Cultural Competence Standards in Managed Care Mental Health Services For Native American 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, tribal sovereign nations, 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 for both urban/suburban and rural/reservation Native Americans should include:

1. Urban/Suburban:

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.

Rural/Reservation:

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. In addition, for those Native Americans whose tribal nations have jurisdictions in more than one state, the planning would emphasize the preservation of tribal unity and guideline consistency within the multiple states and departments.

2. Urban/Suburban and Rural/Reservation:

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. Urban/Suburban and Rural/Reservation:

Identification of service modalities and models that are appropriate and acceptable to the communities served (rural vs. non-rural), population densities, and targeted population subgroups, (e.g., children, adolescents, adults, elders, sexual minorities, and individuals with co-occurring conditions).

4. Urban/Suburban and Rural/Reservation:

Identification and involvement of community resources, (e.g., tribal council or governing body, family members, clans, native societies, spiritual leaders, 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 and tribal health agencies) for purposes of integrated consumer support and service delivery.

5. Urban/Suburban and Rural/Reservation:

Identification of natural, environmental supports (e.g., family members, religious leaders, traditional healers, churches, civic clubs, community organizations) for purposes of reintegrating the individual within his/her natural environment, keeping in mind that for many, this may also include migratory patterns to and from a reservation or reservations.

6. Urban/Suburban:

Working to assure cultural competence at each level of care within the system (e.g., crisis, inpatient, outpatient, residential, home-based).

Rural/Reservation:

Working to assure cultural competence at each level of care within the system (e.g., crisis, inpatient, outpatient, residential, home-based health maintenance, community health liaison services).

7. Urban/Suburban:

Stipulation of adequate and culturally diverse staffing and minimal skill levels (including licensing, certification, credentialing, and privileging) for all staff, clerical through executive management. It is important to note that in some cases there may be qualified personnel without formal credentials, i.e. traditional healers. Therefore, this must be handled in a culturally and community based manner.

Rural/Reservation:

Rationale for staffing patterns which addresses adequacy and cultural diversity of staffing and contains documentation of minimal skill levels (including licensing, certification, credentialing, and privileging) for all staff, clerical through executive management.

8. Urban/Suburban and Rural/Reservation:

The use of culturally competent, total quality management indicators, which are adapted for specific minority cultural values and beliefs, in developing, implementing, and monitoring the Cultural Competence Plan.

9. Urban/Suburban and Rural/Reservation:

Cultural competence performance should be an integral part of the employee-provider performance evaluation system, and provider organization performance evaluation system.

10. Urban/Suburban and Rural/Reservation:

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. It is especially important to develop common indicators for Native Americans belonging to tribes spanning more than one state.

 

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 Native American 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).
  6. Demonstration of staff and consumer awareness of the Cultural Competence Plan.
  7. Presence of a plan for recruitment, retention, and promotion of Native American staff representative of target population served.

 

Recommended Outcomes

  1. Percent of Native American consumers compared to Native American representation in the community
    Benchmark: Comparable to overall service population.
  2. Percent of Native American 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 Native Americans versus the overall community
    Benchmark: Comparable restrictiveness and overall reduced restrictiveness