, and to sup-
TABLE 3. Grand Rounds Topics 2000–2006
• Cultural Competence: Training and Systems Perspectives
• Religion and Spirituality: Psychiatry Takes a New Look
• Overcoming Non-Adherence to Psychotropic Medications:
A Cultural Perspective
• Racism, Culture and Trauma: The Japanese American Case
Study Children of the Camps
• Clinical Issues in Cultural Psychiatry: Native American
Perspectives
• Mental Health Treatment and Services for Asian Americans:
Some Advances and Many Challenges
• Culture and Psychopathology: Foundations and Directions
• The Surgeon General’s Report on Mental Health:
Implications for Hispanic Mental Health
• The Surgeon General’s Supplement to The Report on
Mental Health, Asian American Issues
• Suicide and Hispanics: A Cross-Cultural Perspective
• Mental Health: Culture, Race, and Ethnicity: A Supplement
to Mental Health: A Report of the Surgeon General
• Translating Research Into Practice: Reducing Disparities in
Mental Health Care for Mexican Americans
• Models of Mental Health Care for Multicultural Societies
• Emerging Challenges in International Mental Health
• Global Mental Health: Implications for American Psychiatry
• Massive Psychiatric Trauma in Refugees: The Patients and
Their Doctors
• Clinical Work with Refugees from the Former Soviet Union
• Personality Disorders and Culture: Clinical and Therapeutic
Perspectives
• Co-Morbid PTSD and Substance Use Disorder Following
Trauma in Refugees and Ethnic Minorities
• Psychiatry and Religion
• Primary Care and Cultural Competence
286 http://ap.psychiatryonline.org
port CME symposiums which help spread our mission to
teach cultural psychiatry throughout the medical school
and community. Funding for the CME symposiums were
supplemented by unrestricted educational grants from
pharmaceutical companies. The APA Minority Fellows
support the DAC indirectly with their funds, as their aca-
demic projects can be funded through their stipends, and
on two occasions those stipends have been used to offset
CME symposium expenses. CME symposia can also pro-
vide another source of financial support for the committee.
Finally, being a part of the departmental yearly budget en-
sures that diversity issues will always be a focus of the de-
partment.
Though resident participation is valued, the DAC ini-
tially did not include residents. The group recognized that
residents’ schedules are hectic and unpredictable and it
was thought that their inconsistent attendance would de-
tract from the momentum needed to get the group off the
ground. Once the group had developed an identity through
regular attendance of core members, residents were in-
vited to attend the meetings as their schedules allowed and
now medical students are welcome as well.
Diversity topics can sometimes be divisive and can
arouse powerful emotions. The group is run by consensus
and mutual respect, creating an atmosphere where people
feel comfortable sharing potentially controversial ideas
and opinions. The group was large enough to need a di-
rector, so a chair was selected by committee vote to facili-
tate communication with the department and to organize
the members. The chair capitalizes on the informal struc-
ture of our department by meeting briefly and frequently
with the department chair, the residency-training director,
and residency clerical administrators, either by e-mail or
personal contact. The department chair also supports the
DAC’s chair by giving him academic credit and financial
support in the faculty compensation plan (25) for leading
the group, which is critical because of the time commit-
ment needed to sustain the group.
Products and Accomplishments
The Diversity Advisory Committee has been the recip-
ient of many awards and honors. Three members of the
DAC have been recognized for their community service to
UC Davis by receiving the Chancellor’s Achievement
Award in Diversity and Community in 2004, 2005, and
2006, and many other members have received recognition
for teaching. The 4-year Religion and Spirituality curric-
ulum won the Templeton Award in 2003. The DAC re-
cently received the American College of Psychiatrists’
Academic Psychiatry, 32:4, July-August 2008

Award for Creativity in Psychiatric Education for 2007. We
have also had the good fortune to be granted an endowed
Professorship of Cultural Psychiatry, The Luke and Grace
Kim Professor of Cultural Psychiatry, which was approved
by the School of Medicine as of spring 2007.
Another important activity has been the recruitment of
medical students, residents, and faculty. The DAC has
been active in encouraging minority medical students to
enter psychiatry, thus increasing the ethnic diversity of our
own program as well as that of the medical specialty in
general. The recruitment of medical students fosters the
development of ideas for research and supports education
in cultural psychiatry at the trainee level. In addition, re-
cruiting psychiatry residents to become academic faculty
and recruiting senior faculty to mentor our junior faculty
is part of the continuing process toward developing diver-
sity across the domains of research, teaching, and clinical
services.
In order to stimulate academic discussions, the DAC
started a journal club as well as a works-in-progress meet-
ing to stimulate the production of publications and pro-
jects. The journal club has been an excellent stimulus for
discussion of issues such as resident training in cultural
psychiatry, mental health services utilization, and national
policies. The DAC’s latest initiative is a monthly case con-
ference using the DSM-IV-TR Outline for Cultural For-
mulation (26), which has been a stimulus for one published
paper (27) and several manuscripts in preparation. In ad-
dition, these meetings have been vital in providing a forum
for discussion and review of research projects and other
scholarly work, as well as a venue for resident psychiatrists
to see the benefits of a career in academic psychiatry. The
mentorship relationships built during our meetings en-
courage residents to strongly consider a career in academic
medicine because they are integrally involved in many of
the educational and clinical influences of the DAC. Faculty
members, in turn, have developed informal mentoring re-
lationships with each other and, with the more junior
members, learning valuable teaching and mentoring skills
through their own mentoring process. For more formal
relationships, the DAC uses the resources of the faculty
development office, which pairs faculty in a department-
recognized mentoring relationship with more structured
goals and expectations for both parties.
The Diversity Advisory Committee has been quite active
in developing new curricula for the residents by virtue of
its role on the Training Executive Committee. Our resi-
dents’ exposure to cultural psychiatry has been increased
over the years by creating a first-year course entitled In-
Academic Psychiatry, 32:4, July-August 2008
LIM ET AL.
troduction to Cultural Psychiatry and then expanding the
first-year course from one hour to five. Residents continue
their exposure to diversity issues in their second year, with
a 10-hour course that focuses on the DSM-IV-TR Outline
for Cultural Formulation (26) as well as presentations on
various ethnic groups and ethnopsychopharmacology. We
also have a 6-hour course in the third year on psychother-
apy and culture and, in the fourth year, we provide an
average of 6 hours for the advanced course, where resi-
dents present a case using the Outline for Cultural For-
mulation to a cultural consultant. The committee has also
supported the development of the 4-year Religion and
Spirituality curriculum, which won the John Templeton
Award for Spirituality and Medicine in 2003. The success
of the committee in developing courses has led to the crea-
tion of a cultural track that is part of the curriculum’s or-
ganizing priniciples. The DAC is also involved in medical
student education by giving lectures on how to use inter-
preters, cultural aspects of schizophrenia and psychophar-
macology, and 2 hours of Case Interactives in the psychi-
atry clerkship, which involve a cultural identity exercise
and uses cases to teach cultural issues in a small group
format. In addition, all of the DAC faculty members in-
corporate principles of cultural competence in their su-
pervision with residents. The vice chair of the DAC is a
coprimary investigator of an AAMC grant to study the
adoption of cultural competence principles in medical edu-
cation, one of four schools in California to participate in
this program that provides funding of $150,000 a year for
three years. As part of the full spectrum of cross-cultural
psychiatric education, the DAC plans to develop a post-
graduate fellowship for psychiatry residency graduates
seeking further training in cultural psychiatry. The DAC
has also sponsored four annual CME symposia that were
all well attended and well received (Table 4).
The faculty development seminars that were held in
2004 were an exciting program enhancement. Five cultural
psychiatry experts were invited to come to Sacramento to
TABLE 4. CME Programs Sponsored by the Diversity
Advisory Committee
Cross-Cultural Challenges in the Assessment and Treatment
of Posttraumatic Stress Disorder, 2001
Culturally Competent Care of People with Dual Diagnosis,
2002
Working With Diverse Populations: Practical Approaches for
Mental Health, 2003
Promoting Wellness in Refugee Families: A Mental Health
Perspective, 2005
http://ap.psychiatryonline.org 287
DIVERSITY INITIATIVES
present half-day training, which was a repeat of training
done at the University of California at San Francisco
(UCSF) the day before. There were five plenary sessions,
one on the DSM-IV-TR Outline for Cultural Formulation,
another on ethnopsychopharmacology, and three case dis-
cussions (African American, Asian American, and His-
panic American) using the Outline for Cultural Formula-
tion. Using this framework, 60–80 faculty and staff at
UCSF and 15 at UC Davis were trained in one day in the
use of the DSM-IV-TR Outline for Cultural Formulation
and educated about specific considerations within ethnop-
sychopharmacology. The training was based on a course
that the first author has run for 13 years at the APA Annual
Meeting, which also led to the publication of the Clinical
Manual of Cultural Psychiatry in 2006 (28).
The Diversity Advisory Committee has also promoted
improvements in the delivery of care in clinical settings by
supporting the development of a Cultural Consultation
Service for Sacramento County. The service provides con-
sultation for patients receiving care from the county’s men-
tal health system whenever the lack of attention to culture
has been identified as a possible barrier to care (29). The
Cultural Consultation Service provides an ideal vehicle for
the development of cultural case formulation presenta-
tions for meetings and publication. All Sacramento
County-contracted mental health providers are able to re-
quest a consultation, which consists of an extensive inter-
view or interviews with the patient, clinical team, and care-
givers, if applicable. The consultant uses the DSM-IV-TR
Outline for Cultural Formulation as a format in which to
present a formulation and to inform the treatment team
about possible ways to improve the care of the patient in
a culturally informed manner (30). This clinical service was
specifically cited by the dean in the school of medicine’s
2005 Outstanding Community Service Award from the
American Association of Medical Colleges.
The DAC’s members have published articles about
qualitative research involving the development of the Cul-
tural Consultation Service (29), as well as the study of His-
panic elderly caregivers (31–32). A future project is the
development of standardized patients for the training and
evaluation of cultural competence skills in psychiatry res-
idents. Our curricula is monitored and adjusted yearly and
we plan to spend some time developing ways of helping
trainees explore their cultural identities, as in previous pro-
grams (6). A more immediate goal is to encourage the
development of research skills and encourage collabora-
tions with other groups. A proposed partnership includes
the department of psychology at UC Davis, which has fac-
288 http://ap.psychiatryonline.org
ulty members that lead the Asian American Center on Dis-
parities Research, formerly known as the National Re-
search Center for Asian American Mental Health
(NCRAAMH), or the National Center for Minority
Health and Health Disparities (NCMHD). The challenge
is to find projects that appeal to both collaborators and
make the best use of combined resources: access to pa-
tients, special expertise in psychological measurements, or
ethnography.
Residents as the Future of Cross-Cultural
Psychiatry
To develop future leaders in cross-cultural psychiatry as
well as to increase the number of minority physicians in
leadership roles, the Diversity Advisory Committee began
to nominate residents for the APA/Center for Mental
Health Services (APA/CMHS) Minority Fellowship in
2001, now known as the APA/Substance Abuse and Mental
Health Services Administration (APA/SAMHSA) Minor-
ity Fellowship, and the APA Minority/AstraZeneca Phar-
maceuticals Fellowship. These efforts have been very suc-
cessful with nine resident fellows in 8 years: seven APA/
CMHS and APA/SAMHSA Minority Fellows from 2001–
2008 each received between $10,000 and $42,000 for the
development of cross-cultural education and research, and
two APA/AstraZeneca Pharmaceuticals Minority Fellows
for 2005–2008 received travel support to attend APA meet-
ings. The fellowships not only increase the resources avail-
able for research and training, but also provide residents
with an excellent introduction to APA governance and in-
valuable networking opportunities at APA Fall Compo-
nents, Institute for Psychiatric Services, and APA Annual
Meetings. Beyond the nomination process, the DAC mem-
bers mentor the fellows in their research, education, and
service interests and facilitate their activities in APA. One
of our former fellows (SS) is now a member of the Vol-
unteer Clinical Faculty, is a training site director, and is
active in the residency-training program’s curriculum.
Strategic Planning
Arrendondo (33) suggests that a strategic plan is essen-
tial for the development of a successful cultural compe-
tence program, and this is the approach used by the Di-
versity Advisory Committee. The first step in planning was
to build a consensus. The DAC was started with a frame-
work of clinical services, education, and research to mirror
the mission of the department of psychiatry. The group
was broken up into smaller groups of persons interested
Academic Psychiatry, 32:4, July-August 2008

in each area, and those groups developed needs analyses
for each domain.
Another task was to analyze each group’s presentation
at the retreat and suggest how they could address diversity.
A statement of purpose was developed, along with short
and long-term goals (Table 2). Finally, the group agreed
to meet on a regular basis to develop ideas for education,
services, and research. Many group members have ex-
pressed that meeting regularly gave them a sense of be-
longing that they could not find in other places, as well as
mentorship and faculty development. Although some of
the DAC’s members have left the department, the vast
majority have been with the department for at least four
years. In addition, due to recruitment efforts there contin-
ues to be an influx of new minority faculty to maintain a
critical mass. The DAC has been successful in creating an
infrastructure for strategic planning with an annual retreat
to set our goals for the next year.
Being a part of the department infrastructure has been
an essential component to the early and impressive success
of the diversity initiative. The DAC has representatives on
the Training Executive Committee, the Departmental Ex-
ecutive Committee, the Grand Rounds Committee, the
Psychiatric Academic Council, and the Resident Selection
Committee. Because of these successes, the DAC has be-
come a recruiting tool for our department to attract ethnic
minority psychiatrists to join our faculty as well as to en-
courage ethnic minority medical students to join our resi-
dency-training program. At the medical school level, the
DAC has two representatives on the dean’s Diversity Ad-
visory Council, which was modeled after our own DAC.
Conclusion
The Diversity Advisory Committee has been a challeng-
ing and wonderful experience in administration and edu-
cation in psychiatry, showing that a special interest group
can be a powerful way to create organizational change in
teaching, clinical services, research, and organizational
culture. Several key elements for success were a critical
mass of ethnic minority and mainstream faculty interested
in diversity; a diverse patient population and service com-
mitments to that population; financial and salary support
from the department chair; an identified leader who can
build consensus and coordinate people and activities; rep-
resentation in the infrastructure of the department; a stra-
tegic plan, statement of purpose, and a list of ongoing ob-
jectives; a willingness to invest in the future by recruiting
medical students and faculty to join our department and
Academic Psychiatry, 32:4, July-August 2008
LIM ET AL.
increase our ethnic representation; and an interest in net-
working with faculty from other institutions.
Margaret Mead said, “Never doubt that a small group
of thoughtful, committed citizens can change the world.
Indeed, it is the only thing that ever has” (34). We believe
that the DAC is making a difference and encourage other
departments of psychiatry to adapt this model to further
the development of long-lasting diversity initiatives within
their own institutions.
References
1. US Census Bureau: Profiles of General Demographic Char-
acteristics 2000. Census of Population and Housing-United
States 2000. Available at www.census.gov/prod/cen2000/dp1/
2kh00.pdf
2. Association of American Medical Colleges: Minorities in Medi-
cal Education: Facts and Figures 2005. Available at https://
services.aamc.org/Publications/showfile.cfm?file⳱version42.pdf
&prd_id⳱133&prv_id⳱154&pdf_id⳱42
3. Loboprabbu S, King C, Albucher R, et al: A cultural sensitiv-
ity training workshop for psychiatry residents. Acad Psychiatry
2000; 24:77–84
4. Yager J, Chang C, Karno M: Teaching transcultural psychia-
try. Acad Psychiatry 1989; 13:164–171
5. Layde JB: Cross-cultural issues in forensic psychiatry training.
Acad Psychiatry 2004; 28:34–39
6. Moffic HS, Kendrick EA, Reid K, et al: Cultural psychiatry
education during psychiatric residency. J Psychiatr Education
1988; 12:90–101
7. US Department of Health and Human Services, US Surgeon
General’s Office: Mental Health: Culture, Race, and Ethnic-
ity, a Supplement to Mental Health: A Report of the Surgeon
General, 2001. Available at www.surgeongeneral.gov/library/
mentalhealth/cre
8. Smedley BD, Stith AY, Nelson AR (eds), Institute of Medi-
cine: Unequal Treatment: What Health Care Providers Need
to Know About Racial and Ethic Disparities in Healthcare,
2002. Available at www.nap.edu/books/030908265X/html/
9. Lu FG, Lim RF, Mezzich JE: Issues in the assessment and
diagnosis of culturally diverse individuals, in American Psy-
chiatric Press Annual Review of Psychiatry, Volume 14. Ed-
ited by Oldham J, Riba M. Washington, DC, American Psy-
chiatric Press, 1995, pp 477–510
10. Office of Minority Health: Culturally and Linguistically Ap-
propriate Services (CLAS) Standards, 2000. Available at
www.omhrc.gov/clas/indexfinal.htm
11. California Endowment: Principles and Recommended Stan-
dards for Cultural Competence Education of Health Care Pro-
fessionals, 2003. Available at www.calendow.org/reference/
publications/pdf/cultural/TCE0215–2003_Principles_and.pdf
12. California Endowment: A Manager’s Guide to Cultural Com-
petence Education for Health Care Professionals, 2003. Avail-
able at www.calendow.org/reference/publications/pdf/cultural/
TCE0217–2003_A_Managers_Gui.pdf
http://ap.psychiatryonline.org 289
DIVERSITY INITIATIVES
13. California Endowment: Resources in Cultural Competence
Education for Health Care Professionals, 2003. Available
at www.calendow.org/reference/publications/pdf/cultural/TCE
0218–2003_Resources_in_C.pdf
14. Betancourt JR, Green AR, Carrillo JE: Cultural Competence
in Health Care: Emerging Frameworks and Practical Ap-
proaches. The Commonwealth Fund, Oct 2002. Available at
www.cmwf.org/usr_doc/betan-
court_culturalcompetence_576.pdf
15. Smedley BD, Stith AY, Bristow LR (eds), Institute of Medi-
cine: In the Nation’s Compelling Interest: Ensuring Diversity
in the Health Care Workforce, 2004. Available at www.
nap.edu/books/030909125X/html/
16. Association of American Medical Colleges: Report #3. Con-
temporary Issues in Medicine: Communication in Medicine,
Oct 1999. Available at aamc.org/meded/msop/msop3.pdf
17. Accreditation Council of Graduate Medical Education: Pro-
gram Requirements for Residency Training in Psychiatry. Avail-
able at www.acgme.org/acWebsite/downloads/RRC_progReq/
400pr1104.pdf
18. Darley JM, Zanna MP, Roediger HL: The Compleat Aca-
demic: A Career Guide, 2nd ed. Washington, DC, American
Psychological Association, 2003, pp 295–328
19. Gates PE, Ganey JH, Brown MD: Building the minority fac-
ulty development pipeline. J Dent Educ 2004; 67:1034–1038
20. Kay J, Silberman EK, Pessar L: Handbook of Psychiatric Edu-
cation and Faculty Development. Washington, DC, American
Psychiatric Press, 1999, pp 95–123
21. Parker D: A workshop on mentoring across gender and cul-
ture lines. Acad Med 2002; 77:461
22. Wong EY, Bigby J, Kleinpeter M, et al: Promoting the ad-
vancement of minority women faculty in academic medicine:
the national centers of excellence in women’s health. J Wom-
ens Health Gend Based Med. 2001;10:541–550
23. Lim RF, Primm AB, Hilty DM: Strategies for women, minor-
ity and other under-represented faculty: advice for women,
290 http://ap.psychiatryonline.org
ethnic minorities, and gay, lesbian, bisexual, and transgender
(GLBT) early career psychiatrists, in Handbook of Career
Development in Academic Psychiatry and Behavioral Sci-
ences. Edited by Roberts LW, Hilty DM. Arlington, Va, Amer-
ican Psychiatric Publishing, 2006
24. Stodghill R, Bower A: Welcome to America’s most diverse
city. Time, Aug 25, 2002. Available at www.time.com/time/
nation/article/0,8599,340694,00.html
25. Hales RE, Shahrokh NC, Servis M: A department of psychi-
atry faculty practice plan designed to reward educational and
research productivity. Acad Psychiatry 2005; 29:244–248
26. American Psychiatric Association: Appendix I: Outline for
cultural formulation and glossary of culture-bound syn-
dromes, in Diagnostic and Statistical Manual, 4th ed, Text Re-
vision. Washington, DC, American Psychiatric Publishing,
2000, pp 897–903
27. Shen H, Chiu S, Lim RF: Cross-cultural issues in Asian Amer-
ican youths. Adolesc Psychiatry 2005; 29:315–342
28. Lim RF (ed): Clinical Manual of Cultural Psychiatry. Arling-
ton, Va, American Psychiatric Publishing, 2006
29. Ton H, Koike A, Hales RE, et al: A qualitative needs assess-
ment for development of a cultural consultation service. Tran-
scult Psychiatry 2005; 42:491–504
30. Kirmayer LJ, Groleau D, Guzder J, et al: Cultural consulta-
tion: a model of mental health service for multicultural soci-
eties. Can J Psychiatry 2003; 48:145–153
31. Hinton L, Franz C, Friend J: Pathways to dementia diagnosis:
evidence for cross-ethnic differences. Alzheimer Dis Assoc
Disor 2004; 18:134–144
32. Hinton L, Franz CE, Yeo G, et al: Conceptions of dementia
in a multiethnic sample of family caregivers. J Am Geriatr Soc
2005; 53:1405–1410
33. Arredondo P: Successful Diversity Management Initiatives.
Thousand Oaks, Calif, Sage Publications, 1996
34. Mead M: Margaret Mead Quotes—The Quotations Page.
Available at www.quotationspage.com/quotes/Margaret_Mead/
Academic Psychiatry, 32:4, July-August 2008