In the spectrum of social and human services to racial and ethnic minority populations, disparities exist in all systems in this country; in mental health, education, public health, social services, and the criminal justice system.

Geiger (2001) stated that all over the world, the increased burden of morbidity and mortality afflicts racial and ethnic minorities (See Young T.K., et al, 2000 and Wobeser, W. L., et al., 2000).

In the United States, inferior health status has been documented for African-Americans, Hispanic/Latinos, American Indians, and Asian Americans (DHHS, 2000; National Center for Health Statistics, 1998). In addition, practitioners in the field of mental health remain greatly underrepresented of members from racial and ethnic Minorities.

Cultural Competence is a multifaceted, multi-layered, and multi-systemic intervention whose aim is to eliminate disparities, increase access and utilization, and improve outcomes for people in need of services, that these individuals, regardless of race or ethnicity, receive the best available services they need with dignity, respect, sensitivity, appropriateness, appreciation, and their full participation, as well as that of their families and community (Lopez and Guarnaccia, 2002; Lopez, 1997). For example, Fallot (2001) stated that spirituality and religion were gaining increased research attention because of their possible link to mental health promotion and mental illness prevention. He asserted that research findings, although limited, suggested that various aspects of religious practice, affiliation, and belief were beneficial for mental health.

There are five overarching themes that should be considered in efforts to address cultural competence practice research:

disparities
quality of care
outcomes
process
systemic change

The Seven County Case Study of Cultural Competence has been rooted in a multi-level framework to advance policy, organizational management and practices. The scope of the study warrants a defined structure to align levels of inquiry as data and information are collected, analyzed and reported. Mullen (2001) states that outcome measurement should distinguish among different system levels, and at the very least consider the three levels in mental healthcare: System, Program and Clinical. 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

This was an ambitious 18-month effort which enlisted the participation of numerous county mental health departments through a voluntary application process which was supported by the California Mental Health Directors Association, the California State Department of Mental Health, and numerous other stakeholder organizations in the mental health system.