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

Treatment Services

 

Standard


The Health Plan shall include a full array of available treatment modalities, particularly modalities which are culturally acceptable and effective with APIA populations (e.g. psycho-education, psychosocial rehabilitation, family therapy, specialized group therapy, behavioral approaches, use of traditional healers, outreach). Consideration shall be given to the likelihood of the APIA consumer to accept and implement the Treatment Plan.

 

Implementation Guidelines

  1. APIA consumers and families shall be well-informed by the Health Plan about available treatment choices which shall be freely discussed by the provider including listing medications and other treatments not available in the Health Plan. The final decision to be treated rests with the consumer.
  2. Treatment for APIA consumers and their families shall be consumer-driven and performed by APIA culturally competent Mental Health Specialists. In the absence of sufficient APIA culturally competent Mental Health Specialists, clinical staff serving APIA consumers shall receive supervision or consultation from APIA culturally competent Mental Health Specialists.
  3. Assignment of clinicians to APIA consumers and their families shall be based on a match between clinician skills, including APIA cultural competency, and the consumer’s clinical, cultural, and linguistic needs.
  4. The optimal utilization of the APIA culturally competent Mental Health Specialists workforce includes affording these clinicians a variety of clinical experiences including service to consumers other than APIA consumers.
  5. The workforce serving APIA consumers shall meet the needs of APIA consumers and their families while maintaining comparability in overall workload to other clinical providers. This shall take into consideration requests for interpretation and use of other specialized skills, so that they are not in addition to their regular duties.
  6. The Health Plan shall contract with, and utilize, local APIA community-based organizations and independent APIA practitioners in its network, and include them in the provider's network or panel. Such providers shall demonstrate APIA cultural competence.
  7. Psychotherapeutic modalities shall be conducted within a context of APIA cultural values (e.g., goal oriented, proactive, and family-oriented approaches). Psychotherapeutic modalities shall address psychological issues specific to APIA consumers (e.g., current and historical trauma, acculturation, intergenerational and gender role distinctions, and life transitions), except when clinically and culturally contraindicated.
  8. Psychopharmacological interventions shall be conducted by qualified practitioners trained in APIA ethnic-specific biological and physiological variables, and differential medication response. These interventions shall be provided through use of APIA culturally and linguistically competent literature, and other specialized approaches to treatment consent and family education.
  9. The principle of least restrictive levels of care shall govern treatment and placement decisions with family placement preferable unless otherwise indicated. Level of care decisions shall be governed by protocols to ensure timely and accurate decision making and shall be designed and carried out by, or in consultation with, qualified APIA culturally competent Mental Health Specialists.
  10. The Health Plan shall use flexible psychosocial rehabilitation in the treatment of APIAs.

 

Recommended Performance Indicators

  1. See section on Human Resources and Development for implementation steps and indicators related to staffing patterns.
  2. Protocols for level of care decisions for APIA consumers.
  3. Distinction and equivalence of services for APIA consumers.
  4. Specialized protocols for prevention of symptom relapse and reduction of recidivism for APIA consumers.
  5. APIA culturally and linguistically competent literature on prevalent psychiatric disorders, medical treatment options, and pharmacological interventions distributed to all APIA consumers and their families.
  6. APIA consumers receive services by traditional healers, when appropriate.

 

Recommended Outcomes

  1. APIA consumer and family satisfaction with treatment services.
    Benchmark: 90% satisfaction.
  2. Inclusion of culturally specific activities and attention to domains of daily living relevant to APIAs (e.g., housing, access to primary health care and maintenance, family role, behavioral/developmental, vocational/ educational/employment, community tenure) in treatment services.
    Benchmark: Comparable to overall population served and significant improvement in at least one domain of function for over 75% of consumers.
  3. APIA rates of symptom relapse and recidivism into restrictive level of care or other restrictive placements.
    Benchmark: Comparable to overall population served and significant reductions over time.
  4. APIA rates of medication side effects, adverse incidents, and utilization of latest pharmacological interventions.
    Benchmark: Comparable to overall population served and reduction of medication side effects and adverse incidents.
  5. APIA rates of adverse occurrences during treatment (e.g., suicide, homicide, self-injury, accidents, physical, and sexual abuse) within comparable age groups.
    Benchmark: Comparable to overall population served and decreasing over time.
  6. Documentation supporting the discussion of cultural, ethnic, and racial identity, (including, subgroup membership and mixed origin), and other relevant factors, as indicated.
    Benchmark: 100% documentation.