Cultural Competence Initiatives


Cultural Competence Philosophy & Practices

RAMS has over 40 years of experience and expertise in providing culturally competent services to the community. Founded in San Francisco's Richmond District in 1974, RAMS offers comprehensive services that aim to meet the behavioral health, social, vocational, and educational needs of the diverse community in the San Francisco Area with special focus on the Asian & Pacific Islander American and Russian-speaking populations. The agency was founded in response to the overwhelming need for culturally inclusive, competent, and appropriate mental health services that were accessible to the residents of the Richmond District; today, RAMS has expanded and enhanced its array of programming to offer varying levels of care and services on-site at various community settings, and more. In addition, RAMS actively participates in advocacy efforts and campaigns to enhance access to care and that raises awareness about mental health. The agency and its programs continue to be known by the local, national, and international community for its innovation and cultural competence. 

RAMS is recognized as a leader in providing culturally competent services, and our programs’ breath, depth, and extensiveness have afforded the agency with a highly regarded reputation. As a result, the agency has received acknowledgements such as: Asian American Psychological Association, Mayor’s Committee for the Employment of People with Disabilities, San Francisco Department of Public Health, California Department of Rehabilitation, San Francisco International Program, National Asian American Pacific Islander Mental Health Association, and various local and regional representatives (e.g. Mayor Gavin Newsom, SF Board of Supervisors, U.S. Senator Dianne Feinstein, Senator Leland Yee, and former Senator Jackie Speier) for contributing to the community. 

As such, RAMS has played a key role in defining and implementing culturally competent mental health and integrated behavioral health services in San Francisco. The agency's philosophy of care reflect values that recovery & rehabilitation are more likely to occur where the mental health systems, services, and providers have and utilize knowledge and skills that are culturally competent and compatible with the backgrounds of consumers and their families and communities, at large. 

RAMS implements its commitment to cultural competent practice through many activities and initiatives such as:

  • Culturally Competent Treatment in Client's Primary and/or Preferred Language +
  • Majority of the RAMS client population have indicated a non-English language/dialect as their primary/preferred language for treatment services, with a significant portion being an Asian & Pacific Islander or Russian language. As such, the agency maintains policies and procedures to recruit, retain, and promote at all levels a diverse staff and leadership that reflect the multi-cultural, multi-lingual diversity of the community. When providing services to clients, not only does RAMS take into consideration the primary/preferred language for services but also the immigration status and level of acculturation. The agency offer services in over 30 languages, including Asian languages, Spanish, and Russian. In addition, RAMS is conscious of and responsive to the linguistic and literary needs of the community and displays and distributes multi-lingual health information material, signage, and treatment-related documents.

  • Strengthen and Empower the Roles of Consumers and their Families +
  • Cultural competence involves the empowerment, active participation, employment, and involvement of consumers, such that the agency and program structure and services are consumer-driven. RAMS engages in strategies and activities such as:
    • Offer peer counseling services, at various RAMS programs
    • Offer training, education & consultation on peer counseling
    • Develop, coordinate, and facilitate multi-lingual client councils and advisory groups to inform agency and program structure & services and policies & practices
    • Distribute program-specific client satisfaction surveys that are culturally relevant with translation, as appropriate. Surveys are also distributed to family members. 
    • Facilitate consumer participation and representation at all levels, such as recruiting consumers as staff and involvement with the RAMS Board of Directors
    • Tailor services and therapeutic techniques specific to consumers’ needs and reaching out to consumers and provide services in their natural environments
    • Develop and operate the Peer Specialist Mental Health Certificate Program (in collaboration with SF State University) which is a 12-week program designed to prepare consumers and/or family members for employment in the behavioral health system of care
    • In addition, RAMS has engaged consumers to be involved in the development of several booklets such as How to Be a Smart Consumer in Managed Care and Consumer Satisfaction Report Card. These booklets were published in five Asian languages: Chinese, Tagalog, Cambodian, Vietnamese and Korean. RAMS also played an active role in the development of The Wellness Guide, a bilingual Chinese/English publication of community resources including health care, elder care, prenatal care, mental health, and community advocacy organizations (produced by U.C. Berkeley with funding by the California Endowment). RAMS has provided consultation services to translate documents and materials for the community, such as the California Institute of Mental Health, SF Department of Public Health, and Asians Against Violence.

  • Integrating the Client’s Practice of Holistic & Complementary Health Beliefs within the Scope of Care +
  • Working with cultural competence is an integral aspect and fundamental principle for RAMS’ organizational and program development, planning, polices & procedures, service implementation, staff recruitment & employment practices, and outreach & referral. RAMS respects and honors clients’ holistic & complementary health and medicinal beliefs and engages in ongoing training activities to gain knowledge and understanding about various cultural practices. Also, the agency strives to integrate these activities through collaborative efforts to offer complementary services such as: yoga, acupuncture, movement-oriented groups, literary and music groups, and arts therapy. To further support the consumer’s engagement in the community, RAMS has an established agreement to obtain donated tickets to various performing arts, cultural, and sporting events to be utilized by clients and their families.

  • Wellness Recovery Perspective +
  • RAMS has a well-established record for providing integrated behavioral health services (mental health and substance abuse) that is inclusive of the wellness recovery perspective, with programming such as the Wellness Centers Program and the PAES Counseling & Pre-Vocational Services, located at 15 high school campuses and the SF Department of Human Services, respectively.

    The wellness recovery perspective is also integral in organizational and programmatic policy & procedures that uphold and reflect the vision for a culturally competent, accessible, and integrated system of care in which “any door is the right door” for those seeking services. RAMS maintains a Welcoming and Access Policy, which describes practices that eliminate barriers to access of services for adults, adolescents, children, and their family members, in the request for assistance with mental health, substance abuse or co-occurring disorders. Additional policies and procedures at RAMS also reflect the philosophies of harm reduction and equal access as well as treatment for individuals with co-occurring (mental health and substance use/abuse). In the most recent re-accreditation visit by the Commission for Accreditation of Rehabilitation Facilities (CARF), the outcome report noted that the "organization has a strong recovery focus, resulting in high satisfaction and outcome scores."

    In addition, RAMS maintains Behavioral Health Integration Partnership agreements with San Francisco Veteran’s Administration Medical Center (SFVAMC) Substance Abuse Programs and Horizons Unlimited to further strengthen and support our coordination of wellness recovery services. The SFVAMC Substance Abuse Programs offers structured care for adults through all stages of recovery, and include specialized programs such as day hospital, anger management classes, and opiate replacement therapy; Horizons is a youth development and empowerment organization rooted in community service and advocacy providing culturally competent and linguistically sensitive programs that are driven by the needs of our youth and reflect the diversity of the population served. As partners in the community, RAMS coordinates with SFVAMC Substance Abuse Programs and Horizons Unlimited for services to meet the needs of the adults or children, youth, and their families who present with mental health and/or substance abuse/dependence issues. Also, RAMS maintains Primary Care Integration Agreements with Ocean Park Health Center and Community Health Programs for Youth (SF DPH) to support joint referrals, cross-staff education & program awareness, and cross neighborhood leveraging of resources.

  • Enhancing the Accessibility of Culturally Competent and Community-Based Services +
  • RAMS provides a community-based system of care that includes a full continuum of services. The focus is on treating the consumer in the least restrictive community setting (e.g. outpatient, residential care, vocational training program, schools, community centers), and investing in early intervention and prevention efforts (e.g., consultation programs to 0-5 year olds in pre-school and community building efforts). Services and facilities are made geographically accessible by providing services in more than 80 different sites including schools, childcare centers, youth centers, resource and community centers for refugees and other social service agencies. RAMS also offers evening clinic hours. To respect the cultural beliefs of many Asian immigrants and refugees, holistic approaches to assessment and treatment are encouraged and highly valued.

  • Leadership in the Training and Development of Culturally Competent Mental Health Professionals +
  • RAMS offers valuable clinical training for both undergraduate and graduate students in the fields of psychology, social work, counseling, nursing, medicine, psychiatry, and other mental health disciplines. The National Asian American Psychology Training Center (NAAPTC) provides training for APA-approved, full-time Doctoral psychology internship; post-doctoral psychology internships are also offered. The training approach is rooted in psychodynamic orientation and emphasizes contemporary relational approaches to working with individuals with severe mental illness, who make up a substantial proportion of the clientele. RAMS maintains a collaboration with the San Francisco Center for Psychoanalysis whose members provide clinical supervision, serve as discussants at clinical case conferences, and conduct didactic trainings on clinical issues. Funded in the past by the National Institute of Mental Health, NAAPTC is the first training program in the United States to focus on the development of psychologists with expertise in working with the Asian & Pacific Islander American population. Also, RAMS played an instrumental role in collaborating with National Asian American Pacific Islander Mental Health Association (NAAPIMHA) to develop the Growing Our Own curriculum, the first national effort in creating a core curriculum for mental health related disciplines to provide culturally competent services to the Asian & Pacific Islander communities.

    In addition, RAMS offer training and education on peer counseling services as well as operates the Peer Specialist Mental Health Certificate program (in collaboration with San Francisco State University Department of Counseling) which is a 12-week program designed to prepare consumers and/or family members of underrepresented workforce members with the basic skills & knowledge for entry-level employment in the behavioral health system of care and with academic/career planning that supports success in institutions of higher learning. Funded by the Mental Health Services Act (MHSA), currently, there are a limited number of such similar programs nationally, and with locality in San Francisco. This is empowerment through bridging community and academia. Previously, RAMS (as a sub-contractor with Harm Reduction Therapy Center) conducted a series of community trainings focusing on community-based cultural sensitivity as well as workforce development, education & training; specifically, the agency provided training on working with the Asian & Pacific Islander American communities and Russian-speaking population as well as partnered with other organizations to conducting workforce development activities on the Integration of and Professional Development of Consumers as well as Community Violence. Funded by Mental Health Services Act (MHSA), these trainings were part of the HRTC project’s goal of delivering 16 trainings (on 14 focus areas) aimed to improve the CBHS workforce’s understanding of the cultural & linguistic issues and needs that affect recovery and resiliency and improve access to mental health services.

    RAMS is committed to maintaining and further enhancing the cultural competence of staff, interns, and trainees by coordinating various clinical trainings and conferences on topics that specifically address various cultural issues. On a regular basis at RAMS, there are clinical presentations, case conferences, didactic trainings, and group discussions at which local, nationwide, and internationally renowned experts are invited to present on evidenced-based treatment modalities for specific issues and cultural groups. 

    Many RAMS staff members have served on expert panels and as lead presenters for local, national, and international association conferences, professional organizations, government agencies, and community-based centers with topics that focus on best practices and cultural competent care. RAMS receives visitors from mental health institutions, government agencies, and university faculty & students from other countries such as Japan, Korea, China, and Russia in order to learn about the program structure and client services. 

  • Raise Awareness and Reduce the Stigma of Mental Health in the Community +
  • Cultural competency works at all levels of internal and external community involvements, including macro-level engagement with constituents. Raising awareness about mental health also reduces the stigma about seeking services and promotes detection, early intervention, and prevention of the impact of mental health conditions. RAMS engages in strategies and activities such as:

    • Sponsor and participate in health and neighborhood fairs, serving as a multi-lingual resource for the community and outreach about mental health conditions and services
    • Actively advocate and impact public policy at various local and state meetings to determine community needs and develop and implement culturally relevant strategies and techniques
    • Facilitate workshops about mental health conditions in the community at health fairs, schools, and/or community centers
    • Facilitate workshops for the professional healthcare community about providing cultural competent services at conferences/conventions
    • Establish formal collaborations with other agencies/programs to provide culturally-focused consultation and case conferences
    • Participate in efforts that further enhance the accessibility of psychoeducational materials, including translation projects
    • Operate the Summer Bridge Program, which is an eight-week summer program for youth (ages 16 to 20 years old) designed to promote awareness of psychological well-being and foster interest in the helping professions (social worker, counselor, psychologist, therapist, etc.). This program is funded by SFDPH Mental Health Services Act.
    • Be the lead in spearheading the effort to establish May 10th as “Asian Pacific American Mental Health Day”, in recognition of the importance of raising awareness about mental health in the Asian Pacific American community. Starting in 2010 and each year thereafter, the State of California and City & County of San Francisco is recognizing May 10th as such, presented as resolution SCR 97 at the State Senate and Assembly as well as resolution passed at the San Francisco Board of Supervisors. This resolution has been overwhelmingly supported by many major associations and community coalitions. Also, the city of Austin, Texas, followed San Francisco's lead and proclaimed May 10th as Asian Pacific American Mental Health Day.

    In addition, RAMS actively participates in efforts to bring awareness about mental health through media and/or public campaigns. Various media entities, such as KQED, San Francisco Chronicle, Los Angeles Times, CBS-KPIX, Sacramento Bee, Mental Health Weekly, KTSF-26, KMTP-32 (World Channel), Sing Tao (Radio and Newspaper), Ming Pao, World Journal, Philippine News, AsianWeek, and The Richmond ReView consult with and utilize RAMS to provide expert commentary on relevant issues and matters.

    To raise awareness and address the stigma of mental health, RAMS also actively participates in and are members of various culturally-focused community coalitions and/or committees such as: San Francisco Asian & Pacific Islander Health Parity Coalition, Asian Youth Advisory Network – Behavioral Health Committee, Asians Against Violence, NICOS Chinese Health Coalition, and California Reducing Disparities Project (CRDP) - API Strategic Planning - Bay Area Workgroup (BAWG) as well as work in collaboration with organizations (e.g. National Asian American Pacific Islander Mental Health Association, Chinese Hospital of San Francisco, Chinese Community Health Resource Center, etc.) to assess how to better serve the Asian & Pacific Islande community.

  • Contribute to the Development and Evaluation of Culturally Competent Treatment Strategies and Techniques +
  • RAMS actively engages in and practices innovative treatment approaches of which have been proven and proposed as culturally competent strategies for specific communities. In partnership with various universities and researchers, the agency is involved with research projects, studies, and activities that further evaluate effectiveness of various treatments and/or provide insight of mental health conditions in the Asian & Pacific Islander American community. Such topics include: efficacy of standard cognitive-behavioral therapy with Chinese Americans with depression, domestic violence, treatment strategies with Asian & Pacific Islander American groups, vocational rehabilitation, problem gambling, depression & suicide, early childhood & parenting issues, and substance abuse. In addition, RAMS served as a field testing site for the DSM-5 Cultural Formulation Interview tool and was the only site having utilized the tool with mono-lingual, Chinese-speaking American clients.

  • Organizational Leadership and Management +
  • Historically and currently, the demographic makeup of RAMS Board of Directors is representative of the populations served by the organization. RAMS' Board members include professionals, consumer advocates, leaders, and members of different Asian and Russian communities as well as have experience working in the SF mental/public health field and/or the ethnic/cultural communities served by RAMS.

    As RAMS maintains policies and practices to recruit, retain, and promote at all levels diverse service providers and leadership that reflect the multi-cultural, multi-lingual community, the RAMS staff and management appropriately represent various cultures and ethnicities. They are aware of the unique needs of the communities, its levels of complexities, and changing dimensions. The staff members have demonstrated extensive experience and knowledge in cultural competence and working with various groups. In addition, RAMS is committed to promoting such that many directors, managers, and supervisors have had previous experiences at RAMS as direct service providers and/or former trainees or interns.