Cultural Competence Standards in Managed Care Mental Health Services For Native American Populations

Access and Service Authorization

 

Standard

Access to services should not be individually-oriented only, but also family-oriented in the context of Native American 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. Urban/Suburban and Rural/Reservation:

Specific procedures should be developed to ensure comparability of access across populations. Native American Mental Health Specialists should be involved in the development and ongoing implementation of these procedures.

2. Urban/Suburban and Rural/Reservation:

Access should be facilitated through multiple education, outreach and case-finding approaches, including strategic co-location with Native American community and social service agencies in neighborhood locales accessible to public transit, and through in-home/in-community/mobile assessments.

3. Urban/Suburban:

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. 24-hour crisis services should be readily available to Native American consumers utilizing many points of entry including the use of the telephone. Efforts should be made to inform the Native American population of the various points of entry and these efforts should be regularly monitored.

Rural/Reservation:

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. 24-hour crisis services should be readily available to Native American consumers utilizing many points of entry including the use of the telephone. Efforts should be made to inform the Native American population of the various points of entry and these efforts (i.e. chapter house meetings, pow wow exhibits, tribal council meetings) should be regularly monitored.

 

Recommended Performance Indicators

  1. Procedures for access in place with specific provisions for Native American 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 Native American 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 Native Americans across all levels of care in comparison to the covered population and the Native American community at large
    Benchmark: Proportional to covered population and non-sponsored Native American community at large
  3. Consumer and family satisfaction with access and authorization services
    Benchmark: 90% satisfaction