Cultural Competence Standards in Managed Care Mental Health Services for Latino Populations

Access and Service Authorization

 

Standard

Access to services should not be individually-oriented only, but also family-oriented in the context of Latino cultural values. Access criteria for different levels of care should include health/medical, behavior, and functioning in addition to diagnosis. Criteria should be multidimensional in four domains: psychiatric, medical, social functioning/behavior, and community support.

 

Implementation Guidelines

  1. Specific procedures should be developed to ensure comparability of access across populations. Latino Mental Health Specialists should be involved in the development and ongoing implementation of these procedures.
  2. Gatekeeping and service authorization to Latinos should be performed by, or under the supervision of, Latino Mental Health Specialists.
  3. Restrictive placements for Latino consumers should be made only with the prior involvement and concurrence of Latino Mental Health Specialists. Restrictive placements include inpatient, residential, and involuntary treatment.
  4. Access should be decentralized and facilitated through multiple outreach and case-finding approaches, including strategic co-location with Latino community and social service agencies in neighborhood locales accessible to public transit, and through in-home/in-community/mobile assessments.
  5. The use of telephone numbers (e.g., 1-800 numbers) for access should not be exclusive of other points of entry for 24 hour crisis service and should be accompanied by education of Latino consumers in their use. Staffing for these services should be culturally and linguistically competent, with access to Latino Mental Health Specialists for consultation.
  6. Legal documentation should not be a requirement for service and should not serve as a barrier to service access. (Legal status should not be confused with sponsored and unsponsored status.)
  7. Confidentiality requirements should be adapted to incorporate Latino cultural values, particularly the inclusion of families in care access decisions, so as not to serve as a barrier to care.


Recommended Performance Indicators

  1. Procedures for access in place with specific provisions for Latino consumers.
  2. Time from point of first contact to service provision for all levels of care tracked by age, gender, and ethnicity.
  3. Staffing pattern coverage of access services.
  4. Rate and timeliness of response to telephone calls by Latino consumers.


Recommended Outcomes

  1. Tracking of authorization decisions including denials, rationale, and disposition by ethnicity
    Benchmark: Comparability across ethnic groups served
  2. Tracking of access and utilization rates for Latinos across all levels of care in comparison to the covered population and the Latino community at large
    Benchmark: Proportional to covered population and non-sponsored Latino community at large
  3. Consumer and family satisfaction with access and authorization services
    Benchmark: 90% satisfaction