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

Treatment Services

 

Standard

The Health Plan should include a full array of available treatment modalities, particularly modalities which are culturally acceptable and effective with Latino populations (e.g., family therapy, specialized group therapy, behavioral approaches, use of traditional healers, outreach). Consideration must be given to the likelihood of the consumer to accept and implement the Treatment Plan.

 


Implementation Guidelines

  1. Latino consumers and families should be well-informed by the Health Plan about available treatment choices, over which they should have the final decision.
  2. Treatment for Latino consumers and families should be consumer-driven and performed by culturally competent, clinically qualified Latino mental health specialists (LMHS). In the absence of sufficient LMHS, clinical staff serving Latinos should receive supervision from LMHS.
  3. Assignment of clinicians to Latino consumers and families should be based on a match between clinician skills and the consumer’s clinical, cultural, and linguistic needs.
  4. The optimal utilization of the Latino clinical workforce includes affording these clinicians a variety of clinical experiences including service to consumers other than Latinos.
  5. The workforce serving Latinos should be able to meet the needs of Latino consumers and families while maintaining comparability in overall workload to other clinical providers. This takes into consideration requests for interpretation and use of other specialized skills which are often made in addition to normal duties.
  6. The Health Plan should contract with, and utilize, Latino community-based organizations and independent practitioners in its network.
  7. Psychotherapeutic modalities should be conducted within a context of Latino cultural values (e.g., goal oriented, proactive, and family-oriented approaches) and should address psychological issues specific to Latinos (e.g., acculturation, intergenerational, and gender role distinctions, and life transitions).
  8. Psychopharmacological interventions should be conducted by psychiatrists, physicians, nurse practitioners, and physician assistants trained in culturally and ethnically based biological variables and differential medication response. They should also be provided through use of culturally and linguistically competent literature and other specialized approaches to treatment consent and family education.
  9. Psychological evaluation should be conducted by psychologists trained in culturally and ethnically based biological and psychological variables and the relevance of socioeconomic levels of the population. Psychological evaluations should also be provided based on the use of culturally and linguistically competent literature and other specialized approaches to evaluative consent and family education on the meaning of the interpretations and evaluative findings.
  10. The principle of least restrictive level of care should govern treatment and placement decisions with family placement preferable unless otherwise indicated. Level of care decisions should be governed by protocols to ensure timely and accurate decision making and should be designed and carried out by, or in conjunction with, Latino Mental Health Specialists.
  11. The Health Plan should develop specialized approaches to maintain continuity of care, prevent symptom relapse, and reduce recidivism to more restrictive and expensive services.
  12. Medical and mental health services for Latino consumers and families should be coordinated with a focus on the most prevalent mental health needs in the Latino community.
  13. The Health Plan should recognize, legitimize, facilitate, and compensate the utilization of traditional healers and therapies.
  14. The Health Plan should promote early intervention and prevention.

 

Recommended Performance Indicators

  1. See section on Staff Training and Development for Implementation Guidelines and indicators related to staffing patterns.
  2. Protocols for level of care decisions for Latino consumers.
  3. Distinction and equivalence of services for Latino consumers.
  4. Specialized protocols for prevention of symptom relapse and reduction of recidivism for Latino consumers.
  5. Culturally and linguistically competent literature on prevalent psychiatric disorders, medical treatment options, and pharmacological interventions distributed to all Latino consumers and families.
  6. Consumers receive services by cultural healers, when appropriate.

 

Recommended Outcomes

  1. Consumer and family satisfaction with treatment services
    Benchmark: 90% satisfaction.
  2. Functional outcomes in domains of daily living (e.g., housing, access to primary health care, family role, vocational / educational / employment, community tenure)
    Benchmark: Comparable to overall population served and significant improvement in at least one domain of function for over 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)
    Benchmark: Comparable to overall population served and decreasing over time.
  6. Recognition of ethnicity.