Cultural Competence Standards in Managed Care Mental Health Services for Asian and Pacific Islander Americans

Access and Service Authorization

 

Standard

No one shall be denied services because of immigration status, insurance coverage, and language. Access to services shall not be individually-oriented only, but also family-oriented (including client defined family) in the context of APIA values. Access criteria for different levels of care shall include health/medical, behavior, and functioning in addition to diagnosis. Criteria shall be multidimensional in six domains: psychiatric, medical, spiritual, social functioning, behavior, and community support.


 

Implementation Guidelines

  1. Specific procedures shall be developed to ensure comparability of access across APIA populations. APIA Mental Health Specialists shall be involved in the development, ongoing implementation and evaluation of these procedures.
  2. Gatekeeping, and service authorization for APIA consumers shall be performed by or under the supervision of an APIA culturally competent Mental Health Specialist.
  3. Restrictive placements for APIA consumers shall be made only with prior cultural consultation with an APIA culturally competent Mental Health Specialist. Restrictive placements include inpatient, residential, and involuntary treatment.
  4. Access for APIAs shall be decentralized and facilitated through multiple outreach and case-finding approaches. These approaches shall include strategic co-location within APIA community organizations, social service agencies, community action agencies, health centers, churches, mosques, temples, schools, and neighborhood locales, which are accessible to through public transportation and in-home/in-community/mobile care and publicized using APIA culturally and linguistically appropriate information. APIA agencies shall have the flexibility of providing services to APIA consumers who may not reside in the agency's geographic service area, when this is in the best interest of the clients.
  5. Access to traditional and self-help services more consistent with APIA culture, values, and belief systems, shall be insured.
  6. The use of telephone numbers (e.g. 1-800) for access shall not be exclusive of other points of entry for 24 hour crisis service and shall be accompanied by APIA consumer in the use of such access procedures. Staff providing telephone access services shall be culturally and linguistically competent to serve APIAs, and have access to APIA c mental health professionals for consultation.
  7. Legal documentation for APIA immigrant groups shall not be a requirement for service and shall not serve as a barrier to service access. (Legal status shall not be confused with sponsored and unsponsored status.)
  8. Confidentiality requirements shall be adapted to incorporate the values of APIA consumers, particularly the inclusion of families’ in decisions about services, so as not to serve as a barrier to care.
  9. Equal availability of telephone and other communication means of access, for APIA consumers and families shall be assured.
  10. Programs serving APIA consumers and shall provide culturally inviting environments (e.g. decor, ambiance) as measured by APIA consumer satisfaction surveys.
  11. Points of access shall demonstrate APIA cultural competency in order to reduce such barriers to services, lack of transportation, lack of child care, and cultural insensitivity and prejudiced attitudes (as measured by APIA consumer satisfaction surveys).
  12. The Health Plan shall provide all APIA consumers, families, and providers a culturally based and linguistically complete orientation, and ongoing education as needed, about access to managed care environment. Provider education about APIA access issues shall be documented by the caregiver.
  13. Ability to pay shall not be a barrier to accessing services in a managed health care environment.
  14. Arbitrary elimination of coverage for diagnoses particular to APIAs shall not occur, for this leads to inequitable access to care.
  15. The Health Plan shall develop specialized approaches for APIAs to maintain continuity of care, prevent symptom relapse, and reduce recidivism to more restrictive and expensive services, including flexible purchase of wrap-around services.
  16. Medical and mental health services for APIA consumers and their families shall reflect the most prevalent community mental health needs, including the mental health epidemiology of the community.
  17. The Health Plan shall recognize, legitimize, facilitate, and compensate (in a culturally appropriate manner) the utilization of traditional healers and therapies in the treatment of APIAs. It shall also recognize that some conditions may be better treated by traditional healers, and include procedures for efficiently referring and/or obtaining consultation.
  18. The Health Plan shall promote early intervention and prevention in APIA community populations.

 

Recommended Performance Indicators

  1. Procedures for access in place with specific provisions for APIA consumers.
  2. Time from point of first contact through service provision for all levels of care tracked by age, gender, ethnicity (i.e. particular APIA subgroup and mixed origins), primary language, sexual orientation, diagnosis, spiritual/religious beliefs, country of origin, social class, degree of acculturation, and physical challenge.
  3. APIA staffing pattern coverage of access services.
  4. Rate and timeliness of response to telephone calls by APIA consumers.
     

Recommended Outcomes

  1. Tracking of authorization decisions including denials, rationale, and disposition by ethnicity.
    Benchmark: Comparability across ethnic groups served
  2. Tracking of access and utilization rates for APIA populations across all levels of care, in comparison to the covered population and the APIA community at large.
    Benchmark: Proportional to covered population and non-sponsored Latino community at large
  3. APIA consumer and family satisfaction with access and authorization services.
    Benchmark: 90% satisfaction