Although the authors consider this document to be a work in progress and still in need of more refinement and streamlining, they are issuing it at this time because they believe it is important to begin to get it incorporated into the thinking of the field. Various standards and performance criteria are currently under development and the authors believe that such systems development should integrate products from different sectors of the field. As is true for other special populations, Latinos require consideration of their unique cultural and clinical characteristics in order to maximize cost effectiveness, quality, and access of services.
The transition into managed care in the delivery of health care services has had an impact on both private and public behavioral health systems. As this transition is taking place, a number of potential risks have surfaced. Latino professionals and organizations have concerns about how these major shifts will affect all ethnically diverse populations, but Latinos in particular. Some of these concerns include:
- Cost-cutting that potentially threatens the quality of care;
- Restructuring of services away from local, community-based approaches;
- Relocation of services threatening accessibility;
- Services provided to Latino consumers by mental health professionals not familiar with the language, cultural values, and multiple needs of Latinos;
- Consumer lack of knowledge about how the healthcare system works; and,
- Language barriers interfering with communication and access to resources.
The authors of this document acknowledge that this shift to a new healthcare delivery system offers a number of potential opportunities for behavioral service delivery as well as for the Latino community. Some of these potential opportunities include:
- Increased accountability for services provided;
- Flexibility of care options to consumers;
- Competition for service providers to provide maximum value for the Medicaid consumer dollar;
- Greater cost-efficiency through:
- More accurate diagnosis and effective treatment;
- Use of culturally competent, less restrictive community-based treatment approaches;
- A shift from more restrictive and expensive services to earlier use of services, leading to secondary prevention;
- Use of traditional healers in conjunction with traditional western mental health approaches; and
- Partnership with community organizations for health promotion.
- Greater acceptability through:
- Culturally friendly location and ambiance; and
- Community input into design and governance.
Therefore, to frame the opportunities outlined above, the authors have developed the guiding principles and standards that follow.