Cultural Competence Standards in Managed Mental Health Care

Plan of Treatment

Standard
The Treatment Plan for consumers from the four groups shall be relevant to their culture and life experiences. It shall be developed by or under the guidance of a culturally competent provider in conjunction with the consumer and, where appropriate, family.

 

Implementation Guidelines

  1. The Treatment Plan for consumers from the four groups shall include consumer and family involvement, when appropriate, in its development and agreement
  2. Group homes utilized as least restrictive placements shall be monitored for compliance with state and local standards, regulations, and laws, as well as protocols for services. Best practices shall be encouraged in the process. Where such protocols do not exist, they shall be developed to ensure that group homes do not become holding facilities.
  3. If authorized by the consumer, the Treatment Plan shall include contact with and utilization of racial/ethnic community organizations.
  4. Psychotherapeutic modalities shall be conducted within the context of the value system of consumers from the four groups 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 culturally competent interventions and models of care. These shall include concepts of recovery and rehabilitation that also consider cultural norms, values (e.g., spirituality, community, family), and critical life experiences (e.g., racism and discrimination).
  6. Care planning and other critical treatment decisions for consumers from the four groups shall be performed or supervised directly by a culturally competent mental health professional. Managed care plans shall include culturally competent independent mental health practitioners within their networks..
  7. The Treatment Plan for consumers from the four groups shall incorporate consumer-driven goals and objectives that are functionally defined and oriented towards measurable recovery and rehabilitative outcomes.
  8. The Treatment Plan for consumers from the four groups shall address culturally defined and socio-economic needs.
  9. Treatment plans for consumers from the four groups 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.
  10. Treatment plans for consumers from the four groups 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.
  11. The Treatment Plan for consumers from the four groups shall be developed so that interventions provide for least restrictive placements, continuum of care, discharge, and cultural competence in treatment modalities and medication usage.
  12. Level of care decisions shall be based on established protocols that are culturally relative to the consumer. These protocols shall be reviewed periodically with the consumer, and involved family as appropriate, by providers. Placement considerations shall include consumer and family preferences. Placement within or supported by the family shall be the preferred arrangement unless otherwise clinically contraindicated.
  13. Creative or innovative options and interventions should be developed for consumers from the four groups who, for whatever reason, have been labeled historically as non-compliant to treatment.
  14. Treatment plans for consumers from the four groups shall include broad based 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 consumer.
  15. Treatment plans for consumers from the four groups shall be developed by a culturally competent staff. In the absence of a culturally competent staff, external consultation with a culturally competent mental health professional shall be obtained.
  16. The decision to go forward with treatment of a consumer from one of the four groups shall be based on a mutually agreed upon written understanding or contract between the consumer and provider.
  17. In cases of 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 statement signed by the consumer and counter-signed by the provider that this guideline has been followed shall be inserted in the case record.
  18. The Treatment Plan shall reflect specialized approaches to maintain continuity of care, prevent symptom relapse, and reduce re-hospitalization.
  19. Culturally specific literature in the communication style, language, and appropriate to the literacy level of the consumer on the prevalence of psychiatric disorders, treatment options, and psychopharmacological interventions shall be distributed to consumers from the four groups and their families.
  20. Informed consent shall be obtained prior to dispensing 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 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 physiologically-specific effects of psychotropic medication on consumers from the four groups.

 

Recommended Performance Indicator

  1. The Treatment Plan reflects both consumer and family involvement in its development and agreement. The degree of family involvement depends on the wishes of the consumer
  2. The organization has a written policy and a demonstrated practice linking families to advocacy and education groups.
  3. The organization has a written policy which expressly targets least restrictive environments for residential placement in or near the community.
  4. There is evidence in the Treatment Plan that proposed psychotherapeutic modalities address specific cultural issues and are conducted with specific cultural values.
  5. There is evidence in the Treatment Plan of the use of racial/ethnic community services and resources.
  6. The Treatment Plan was developed with a culturally competent clinician (defined in chapter on Human Resource Development) or consultation from such a clinician.
  7. The Treatment Plan is oriented towards measurable recovery and rehabilitation outcomes.
  8. Creative options are used in treatment planning for racial/ethnic consumers who may seem to be "non-compliant".
  9. Treatment planning is based on knowledge and skills derived from culturally competent interventions and models of care.
  10. Treatment Plan includes coordinated care at a single point.
     
  11. Medication is dispensed with culturally competent education on its use and side effects, and with a mutually agreed upon contract.

 

Recommended Outcomes

  1. Documented level of involvement of racial/ethnic consumers, and family when appropriate, in the development of and agreement with the Treatment Plan. The level of involvement is at least comparable with non-racial/ethnic groups.
  2. Evidence of a policy linking families to advocacy and education groups and documentation of the level of referrals of families to advocacy and education groups.
  3. Evidence of a policy which expressly targets least restrictive environments for residential placement in or near the community. Evidence that the policy has been approved by culturally competent consultants.
  4. Documentation that illustrates how critical life issues such as racism, discrimination, violence, gender role conflicts, and life transitions are addressed. Documentation that illustrates how values such as spirituality, community, and family are addressed.
  5. Evidence that a culturally competent clinician was involved in the development of the Treatment Plan, e.g. signature. Evidence that outcomes are re-evaluated by a culturally competent clinician when goals have been achieved.
  6. Consumer satisfaction with the Treatment Plan.
    Benchmark: 90% satisfaction
  7. Written consent stating that the consumer understands the use and side effects of medications.
    Benchmark: 100% documentation
  8. Consumer satisfaction with available mental health education and literature.
    Benchmark: 90% satisfaction.