Measuring trust in public health authorities in the United States: An item response theory analysis.

Counseling is a professional relationship that empowers individuals, families, groups, and communities to accomplish mental health, wellness, education, and career goals through developmentally and culturally responsive interventions [,]. Distinct characteristics of counseling include and emphasis on the therapeutic relationship, client empowerment, multicultural humility and responsiveness, advocacy, and the promotion of wellness across diverse populations [,]. Cultural competence is a foundational ethical and professional responsibility in the counseling field. This study examined whether counselors’ demographic characteristics and prior training experiences predict self-reported competence in working with gender nonconforming clients. This competence encompasses awareness, knowledge, skills, and advocacy needed to work effectively with diverse populations []. Counselor education programs, licensure boards, and accreditation standards also emphasize the importance of ongoing professional development, continuing education, and advocacy to maintain competence. Continuing Education Units (CEUs) play a critical role in helping counselors stay current on evidence-based practices, ethical standards, and culturally responsive interventions []. In recent years, the counseling field has increased focus and training on specific intersectional identities, including race/ethnicity and sexual orientation. This targeted approach has demonstrated increased counselor competence and cultural humility [] when working with diverse clients. With this, we know that targeted training, exposure, and advocacy initiatives can have a significant impact on the counseling field and client outcomes. However, we also know that change often takes time and that systemic barriers continue to impact minoritized communities, one such community being those who are gender diverse, this includes people who are gender nonconforming. Gender diverse individuals warrant particular attention for several reasons: they experience disproportionately high rates of discrimination, mental health disparities, and barriers to affirming healthcare; counselor training has historically emphasized race and sexual orientation with less focus on gender identity and expression; and the rapidly evolving understanding of gender requires ongoing professional development to provide competent care. To aid in building cultural humility and competence, many educators and advocates are working hard to share knowledge, resources, and skills in working with gender diverse clients [–]. The purpose of this study was to explore if counselor demographic characteristics and prior training experiences were associated with increased counselor competence when working with gender nonconforming clients. Cultural competence is recognized as a fundamental obligation in counseling, formally established through ethical codes, accreditation requirements, and licensure regulations. According to the American Counseling Association [], counselors are ethically obligated to develop awareness, knowledge, skills, and behaviors that enable them to engage effectively with clients from diverse cultural backgrounds. This ethical mandate includes ensuring that the counseling relationship and intervention strategies are culturally responsive, that biases are examined, and notes that value-based referrals are prohibited []. In parallel, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) established explicit curriculum and program standards aimed at ensuring graduates are culturally competent. The 2024 CACREP Standards require that counselor education programs include social and cultural diversity as a foundational curricular area; one that is woven throughout the program rather than covered in a single course []. Similarly, state licensure boards embed cultural competence within their requirements, both in initial licensure and ongoing continuing education regulation. For example, Florida statutes require that counseling programs include coursework in social and cultural foundations [], whereas other states like Georgia explicitly require applicants to have a knowledge of societal trends, culture, subgroups, diversity, and competency in counseling diverse populations []. Additionally, licensure boards also often require CEUs in multicultural or diversity topics to maintain competence post-licensure. Although specific hours and definitions vary by state, this requirement reinforces the idea that cultural competence is not static but must be maintained and deepened over time. Together, ACA, CACREP, and state licensure boards require: (1) counselor self-awareness and examination of one’s cultural identity; (2) acquisition of knowledge about diverse clients’ worldviews, history, and sociocultural context; (3) development of culturally responsive skills in assessment and intervention; and (4) following legal and ethical mandates in working with diverse clients.