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Developing Organizational Commitment to Cultural Competence Peter J. Guarnaccia, Ph.D. Institute for Health, Health Care Policy and Aging Research Rutgers,

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Presentation on theme: "Developing Organizational Commitment to Cultural Competence Peter J. Guarnaccia, Ph.D. Institute for Health, Health Care Policy and Aging Research Rutgers,"— Presentation transcript:

1 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

2 Focus on Health Disparities IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [2002] IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [2002] Surgeon Generals report on Mental Health: Culture, Race and Ethnicity [2001] Surgeon Generals report on Mental Health: Culture, Race and Ethnicity [2001] Presidents New Freedom Commission on Mental Healths report Achieving the Promise: Transforming Mental Health Care in America [2003] Presidents New Freedom Commission on Mental Healths report Achieving the Promise: Transforming Mental Health Care in America [2003]

3 CULTURAL SENSITIVITY AND DIVERSITY CULTURAL SENSTIVITY: How staff explore their own backgrounds and attitudes towards consumers. 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 DIVERSITY: How an organization deals with differences among staff and matches staff to consumers.

4 CULTURAL COMPETENCE CULTURAL COMPETENCE: System level, organizational issues in dealing with a multicultural consumer population System level, organizational issues in dealing with a multicultural consumer population Includes cultural sensitivity and cultural diversityIncludes cultural sensitivity and cultural diversity Goes beyond attitudes and staffing patternsGoes beyond attitudes and staffing patterns Includes skills and program elements which enhance services to a diverse consumer populationIncludes skills and program elements which enhance services to a diverse consumer population

5 CLAS & SAMHSA Standards Culturally and Linguistically Appropriate Standards (CLAS) from the Office of Minority Health, DHHS 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 organizationProvide a comprehensive overview of the components of a culturally competent health care organization Lack implementation guidelines or performance standardsLack implementation guidelines or performance standards SAMHSA Cultural Competence Standards for Managed Behavioral Health Care Organizations SAMHSA Cultural Competence Standards for Managed Behavioral Health Care Organizations Provide consensus guidelines developed through a multi- ethnic process of developmentProvide consensus guidelines developed through a multi- ethnic process of development Lack implementation guidelines, but provide extensive performance standards for organizationsLack implementation guidelines, but provide extensive performance standards for organizations

6 Barriers to Implementation of Organizational Cultural Competence Cultural competence training needs to incorporate the senior leadership Cultural competence training needs to incorporate the senior leadership There are significant costs to implementing cultural competence training 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. Staff in managed mental health care programs are often overwhelmed by productivity demands and paperwork requirements.

7 Barriers to Implementation of Organizational Cultural Competence There is a dearth of research establishing the impact of cultural competence interventions on: There is a dearth of research establishing the impact of cultural competence interventions on: improving program qualityimproving program quality success in recruiting and retaining a diverse patient population.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. Management information systems need to be adapted to identify the differential experiences of diverse client populations.

8 Crossing Cultural Bridges Research team at large northeastern, university-based managed behavioral health care program 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 Funding from SAMHSA to develop a model curriculum for training mental health professionals to provide culturally competent care William Vega & Paulette Hines, PIsWilliam Vega & Paulette Hines, PIs Comprehensive program of organizational and clinical training with links to quality improvement processes Comprehensive program of organizational and clinical training with links to quality improvement processes

9 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) 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 Providing a structured format for working through the issues WorksheetsWorksheets Resource materialsResource materials Data and photos from their programsData and photos from their programs Integrating the Directors of Training and Quality Improvement into the program Integrating the Directors of Training and Quality Improvement into the program Emphasizing a Quality Improvement Focus Emphasizing a Quality Improvement Focus

10 Organizational Curriculum Elements Module 1 Overview of Cultural Competence Overview of Cultural Competence National and Local Standards for Cultural Competence – The Context of Change National and Local Standards for Cultural Competence – The Context of Change Adapting Mission Statement and Objectives to Incorporate Cultural Competence Adapting Mission Statement and Objectives to Incorporate Cultural Competence

11 Organizational Curriculum Elements Module 2 Community Demographics and Staffing Patterns Community Demographics and Staffing Patterns Recruitment/Retention of Multicultural Staff Recruitment/Retention of Multicultural Staff Review and Assessment of the Program Environments for Cultural Competence Review and Assessment of the Program Environments for Cultural Competence

12 Organizational Curriculum Elements Module 3 Cultural Competence Self- Assessment: Tools and How to Use Them Cultural Competence Self- Assessment: Tools and How to Use Them Integrating Cultural Competence into Human Resource Development Programs Integrating Cultural Competence into Human Resource Development Programs

13 Organizational Curriculum Elements Module 4 Integrating Cultural Competence into Quality Improvement Programs Integrating Cultural Competence into Quality Improvement Programs Putting It All Together: Agencys Cultural Competence Plan and Planning Process Putting It All Together: Agencys Cultural Competence Plan and Planning Process

14 Ethnic Diversity in State and Among Program Clients and Staff

15 Interventions on Staffing Presented data on demographics of local communities for each of the sites Presented data on demographics of local communities for each of the sites During the training, leadership spoke with personnel office about recruitment approaches During the training, leadership spoke with personnel office about recruitment approaches Discovered major method was an ad in a single regional newspaper Discovered major method was an ad in a single regional newspaper Brainstormed alternative approaches Brainstormed alternative approaches

16 Remember: lower scores mean better cultural competence! Sub Scores on the Agency Cultural Competence Survey

17 Agency Cultural Competency A Staff Survey Developed by head of QI Developed by head of QI Designed to be easily administered and analyzed Designed to be easily administered and analyzed Given to all staff to report on their perceptions of the organization Given to all staff to report on their perceptions of the organization Identifies weaknesses and strengths Identifies weaknesses and strengths Designed to assess organization; not evaluate individuals Designed to assess organization; not evaluate individuals Provides benchmark to measure progress Provides benchmark to measure progress

18 No-Shows for Follow-Up Appointments by Ethnicity and Site

19 Focus on Quality Improvement Cultural competence efforts need to be tightly linked to quality improvement efforts Cultural competence efforts need to be tightly linked to quality improvement efforts Need to include ethnicity in management information system Need to include ethnicity in management information system Need to work with staff to collect data on ethnicity of clients 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 Need to make the data readily available in ways that program staff can use

20 Lessons to Be Learned Start with leadership and programs that are ready to innovate, rather than trying to transform the entire agency 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 Introduce data on client outcomes and processes early in the effort Link clinical training to regular clinical work (e.g. case consultations) Link clinical training to regular clinical work (e.g. case consultations) Infuse cultural competence into on-going training programs (orientation, treatment modalities, clinical assessments) Infuse cultural competence into on-going training programs (orientation, treatment modalities, clinical assessments)


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