The Seven County Case Study of Cultural Competence (CMD-7) was rooted in a multi-level framework to advance policy, organizational management, and service delivery with the express purpose of operationalizing cultural competence to improve consumer outcomes. The study acknowledged that culturally competent interventions must occur at three critical levels to fully realize system change: (1) policy; (2) program; and (3) clinical. Utilizing an Ethnographic/Qualitative approach, twenty-one practices/programs were studied.

Diverse teams of mental health consumers, family members, direct services providers, administrators, and policy-makers contributed their expertise to the project in multiple capacities. Various data sources were reviewed in each county and within each individual practice/program. Overall, the grounded theory methods were effective for collecting and analyzing the data and the composition of the research team contributed to the Study's success. The results suggest that California has indeed manifested a paradigm shift in cultural competence. Among the practices/programs studied many promising and effective interventions are occurring that provide the research community and policy-makers with relevant hypotheses to consider. California is ripe for future research and evaluation activities in cultural competence.

The following table summarizes pertinent levels of measurement and aligns both the purpose and target of inquiry to each level. This table does not represent an exhaustive approach to the Study, but does provide a context while also helping to identify supplementary areas for investigation.

Level of Inquiry	Area of Influence	Target of Investigation
System Level	Public Policy	Population-Based Inquiry
Program Level	Organization/Management	Program Evaluation
Clinical Level	Practices and Interventions	Evidenced-Based Practice