The Annapolis Coalition - Cultural Competencies and Disparity Issues

Cultural Competencies and Disparity Issues

Additional Content

The current behavioral health workforce is at a crisis point for communities of color including African Americans, Asian Americans, Native Hawaiians and other Pacific Islanders, Hispanic/Latinos and Native Americans. The Surgeon General’s Report on Culture, Race and Ethnicity, the final report of the President’s New Freedom Commission on Mental Health the Institute of Medicine’s Report on Crossing the Quality Chasm, all come to the same conclusion: the current workforce consistently fails to adequately provide services that can address the cultural and linguistic needs of the target populations, resulting in poor assessments, misdiagnoses and inappropriate treatment plans. Even when quality services do exist, the resources to provide support for the small number of staff and agencies are missing, resulting in burnout at all levels.

To develop a culturally and linguistically competent behavioral health workforce, basic questions must be addressed:

WHO: the training must go beyond traditional graduate training programs in psychology, social work, counseling and psychiatry and must include para-professionals, consumers of services and persons in recovery, family members and interpreters. This must be done not only to increase the number of potential providers, but also to increase the quality of services for consumers and persons in recovery by allowing consumers and families to share their wealth of experience. Training must also include administrators, supervisors, policy makers and others in decision-making positions.

WHAT: Increasing the number of providers alone is inadequate if what providers are taught is not significantly different from the norm in today’s curricula. Models that address infusing culture at all levels of prevention, engagement, assessment, diagnosis and treatment planning and service delivery must be developed, implemented and evaluated in order to change the potential for impact.

WHERE: Culturally competent workforce issues must be addressed at all levels, including graduate training programs, mental health and substance use treatment agencies, as well as within communities, in hospitals, health clinics, substance abuse centers, jails, courts and other human and social services.

HOW: Efforts to improve the workforce may use traditional methods of face-to-face, ongoing training-- although not the ineffective one-shot, one hour workshop model-- using consumers/family members as faculty, training at internship sites, and within healthcare settings. There is also the need to incorporate technology, such as teleconferencing, distance learning and other methods, to reach communities isolated through either geography or language.

There are numerous policies, standards and practices that have been developed to address cultural competency in the mental health and substance use treatment, as well as health promotion and prevention activities. These include the American Psychological Association Guidelines on Multicultural Education Training, Research, Practice, and Organizational Change for Psychology; the Department of Health and Human Services Culturally and Linguistically Appropriate Services (CLAS) Standards; and Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups. The web sites for these resources are listed below. The American Psychological Association’s Minority Fellowship Program has been instrumental in providing support to bring young clinicians of color into the field. Their support has been critical in developing an ongoing stream of young professionals who can address culture, race, and ethnicity in the workforce. Our Lady of the Lake and the National Asian American Pacific Islander Mental Health Association (NAAPIMHA) have both developed and implemented training programs that train clinicians on the provision of culturally and linguistically appropriate services to communities of color, primarily Spanish speaking and Asian American, Native Hawaiian and other Pacific Islanders. Other programs and initiatives will be highlighted in the future.

Resources that can be found on the web

Achieving Cultural Competence

www.aoa.gov

The American College of Mental Health Administration Summit March 2003 focused on "Reducing Disparity: Achieving Equity in Behavioral Health Services."
www.acmha.org

American Psychological Association Guidelines on Multicultural Education Training, Research, Practice, and Organizational Change for Psychology
www.apa.org.(PDF)

Assuring Cultural Competence in Health Care: Recommendations for National Standards, Health and Human Services' Office of Minority Health:
www.omhrc.gov

Compendium of Cultural Competence Initiatives in Health Care
Public and private sector organizations are involved in a number of activities that seek to reduce cultural and communication barriers to health care.
www.kff.org

Cultural Competency for California Public Health Staff. California Department of Health Services' Office of Multicultural Health. September 2004
futurehealth.ucsf.edu

Cultural Competency: Measurement as a Strategy for Moving Knowledge into Practice in State Mental Health Systems, National Technical Assistance Center for State Mental Health Planning (NTAC), National Association of State Mental Health Program Directors (NASMHPD) Final Report September 2004

www.nasmhpd.org

Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups Center for Mental Health Services:
www.mentalhealth.samhsa.gov

Cultural Competence Standards: Full Report and Commentary
www.omhrc.gov

Dept of Health and Human Services ~ CMS (Centers for Medicare & Medicaid Services)
www.cms.gov:

Providing Oral Linguistic Services: A Guide for Managed Care Plans
Planning Culturally and Linguistically Appropriate Services: A Guide For Managed Care Plans
Best Practices for Culturally and Linguistically Appropriate Services in Managed Care Conference: June 3 and 4, 2002 in Research Triangle Park, North Carolina.

Dept of Health and Human Services Culturally and Linguistically Appropriate Services (CLAS) Standards
www.omhrc.gov

Developing a Self-Assessment Tool for Culturally and Linguistically Appropriate Services in Local Public Health Agencies: Final Report, December 2003.
Office of Minority Health
www.omhrc.gov(PDF)

Ensuring Linguistic Access in HealthCare-Settings: Legal Rights and Responsibilities, 2nd Edition, August 2003, National Health Law Program.

www.calendow.org

Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR (Eds.). Washington, DC: National Academies Press; 2003.
www.iom.edu

Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. www.iom.edu

Mental Health: Culture, Race, and Ethnicity, U.S. Surgeon General:
www.surgeongeneral.gov

The Provider's Guide to Quality and Culture, HRSA
http://erc.msh.org/

State of California Department of Mental Health Office of Multicultural Affairs:
www.dmh.cahwnet.gov

Why Is There A Compelling Need For Cultural Competence?
www.gucchd.georgetown.edu

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	Home About Us Action Plan Core Competencies Behavioral Health Pacesetter Award Governance Publications Presentations E-News Technical Assistance Links Innovation Register for Updates Special Topics Contact Us Join our mailing list	Cultural Competencies and Disparity Issues Additional Content The current behavioral health workforce is at a crisis point for communities of color including African Americans, Asian Americans, Native Hawaiians and other Pacific Islanders, Hispanic/Latinos and Native Americans. The Surgeon General’s Report on Culture, Race and Ethnicity, the final report of the President’s New Freedom Commission on Mental Health the Institute of Medicine’s Report on Crossing the Quality Chasm, all come to the same conclusion: the current workforce consistently fails to adequately provide services that can address the cultural and linguistic needs of the target populations, resulting in poor assessments, misdiagnoses and inappropriate treatment plans. Even when quality services do exist, the resources to provide support for the small number of staff and agencies are missing, resulting in burnout at all levels. To develop a culturally and linguistically competent behavioral health workforce, basic questions must be addressed: WHO: the training must go beyond traditional graduate training programs in psychology, social work, counseling and psychiatry and must include para-professionals, consumers of services and persons in recovery, family members and interpreters. This must be done not only to increase the number of potential providers, but also to increase the quality of services for consumers and persons in recovery by allowing consumers and families to share their wealth of experience. Training must also include administrators, supervisors, policy makers and others in decision-making positions. WHAT: Increasing the number of providers alone is inadequate if what providers are taught is not significantly different from the norm in today’s curricula. Models that address infusing culture at all levels of prevention, engagement, assessment, diagnosis and treatment planning and service delivery must be developed, implemented and evaluated in order to change the potential for impact. WHERE: Culturally competent workforce issues must be addressed at all levels, including graduate training programs, mental health and substance use treatment agencies, as well as within communities, in hospitals, health clinics, substance abuse centers, jails, courts and other human and social services. HOW: Efforts to improve the workforce may use traditional methods of face-to-face, ongoing training-- although not the ineffective one-shot, one hour workshop model-- using consumers/family members as faculty, training at internship sites, and within healthcare settings. There is also the need to incorporate technology, such as teleconferencing, distance learning and other methods, to reach communities isolated through either geography or language. There are numerous policies, standards and practices that have been developed to address cultural competency in the mental health and substance use treatment, as well as health promotion and prevention activities. These include the American Psychological Association Guidelines on Multicultural Education Training, Research, Practice, and Organizational Change for Psychology; the Department of Health and Human Services Culturally and Linguistically Appropriate Services (CLAS) Standards; and Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups. The web sites for these resources are listed below. The American Psychological Association’s Minority Fellowship Program has been instrumental in providing support to bring young clinicians of color into the field. Their support has been critical in developing an ongoing stream of young professionals who can address culture, race, and ethnicity in the workforce. Our Lady of the Lake and the National Asian American Pacific Islander Mental Health Association (NAAPIMHA) have both developed and implemented training programs that train clinicians on the provision of culturally and linguistically appropriate services to communities of color, primarily Spanish speaking and Asian American, Native Hawaiian and other Pacific Islanders. Other programs and initiatives will be highlighted in the future. Resources that can be found on the web Achieving Cultural Competence www.aoa.gov The American College of Mental Health Administration Summit March 2003 focused on "Reducing Disparity: Achieving Equity in Behavioral Health Services." www.acmha.org American Psychological Association Guidelines on Multicultural Education Training, Research, Practice, and Organizational Change for Psychology www.apa.org.(PDF) Assuring Cultural Competence in Health Care: Recommendations for National Standards, Health and Human Services' Office of Minority Health: www.omhrc.gov Compendium of Cultural Competence Initiatives in Health Care Public and private sector organizations are involved in a number of activities that seek to reduce cultural and communication barriers to health care. www.kff.org Cultural Competency for California Public Health Staff. California Department of Health Services' Office of Multicultural Health. September 2004 futurehealth.ucsf.edu Cultural Competency: Measurement as a Strategy for Moving Knowledge into Practice in State Mental Health Systems, National Technical Assistance Center for State Mental Health Planning (NTAC), National Association of State Mental Health Program Directors (NASMHPD) Final Report September 2004 www.nasmhpd.org Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups Center for Mental Health Services: www.mentalhealth.samhsa.gov Cultural Competence Standards: Full Report and Commentary www.omhrc.gov Dept of Health and Human Services ~ CMS (Centers for Medicare & Medicaid Services) www.cms.gov: Providing Oral Linguistic Services: A Guide for Managed Care Plans Planning Culturally and Linguistically Appropriate Services: A Guide For Managed Care Plans Best Practices for Culturally and Linguistically Appropriate Services in Managed Care Conference: June 3 and 4, 2002 in Research Triangle Park, North Carolina. Dept of Health and Human Services Culturally and Linguistically Appropriate Services (CLAS) Standards www.omhrc.gov Developing a Self-Assessment Tool for Culturally and Linguistically Appropriate Services in Local Public Health Agencies: Final Report, December 2003. Office of Minority Health www.omhrc.gov(PDF) Ensuring Linguistic Access in HealthCare-Settings: Legal Rights and Responsibilities, 2nd Edition, August 2003, National Health Law Program. www.calendow.org Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR (Eds.). Washington, DC: National Academies Press; 2003. www.iom.edu Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. www.iom.edu Mental Health: Culture, Race, and Ethnicity, U.S. Surgeon General: www.surgeongeneral.gov The Provider's Guide to Quality and Culture, HRSA http://erc.msh.org/ State of California Department of Mental Health Office of Multicultural Affairs: www.dmh.cahwnet.gov Why Is There A Compelling Need For Cultural Competence? www.gucchd.georgetown.edu BACK