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

Triage and Assessment

 

Standard

Assessment shall include a multi-dimensional focus including individual, family, and community strengths, functional, psychiatric, medical, and social status, as well as family support. Additionally, an evaluation of cultural and socio-economic stressors and factors shall be completed. The assessment shall be of appropriate breadth and depth to establish the nature of problems, the consumer’s willingness and ability to work, and the provider’s ability to deliver culturally competent services. All assessment scales and measurement tools shall be culturally valid and reliable, and administered, scored, and interpreted by culturally competent Mental Health Specialists.

 

Implementation Guidelines

  1. Cultural and demographic factors in the assessment process relating to age, gender, sexual orientation, and relational roles shall be addressed in the assessment of APIA consumers and families.
  2. The cultural component of the assessment shall identify beliefs and practices; family organization and relational roles (traditional & non-traditional); impact of ethnically related stressors such as poverty and discrimination; beliefs related to health/mental health; attribution of condition; spirituality; and previous attempts at help-seeking. History of immigration, or acculturation and racial/ethnic identity shall be considered as needed. APIA consumers shall be asked why they are seeking services, what their expectations are of the agency, previous efforts to obtain and use help, and outcomes of previous treatment efforts. APIA consumers shall be asked to identify the criteria they use to determine when their condition is improved.
  3. Clinical and functional assessment scales utilized by managed mental health care systems, organizations, or providers shall be culturally competent, reliable, and validated for use with APIA consumers and their families.
  4. Where indicated, the cultural component of the assessment shall be family-oriented and systems-oriented, incorporating key members of the nuclear and extended family (especially family decision makers), as well as significant community stakeholders. The assessment shall also utilize specialized techniques such as culturally competent use of family and community, system of care, traditional healers, spiritual and religious helpers and other collateral informants, and incorporate traditional healers where indicated and when appropriate. As appropriate, the APIA consumer shall be asked to identify what family and community resources, if any, are available to help resolve the presenting problems.
  5. Systemic cultural and ethnic factors shall be addressed to ensure accurate assessment and service planning (e.g., linguistic barriers, differences in symptom expression, culture-bound syndromes).
  6. APIA Mental Health Specialists shall be involved, where possible either directly or via consultation, in triage and assessment processes, especially at the time of care determination and prior to more restrictive placements, particularly with involuntary placement and treatment.
  7. For systems without APIA culturally competent services, consultation with such a provider shall be necessary to review the assessment as the level of care determination is made.
  8. Information on differential diagnosis and mental health status with regards to impact of institutional and social racism, and culturally-based trauma, shall be addressed.
  9. APIA consumer’s preference for therapeutic linkages to their community or family prior to initiating service, shall be considered.
  10. The use of family members as culturally informed individuals, including children when appropriate, shall be encouraged.
  11. Psychological evaluation shall be conducted by qualified practitioners trained in APIA culturally and ethnically based biological, physiological, socio-economic, and psychological variables. Psychological evaluations shall also be provided based on the use of APIA culturally and linguistically competent literature and other specialized approaches to evaluative consent and family education. Specific knowledge concerning the norms, biases, and limitations of each instrument used shall be demonstrated.

 

Recommended Performance Indicators

  1. Presence of specialized assessment procedures for APIA consumers.
  2. Inclusion of cultural factors in the assessment of APIA consumers.
  3. Inclusion of family members and significant community stakeholders as appropriate in the assessment process for APIA consumers. Documentation, as appropriate, of efforts to include family and significant others or rationale when not accomplished.
  4. Inclusion of culturally competent functional assessment, when available, within the overall assessment process for APIA consumers.
  5. Involvement of APIA culturally competent Mental Health Specialists in assessment and treatment planning process.
  6. The recognition of not attributing to culture what is the person's psychopathology.


Recommended Outcomes

  1. APIA consumer, family, and stakeholder satisfaction with the assessment process.
    Benchmark: 90% satisfaction
  2. Consistency of service authorizations with utilization management practice for APIA consumers.
    Benchmark: Comparable across the four underserved/underrepresented racial/ ethnic groups and in general increasing over time
  3. Frequency of diagnostic revisions resulting from failure to respond to treatment.
    Benchmark: Comparable across the four underserved/underrepresented racial/ ethnic groups and decreasing over time.
  4. Compliance with implementation steps for assessment.
    Benchmark: 90% compliance