Cultural Competence Standards in Managed Care Mental Health Services For Native American 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 Native American 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. Urban/Suburban and Rural/Reservation:

Consumers and families should be well-informed by the Health Plan about available treatment choices which should be freely discussed by the provider including listing prescriptions and medications not available in the Health Plan. The final decision to be treated rests with the consumer.

2. Urban/Suburban:

Treatment for Native American consumers and families should be consumer-driven and performed by culturally competent, clinically qualified Native American mental health specialists. In the absence of sufficient Native American clinical staff serving Native American should receive supervision or consultation from Native American mental health specialists.

Rural/Reservation:

Treatment for Native American consumers and families should be consumer-driven and performed by culturally competent, clinically qualified Native American mental health specialists. In the absence of sufficient Native American clinical staff serving Native American should receive supervision or consultation from Native American mental health specialists, or from cultural competent mental health specialists with specialization in Native American populations.

3. Urban/Suburban and Rural/Reservation:

Assignment of clinicians to minority consumers and families should be based on a match between clinician skills and the consumer’s clinical, cultural, and linguistic needs.

4. Urban/Suburban and Rural/Reservation:

The workforce serving Native Americans should be able to meet the needs of Native American 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.

5. Urban/Suburban and Rural/Reservation:

When appropriate, the Health Plan should contract with, and utilize qualified minority community-based organizations and independent practitioners in its network..

6. Urban/Suburban and Rural/Reservation:

Psychotherapeutic modalities should be conducted within a context of Native American cultural values (e.g., goal-oriented, proactive, and family-oriented approaches) and should address psychological issues specific to Native American (e.g., current and historical trauma, acculturation, intergenerational and gender role distinctions, and life transitions).

7. Urban/Suburban and Rural/Reservation:

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.

8. Urban/Suburban and Rural/Reservation:

Psychological evaluation should be conducted by psychologists specifically 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 treatment consent and family education. Specific knowledge concerning the norms, biases, and limitations of each instrument used must be demonstrated.

9. Urban/Suburban and Rural/Reservation:

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 consultation with, qualified minority Mental Health Specialists.

10. Urban/Suburban and Rural/Reservation:

The Health Plan should develop specialized approaches to maintain continuity of care, prevent symptom relapse, and reduce recidivism to more restrictive and expensive services.

11. Urban/Suburban and Rural/Reservation:

Medical and mental health services for Native American consumers and families should be adapted to the mental health epidemiology of the community.

12. Urban/Suburban and Rural/Reservation:

The Health Plan should recognize, legitimize, facilitate, and compensate (if appropriate) the utilization of traditional healers and therapies. It should also recognize that some conditions may be better treated by traditional healers and thus, referrals and/or consultation is appropriate in those cases.

13. Urban/Suburban and Rural/Reservation:

The Health Plan should promote early intervention and prevention.

 

Recommended Performance Indicators

  1. See section on Staff Training and Development for guidelines and indicators related to staffing patterns.
  2. Protocols for level of care decisions for Native American consumers.
  3. Distinction and equivalence of services for Native American consumers.
  4. Specialized protocols for prevention of symptom relapse and reduction of recidivism for Native American consumers.
  5. Culturally and linguistically competent literature on prevalent psychiatric disorders, medical treatment options, and pharmacological interventions distributed to all Native American 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, restrictiveness of placement, access to primary health care, family role, vocational/education/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.