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

Plan of Treatment

 

Standard

The Treatment Plan for APIA consumers shall be relevant to their culture and life experiences. It shall be developed by an APIA culturally competent Mental Health Specialist in conjunction with the APIA consumer and family, where appropriate. In the absence of an APIA culturally competent Mental Health Specialist, review of the proposed plan of treatment and supervision by an APIA culturally competent clinical consultant is necessary.


 

Implementation Guidelines

  1. The Treatment Plan for APIA consumers shall include consumer and family involvement, when appropriate, in its development and agreement.
  2. Group homes utilized as least restrictive placements for APIA consumers shall be monitored for compliance with state and local standards, regulations, and laws, as well as protocols for services. Where such protocols do not exist, they shall be developed to insure that group homes do not become holding facilities for APIA consumers.
  3. If authorized by the APIA consumer, the Treatment Plan shall include contact with and utilization of the appropriate APIA community organizations.
  4. Psychotherapeutic modalities shall be conducted within the context of the value system of APIA consumers and their families (e.g. egalitarian, participatory, family focused, spirituality), and shall address issues specific to their life experiences (e.g., racism, discrimination, violence, gender role conflicts, and life transitions).
  5. Treatment planning shall be based on knowledge and skills derived from APIA culturally competent interventions and models of care. These shall include concepts of recovery and rehabilitation that also consider cultural norms, values (spirituality, community, family), and critical life experiences (e.g., racism and discrimination).
  6. Care planning and other critical treatment decisions for APIA consumers shall be performed or supervised directly by an APIA culturally competent Mental Health Specialist. Managed care plans shall include APIA culturally competent independent practitioners within their networks.
  7. The Treatment Plan for APIA consumers shall incorporate consumer-driven goals and objectives that are functionally defined and oriented towards measurable recovery and rehabilitative outcomes.
  8. The Treatment Plan for APIA consumers shall address culturally defined and socio-economic needs.
  9. Treatment plans for APIA consumers shall incorporate individual, familial, and community strengths. Additionally, cultural strengths, spiritual/religious persons, natural support systems, community organizations, self-help organizations, and interagency resources shall be included in the plan of care, as appropriate.
  10. Treatment plans for APIA shall reflect awareness of the mental health needs of the entire family, especially when children are the consumers. Coordination among multiple providers, with a single point of clinical accountability, shall occur and be documented.
  11. Treatment plans for APIA consumers shall address coordination of mental health and physical health, substance abuse, as well as other needed clinical services such as housing, transportation, employment, and education.
  12. The Treatment Plan for APIA consumers shall be developed so that interventions consider least restrictive placements, continuum of care, discharge, and cultural sensitivity in the treatment modalities and medication usage.
  13. Level of care decisions shall be based on established protocols that are culturally relevant to the APIA consumer. These protocols shall be reviewed periodically by the APIA consumer and family, as appropriate. Placement considerations shall include APIA consumer and family preferences. Placement with the family shall be the preferred arrangement unless otherwise clinically contraindicated.
  14. Creative options and procedures for APIA consumers who, for whatever reason, have been labeled as non-compliant to treatment.
  15. In developing creative options, the APIA consumer’s right to choice shall be preserved. However, the provider shall have the ultimate responsibility for documents both the recommendations and rationale for the Treatment Plan, as well as informing the APIA consumer and family of potential risks if recommendations are not followed.
  16. Treatment plans for APIA consumers shall include broad based APIA culturally competent educational programs that explain the problems or conditions being treated, treatment methods, concepts of recovery, rehabilitation, prevention, and self-help approaches in communication styles understandable to the APIA consumer.
  17. Treatment plans for APIA consumers shall be developed by an APIA culturally competent Mental Health Specialist. In the absence of an APIA culturally competent Mental Health Specialist, APIA cultural competency training shall be provided to staff and external consultation with an APIA culturally competent Mental Health Specialist shall be obtained.
  18. The decision to go forward with treatment of an APIA consumer shall be based on a mutually agreed upon written understanding or contract between the consumer and provider.
  19. In cases of APIA consumers who present with acute mental illnesses requiring psychopharmacological interventions, the provider shall discuss medications and their effects with the consumer and family as soon as the consumer is able. A signed statement by the consumer (and counter-signed by the provider) that this guideline has been followed shall be inserted in the case record.
  20. The Treatment Plan for the APIA consumer shall reflect specialized approaches to maintain continuity of care, prevent symptom relapse, and reduce re-hospitalization.
  21. Culturally specific literature in the communication style, language, and appropriate to the literacy level of the APIA consumer on the prevalence of psychiatric disorders, treatment options, and psychopharmacological interventions shall be distributed to APIA consumers and their families.
  22. Informed consent shall be obtained prior to the dispensing of medication. The informed consent document shall be specific regarding the nature of the medication and its potential and demonstrated benefits and side effects. The physician prescribing the medication shall be responsible for ensuring that medication information is explained in a culturally specific and clear manner. The APIA consumer shall acknowledge, by signature, that he/she understands the medication prescribed and its potential benefits and side effects. The signed forms shall be dated and included in the consumer’s chart. The prescribing physician shall be knowledgeable regarding the physiological specific effects of psychotropic medication in APIA consumers.

 

Recommended Performance Indicators

  1. Treatment planning is APIA consumer-driven, and includes consumer’s family involvement when appropriate.
  2. Treatment planning includes collaboration with appropriate APIA community organizations.
  3. Treatment planning incorporates APIA consumers and families value systems and support systems.
  4. Creative options are used in treatment planning for APIA consumers who may seem to be "non-compliant".
  5. Treatment planning is based on knowledge and skills derived from APIA culturally competent interventions and models of care.
  6. Treatment planning is performed or directly supervised by APIA culturally competent Mental Health Specialist.
  7. APIA Treatment Plan includes coordinated and care at a single point.
  8. Medication is dispensed with culturally competent education on its use and side effects, and with a mutually agreed upon contract.
  9. Availability of mental health care literature specific to the APIA consumer/family language and literature needs.
  10. APIA Treatment Plan shall include consumer and family education on the mental health condition being treated and intervention methods.

 

Recommended Outcomes

  1. APIA consumer satisfaction with the Treatment Plan.
    Benchmark: 90% satisfaction
  2. Treatment planning performed or directly supervised by APIA Mental health Specialist.
    Benchmark: 100% satisfaction
  3. Written consent stating that the APIA consumer understands the use and side effects of medications.
    Benchmark: 100% documentation
  4. APIA consumer satisfaction with available mental health education and literature.
    Benchmark: 90% satisfaction.