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]
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]

3. 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.

4. 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

5. 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 multi-ethnic process of development
Lack 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
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.

7. 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.

8. 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

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)
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

10. 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

11. 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

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

13. Organizational Curriculum Elements
Module 4
Integrating Cultural Competence into Quality Improvement Programs
Putting It All Together: Agency’s 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
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

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

17. 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

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
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

20. 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)