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

Cultural Competence Planning

 

Standard

A Cultural Competence Plan should be developed and integrated within the overall organization and/or provider network plan, using an incremental strategic approach, to assure attainment of cultural competence within manageable but concrete timelines. Development and integration of the Cultural Competency Plan should be achieved with the participation and representation of top and middle management administrators, front-line staff, consumers and/or their families, and community stakeholders. A culturally competent individual at the executive level, should be appointed to take responsibility for, and have authority to monitor, implementation of the Cultural Competence Plan. Additionally, each individual manager should be accountable for the success of the Cultural Competence Plan based on their level within the organization.

 

Implementation Guidelines

The Cultural Competence Plan should include:

  1. A process for integrating the Cultural Competence Plan into the overall state and/or department plan, and for including the principles of cultural competency in all aspects of organizational strategic planning and in any future planning process;
  2. A process for determining unique regionally-based needs and ecological variables within the communities/populations served using existing agency databases, surveys, community forums and key informants;
  3. Identification of service modalities and models which are appropriate and acceptable to the communities served, e.g., rural vs. non-rural, migrant workers, minority subcultures, population densities and the age group served (children, adolescents, adults, and elderly);
  4. Identification and involvement of community resources, (e.g., family members, churches, civic clubs, and community organizations) and cross-system alliances (e.g., corrections, juvenile justice, education, social services, substance abuse, developmental disability, primary care plans, public health agencies) for purposes of integrated consumer support and service delivery;
  5. Identification of natural supports (e.g., family members, traditional healers, churches, civic clubs, community organizations) for purposes of reintegrating the individual within his/her natural environment;
  6. Identification of key issues and approaches to assure cultural competence at each level of care within the system (e.g., crisis, inpatient, outpatient, residential, home-based);
  7. Stipulation of staffing patterns and skills (including licensing, certification, credentialing, and privileging) for all staff, clerical through executive management;
  8. The use of formal cultural competence assessment tools, which are adapted for specific minority cultural values and beliefs, in developing, implementing, and monitoring the Cultural Competence Plan;
  9. Development of rewards and incentives (e.g., salary, promotion, bonuses) for cultural competence performance, as well as sanctions for culturally destructive practices (e.g., discrimination). These should be made an integral part of the employee/provider performance evaluation system.
  10. Development and ongoing plan monitoring of indicators to assure equal access, comparability of benefits, and outcomes across each level of the system of care and for all services provided through the Health Plan.
     

Recommended Performance Indicators

  1. Presence of a Cultural Competence Plan and defined steps for its integration at every level of organizational planning.
  2. Presence, within the Cultural Competence Plan, of related policy/procedure changes.
  3. Percentage/number of staff receiving initial and ongoing cultural competence training.
  4. Demonstration of staff knowledge regarding Latino values, traditions, expression of illness, cultural competency principles (e.g., credentialing and performance based testing).
  5. Demonstration of a cultural competence system evaluation (e.g., Mason, 1995, Cultural competence self assessment questionnaire: A Manual for users).(1)
  6. Demonstration of staff and consumer awareness of the Cultural Competence Plan.
  7. Presence of a plan for recruitment, retention, and promotion of Latino staff representative of target population served.


Recommended Outcomes

  1. Percent of Latino consumers compared to Latino representation in the community
    Benchmark: Comparable to overall service population
  2. Percent of Latino consumers served by, or under direct supervision of, culturally competent staff
    Benchmark: 100% served
  3. Consumer satisfaction with services
    Benchmark: 90% satisfaction
  4. Proportionality of access to, and length of service of, the full range of treatment services offered
    Benchmark: Comparable to overall service recipients for access to specific levels and types of services
  5. Restrictiveness of placement (including incarceration/detention) for Latinos versus the overall community
    Benchmark: Comparable restrictiveness and overall reduced restrictiveness