Focus on Health Disparities
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
„
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]
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
CULTURAL SENSITIVITY AND
DIVERSITY
™
™
CULTURAL SENSTIVITY:
SENSTIVITY: How
staff explore their own backgrounds
and attitudes towards consumers.
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
„
CULTURAL COMPETENCE:
COMPETENCE:
level,
organizational issues
™ SystemSystem
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
CULTURAL DIVERSITY:
DIVERSITY: How an
organization deals with differences
among staff and matches staff to
consumers.
CLAS & SAMHSA Standards
„
CULTURAL COMPETENCE
SAMHSA Cultural Competence Standards for
Managed Behavioral Health Care Organizations
• Provide consensus guidelines developed through a multimultiethnic 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.
1
Barriers to Implementation of
Organizational Cultural Competence
Crossing Cultural Bridges
„
„
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.
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
Research team at large northeastern,
universityuniversity-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
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
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
Module 3
„ Cultural Competence SelfSelfAssessment: Tools and How to Use
Them
„ Integrating Cultural Competence into
Human Resource Development
Programs
2
Ethnic Diversity in State
and Among Program Clients and Staff
Organizational Curriculum Elements
80
70
60
Percent
Module 4
„ Integrating Cultural Competence into
Quality Improvement Programs
„ Putting It All Together: Agency’s
Cultural Competence Plan and
Planning Process
50
40
30
20
10
0
Euro-Am
African-Am
Statewide
„
„
Other
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
4
3
Score
„
Asian-Am
MH Program Clients
Sub Scores on the Agency Cultural
Competence Survey
Interventions on Staffing
„
Latino
MH Program Staff
2
1
Training
Diversity
Assess/Tx
Total
Environment
Language
org A
Total
org B
Remember: lower scores mean better cultural competence!
NoNo-Shows for FollowFollow-Up Appointments
by Ethnicity and Site
Agency Cultural Competency
A Staff Survey
„
„
„
24.6
16.4
10
16.8
15
22.4
26.3
20
24.6
25
19.5
„
30
16
„
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
Percent
„
5
0
Asian
A-A
Site A
Latino
E-A
Site B
3
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 onon-going
training programs (orientation, treatment
modalities, clinical assessments)
4