While matching patients with clinicians of similar backgrounds improves outcomes and care satisfaction, staffing constraints often make this challenging.

Many providers have turned to practicing culturally responsive care as one way to improve connections between patients and providers who do not necessarily share lived experiences. Mental health providers use the practice to apply behavioral health techniques in a way that acknowledges and respects patients’ cultural backgrounds. Training programs and educational institutions are increasingly promoting cultural responsiveness – but work remains to be done in the behavioral health industry to fund and operationalize the practice.

Some behavioral health providers are staking their foundations on culturally responsive practices.

Virtual mental health provider Anise Health was created using cultural responsiveness as its premise. The company specializes in treating underserved populations and is getting its start focusing on Asian Americans, using specific training practices and technology to improve care practices.

“It can be extremely frustrating to feel like your provider doesn’t understand you; many clients have told us how tired they felt explaining their culture to people who didn’t “get it,”’ Alice Zhang, co-founder and CEO of Anise Health, told Behavioral Health Business. “Therefore, one of the many benefits of having clinicians who are specifically trained to understand cultural stressors and use culturally appropriate clinical tools, is higher provider compatibility, which translates into stronger therapeutic alliance, a key determinant of treatment success.”

New York City-based Anise Health offers therapy, coaching and self-guided resources to patients in California, New York, Massachusetts, Florida and Washington. Anise has raised a total of $5 million, including a $3 million raise in December.

Along with improved therapeutic alliance, which research consistently shows improves the success of psychotherapeutic treatment, other clinical benefits to culturally responsive care include increased trust and decreased likelihood of dropping out of care, Zhang said.

Improving patient retention is especially important for people of color, Zhang said, because Black, Indigenous, and People of Color (BIPOC) are up to five times more likely to drop out of therapy prematurely and 50% more likely to report mental health treatment as ineffective when compared to white patients.

Providers interviewed for this story use varying terms like “culturally responsive care,” “culturally sensitive care,” and “cultural humility” instead of “cultural competence,” which could oversimplify cultural understanding.

How culturally responsive care is practiced

The behavioral health industry has significantly shifted toward culturally responsive care in recent years. The practice is now a core component of graduate education and state licensing exams, according to L. Tully, vice president of clinical integrations and partnership at Kooth.

“That doesn’t mean that everybody is practicing it in their day-to-day, but the initiative is there,” Tully said.

London-based Kooth provides youth-focused virtual care, including self-guided tools and peer support. The company operates several notable partnerships in the U.S., including with Aetna Better Health of Illinois and California’s Children and Youth Behavioral Health Initiative.

Two ways Kooth practices culturally responsive care are through recruitment and training.

Clinicians working for Kooth’s mental health support app, Soluna, receive regular training in what Tully calls cultural humility and are regularly evaluated using a clinical fidelity mode.

“It’s hiring, it’s training, and then it’s evaluation,” Tully said. “So having a fidelity model that includes how your practitioners engage with this kind of practice, and this takes time and resources and dedication. If you are a for profit company, there is always that tension between speed and quality and cost. Organizations that want to do this work have to recognize that there are costs associated with it, and they have to be honest about that. I think it is a worthwhile cost, because in the long term, your outcomes are better.”

Cultural humility requires data infrastructure to perform regular evaluations, Tully said. The business case for instituting a robust cultural humility practice, therefore, requires “medium to long-term thinking,” Tully said.

Like Kooth, New York City-based Spring Health’s culturally responsive approach to care starts with an initial assessment that takes cultural factors into account. That data is then used to create a treatment plan supported by a personalized care navigator.

“Competence is essential when it comes to understanding the cultural nuances that affect someone’s mental health, but responsiveness is key,” Karishma Patel Buford, chief people officer of Spring Health, told BHB in an email. “The ability to take that understanding and put it into practice through tangible actions and methods of support, such as offering multilingual services, adapting care to cultural norms, and ensuring that providers integrate cultural context into their treatment approaches, is what truly matters.”

New York City-based Spring Health partners with payers, employers and other organizations to provide a suite of mental health services, including coaching, therapy, medication and digital resources. The unicorn startup has raised a total of $466.5 million, including a $100 million Series E raise in July 2024.

Spring’s care navigators are located in the same geographic area as their patients. Shared locality aids in the practice of culturally responsive care, Buford said. The provider also prioritizes therapeutic alliance between patients and clinicians.

Anise’s diagnosis tools go “a layer deeper” than traditional diagnostics, Zhang said. The company uses an AI-enabled technology to assess cultural stressors using tools that Zhang said are validated within the Asian population.

Anise also provides clinician training to help understand stressors unique to Asian people and provide tools to address them.

“Relying solely on people with lived experiences is neither a scalable solution to empower people en masse nor will it help us achieve our vision of becoming the gold standard used by the entire mental health system to deliver high-quality care,” Zhang said. “Without caution, this could also lead to bias where providers rely too heavily on their own lived experiences and insert themselves into their clients’ narratives. We understand that there is insufficient specialization at the provider level in cultural sensitivity, which we are mitigating by building comprehensive training programs and AI-powered tools for providers to ensure consistency in quality care regardless of a provider’s own ethnic background or experience level.”

Threats and challenges

While cultural responsiveness initiatives are increasing, implementation is not without its challenges.

Culturally appropriate screening tools and interventions on the market today are insufficient, according to Buford. To combat this lack of tools, Spring has developed its own technology.

Buford also sees persistent workforce challenges as a challenge to implementing culturally responsive care.

‘The best providers out there already have a thriving practice,” Buford said. “We draw the best in the industry to Spring Health by prioritizing their needs and creating tech that solves their problems. We work globally with our provider advisory network to help us attract the best providers in the marketplace that also meet the needs of our members.”

Culturally responsive care could also be impacted by the newly installed Trump administration.

President Donald Trump has ordered the termination of diversity, equity and inclusion efforts, which he called “illegal and immoral discrimination programs.” This pivot away from DEI could result in the elimination of grants, funding and research crucial to advancing culturally sensitive care, according to Zhang.

Training programs that are crucial to implementing culturally responsive care also present struggles. While these programs exist, they often put pressure on overworked and under-resourced providers to do the work to be more informed.

One way to improve the standings for culturally responsive care in the behavioral health industry is through increased funding.

“We would like to see increasing willingness from payers and investors to fund access to culturally sensitive care,” Zhang said. “That’s why Anise’s immediate focus is activating the insurance contracts we’ve negotiated to make care as accessible as possible.”