Developing Organizational
Commitment to Cultural
Competence
Peter J. Guarnaccia, Ph.D.
Institute for Health, Health Care Policy
and Aging Research
Rutgers, The State University of New Jersey
Presentation at the Annual Research Meeting Of Academy Health in the session on
“National Standards For Culturally & Linguistically Appropriate Behavioral Health Care:
Are We Kidding Ourselves,” June 27, 2005, Boston, MA
Focus on Health Disparities



IOM report “Unequal Treatment:
Confronting Racial and Ethnic Disparities
in Health Care [2002]
Surgeon General’s report on “Mental
Health: Culture, Race and Ethnicity”
[2001]
President’s New Freedom Commission on
Mental Health’s report “Achieving the
Promise: Transforming Mental Health Care
in America” [2003]
CULTURAL SENSITIVITY AND
DIVERSITY


CULTURAL SENSTIVITY: How
staff explore their own backgrounds
and attitudes towards consumers.
CULTURAL DIVERSITY: How an
organization deals with differences
among staff and matches staff to
consumers.
CULTURAL COMPETENCE
CULTURAL COMPETENCE:
 System-level, organizational issues
in dealing with a multicultural
consumer population
• Includes cultural sensitivity and cultural
diversity
• Goes beyond attitudes and staffing
patterns
• Includes skills and program elements
which enhance services to a diverse
consumer population
CLAS & SAMHSA Standards

Culturally and Linguistically Appropriate
Standards (CLAS) from the Office of Minority
Health, DHHS
• Provide a comprehensive overview of the components of
a culturally competent health care organization
• Lack implementation guidelines or performance
standards

SAMHSA Cultural Competence Standards for
Managed Behavioral Health Care Organizations
• Provide consensus guidelines developed through a multiethnic process of development
• Lack implementation guidelines, but provide extensive
performance standards for organizations
Barriers to Implementation of
Organizational Cultural Competence



Cultural competence training needs
to incorporate the senior leadership
There are significant costs to
implementing cultural competence
training
Staff in managed mental health care
programs are often overwhelmed by
productivity demands and paperwork
requirements.
Barriers to Implementation of
Organizational Cultural Competence

There is a dearth of research
establishing the impact of cultural
competence interventions on:
• improving program quality
• success in recruiting and retaining a
diverse patient population.

Management information systems
need to be adapted to identify the
differential experiences of diverse
client populations.
Crossing Cultural Bridges


Research team at large northeastern,
university-based managed behavioral
health care program
Funding from SAMHSA to develop a model
curriculum for training mental health
professionals to provide culturally
competent care
• William Vega & Paulette Hines, PIs

Comprehensive program of organizational
and clinical training with links to quality
improvement processes
Important Elements of the
Organizational Component


Creating dedicated time for senior
leadership to focus on cultural competence
issues (4 half days and 2 full day models)
Providing a structured format for working
through the issues
• Worksheets
• Resource materials
• Data and photos from their programs


Integrating the Directors of Training and
Quality Improvement into the program
Emphasizing a Quality Improvement Focus
Organizational Curriculum Elements
Module 1
 Overview of Cultural Competence
 National and Local Standards for
Cultural Competence – The Context of
Change
 Adapting Mission Statement and
Objectives to Incorporate Cultural
Competence
Organizational Curriculum Elements
Module 2
 Community Demographics and
Staffing Patterns
 Recruitment/Retention of
Multicultural Staff
 Review and Assessment of the
Program Environments for Cultural
Competence
Organizational Curriculum Elements
Module 3
 Cultural Competence SelfAssessment: Tools and How to Use
Them
 Integrating Cultural Competence into
Human Resource Development
Programs
Organizational Curriculum Elements
Module 4
 Integrating Cultural Competence into
Quality Improvement Programs
 Putting It All Together: Agency’s
Cultural Competence Plan and
Planning Process
Ethnic Diversity in State
and Among Program Clients and Staff
80
70
Percent
60
50
40
30
20
10
0
Euro-Am
African-Am
Statewide
Latino
MH Program Staff
Asian-Am
Other
MH Program Clients
Interventions on Staffing




Presented data on demographics of
local communities for each of the
sites
During the training, leadership spoke
with personnel office about
recruitment approaches
Discovered major method was an ad
in a single regional newspaper
Brainstormed alternative approaches
Sub Scores on the Agency Cultural
Competence Survey
4
Score
3
2
1
Training
Diversity
Assess/Tx
Total
Environment
org A
Language
Total
org B
Remember: lower scores mean better cultural competence!
Agency Cultural Competency
A Staff Survey






Developed by head of QI
Designed to be easily administered
and analyzed
Given to all staff to report on their
perceptions of the organization
Identifies weaknesses and strengths
Designed to assess organization; not
evaluate individuals
Provides benchmark to measure
progress
No-Shows for Follow-Up Appointments
by Ethnicity and Site
10
16.8
22.4
24.6
26.3
16.4
15
16
20
19.5
Percent
25
24.6
30
5
0
Asian
A-A
Site A
Latino
E-A
Site B
Focus on Quality Improvement




Cultural competence efforts need to
be tightly linked to quality
improvement efforts
Need to include ethnicity in
management information system
Need to work with staff to collect
data on ethnicity of clients
Need to make the data readily
available in ways that program staff
can use
Lessons to Be Learned




Start with leadership and programs that
are ready to innovate, rather than trying
to transform the entire agency
Introduce data on client outcomes and
processes early in the effort
Link clinical training to regular clinical
work (e.g. case consultations)
Infuse cultural competence into on-going
training programs (orientation, treatment
modalities, clinical assessments)