Cultural Competence Standards in Managed Mental Health Care

Treatment Services

Standard
The Health Plan shall assure that the full array of generally available treatment modalities are tailored such that they are culturally acceptable and effective with populations of the four groups (e.g., education, psychiatric rehabilitation, family therapy, specialized group therapy, behavioral approaches, use of traditional healers, and outreach).

 

Implementation Guidelines

  1. Consumers and families shall be informed about treatment choices available under the Health Plan, as well as about medications and other treatments not available in the Health Plan. The final decision to be treated rests with the consumer.
  2. Treatment for consumers from the four groups and their families shall be consumer-driven and performed or guided by culturally competent Mental Health Specialists.
  3. Assignment of clinicians to consumers from the four groups and their families shall be based on a match between clinician skills, including cultural competency, and the consumer's clinical, cultural, and linguistic needs.
  4. The optimal utilization of the racial/ethnic clinical workforce includes affording these clinicians a variety of clinical experiences including service to consumers other than consumers from similar backgrounds.
  5. The workforce serving consumers from the four groups shall meet the needs of these consumers and their families while maintaining comparability in overall workload with 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 regular duties.
  6. The Health Plan shall contract with, and utilize, local racial/ethnic community-based organizations and independent practitioners in its network and include them in the provider's network or panel. Such providers shall demonstrate cultural competence.
  7. Psychotherapeutic modalities shall address psychological issues specific to consumers from the four groups, e.g., current and historical trauma, acculturation, intergenerational and gender role distinctions, and life transitions.
  8. Psychological evaluation shall be conducted by qualified practitioners trained in ethnic-specific biological, physiological, cultural, socioeconomic, and psychological variables. Psychological evaluations also shall be provided based on the use of culturally and linguistically competent literature and other specialized approaches. Specific knowledge concerning the norms, biases, and limitations of each instrument used shall be demonstrated.
  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 culturally competent Mental Health Specialists.

 

Recommended Performance Indicators

  1. Protocols for level of care decisions for consumers from the four underserved/ underrepresented groups.
  2. Distinction and equivalence of services for consumers from the four underserved/ underrepresented groups.
  3. Specialized protocols for prevention of symptom relapse and reduction of recidivism for consumers from the four groups.
  4. Culturally and linguistically competent literature on prevalent psychiatric disorders, medical treatment options, and pharmacological interventions distributed to all consumers from the four groups and their families.
  5. Consumers receive services by traditional healers, when appropriate and accepted.

 

Recommended Outcomes

  1. Consumer and family satisfaction with treatment services.
    Benchmark: 90% satisfaction.
  2. Inclusion of culturally specific activities and domains of daily living (e.g., housing, access to primary health care and maintenance, family role, behavioral/developmental, vocational/ educational/employment, and community tenure) in treatment services.
    Benchmark: Comparable to overall population served and significant improvement in at least one domain of function for more than 75% of consumers.
  3. 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. 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. 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. Demonstrated incorporation of value of cultural identity, including ethnicity (subgroup membership and mixed origin) and other relevant factors in treatment services.