keeping the promise of cultural competence a collaborative approach
TRANSCRIPT
KEEPING THE PROMISE OF CULTURAL COMPETENCE A Collaborative Approach
NYS OMH ORGANIZATION CHART
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Emy MurphyChief Diversity Officer
Diversity Planning & ComplianceMarisol Nunez-Rodriquez
DirectorFrances Priester Community Relations/MAC Coordinator
Elatisha Kirnon Cultural Competence /Operations Coordinator
Hextor Pabon Education /Training Coordinator
Deirdre Goss Office Coordinator
Shelly Fiebich Assistant Director
Omer Jirdeh Info Tech/Data Analysis
Donna Swartout Office Manager/Secretary
Diversity Management
Centers of Excellence For Cultural Competence
Nathan Kline Institute Director Carole Siegel
NYS Psychiatric Institute Director Roberto Lewis-Fernandez
Bureau Of Cultural Competence
Disparities
GeneticsInsurance Status
Employment
BehaviorsDiet &Lifestyle Transportatio
n
Religion Social Support
Culture
Ethnicity
LivingConditions
Education
Income
Racism
Stress
GenderLanguage
Health & Mental Health
Drug Use
Incarceration
Government & Policies
Community
Economics
Social Foundation of Disparities Web Model
SES
New Yorkers Helping New Yorkers!
Team New York!
Why the Regional MAC
Those Directly Impacting ConsumersFacility Staff
Administrative Staff (Mid-Managers)
Executive Branch
Commissioner
NYS Mental Health Consumers & Their Families
Advocacy Groups MAC
Regional/State
Community Providers
Other State Agencies
You !!
Definition of CC
An integrated set of behaviors, attitudes and skills, policies and procedures that come together to enable caregivers to work effectively and efficiently in multicultural situations.
It is an attribute of a system, an agency or an individual
(New York State Office of Mental Health 1998, adapted from Cross et al. 1989).
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• Gather and share cultural Competence information and best practices
• Initiate and maintain stakeholder partnership
• Hiring Attention
• Developed and presented training for Staff
• Standardize process for language accommodation
• Monitor services for cultural competence
• Assess state operate facilities
• Assess county providers
• Conduct language survey
Needs/Capacity
Assessment
Services
Information Exchange
Human Resources
NYS OMH Statewide Cultural Competence Strategic Plan
CC
Information Exchange
Cultural Competence Website
Establishing Cultural Competence List serve
Conduct webinars for best practices
Need/Capacity AssessmentsChildren Assessment
ServicesRevised our translated website in Russian, Chinese Mandarin, Haitian(Creole)
Collaborated with Quality Management to develop Cultural and Linguistic Policy
Human Resources Increasing staff cultural and linguistic skill sets through training and education
Attend cultural specific events to endorse employment opportunities at NYS OMH
OutcomesConduct a cultural competence survey
Collaborating with Citer to revised our admission form to gather pertinent demographic information about the population served
Bureau of Cultural Competence
For additional information contact:
518-473-4144http://www.omh.state.ny.us/omhweb/cultural_competence/index.html
HEALTH CARE REFORM ANDORGANIZATIONAL LEVEL CULTURAL COMPETENCY
Carole SiegelGary Haugland
Eugene Laska
Lenora Reid-Rose
Dei-In Tang
Joseph Wanderling
Ethel Chambers
Brady Case
NKI Center of Excellence in Cultural Competency
NYAPRS: April 27, 2011
Acknowledgments
New York State Office of Mental Health Nathan S. Kline Institute Center of
Excellence in Culturally Competent Mental Health.
Outline
Cultural Competency (CC) at the Organizational
Level What it covers/what it does not
NKI Cultural Competence Assessment Instrument: Organizational Level
Can we show that organizational level CC reduces disparities? Partial successes
Study results
Integration with health care reform Where should it operate How to ensure that it operates
Definition of CC
An integrated set of behaviors, attitudes and skills, policies and procedures that come together to enable caregivers to work effectively and efficiently in multicultural situations.
It is an attribute of a system, an agency or an individual
(New York State Office of Mental Health 1998, adapted from Cross et al. 1989).
ADMINISTRATIVE ENTITY
e.g., State Mental Health Authority,
Managed Care Organization
Program ProgramProgram
Agency A
Inpatient unitAgency B
Clinic
Agency C
Rehab
CaregiverCaregiver
Caregiver
Levels of a Mental Health SystemIn which CC needs to operate
ProgramProgram
Program
Caregiver
CaregiverCaregiver
Consumers
Caregiver
NKI Cultural Competency Assessment Scale (CCAS) Organizational Level Organizational commitment to CC Collecting needs assessment data Receiving community input Infusing CC throughout an organization Training staff Making language accommodations
Interpreters Bi-lingual Staff Key Forms, Service Descriptions, Educational Materials
Hiring and retention policies Adapting and creating new services
Study design
Agencies studied: 25 contract outpatient mental health service
agencies Monroe County Office of Mental Health
Agency CC data: Assessed from CCAS instrument
Client data: Characteristics and service use of agency users
Recorded in County mental health information system.
Measures and Models
Service Event Measures Engagement: Second visit occurs in first month post admission.
Retention: At least 4 visits in 6 months post admission
Statistical Model: Hierarchical logistic model on service outcomes. Level 1 person regression: on dx, age, gender, race/ethnicity,
interaction terms. Level 2 agency regression: on size, ethnic mix and CCAS score.
Disparity measure Odds ratio: odds of event for Whites divided by odds of event for
racial/ethnic group.
What CC items predicted lower disparity rates between Hispanics and Whites ?
For Hispanics with mood, anxiety, other non-psychotic disorders: at least one of following
Agency has Interpreters Bilingual staff Hiring, retention policies Translated forms, educational and service material Modifies and/or has new services
For Blacks with mood disorders Agency has interpreters
What CC items did not predict disparity reduction?
Administrative items Agency commitment, plan, CC committee,
CC integrated in agency, having data Comment: Items are distant from direct care.
However, they are necessary prerequisites Training
Comment: Mixed quality of training materials has been cited.
Materials are not relevant to direct care Often unrelated to populations being served.
Why was disparity reduction predicted for Hispanics and not for Blacks? Language related items more relevant to Hispanics than Blacks
Communication competencies for Blacks need to be differently addressed.
Modified programs for Blacks may not have been in place in studied agencies. Difficulties in adapting services when adaptation is more than
‘translation’
Scale may not contain organizational items of relevance to Blacks E.g., transportation and hours
Disparity reduction for Blacks may be more related to program delivery and therapeutic alliances E.g, trust building, stigma reduction
Ensuring CC under State Health Care Reform
Reimbursements to participating organizations should take into account dollars required to set up CC activities, e.g., for interpretation services e.g., to support a CC specialist
Participating Managed Care Organizations: Medicaid or Other Contracts should require
MCO has a CC Plan MCO has financial commitment to CC MCO conducts annual CC assessment
Participating Agencies under Managed Care Contracts should require
Agency has a CC Plan Agency has financial commitment to CC Agency conducts annual CC assessment
Conclusion
The business case still needs to be made for CC, since it can be expensive to implement.
Cost Benefit Ratios CC Costs/Disparity Reduction Savings
For your interest
Siegel C, Haugland G, Laska E, Reid-Rose L, , Tang D-I, Wanderling J, Chambers ED, Case B. (2011) The Nathan Kline Institute Cultural Competency Assessment Scale: Psychometrics and Implications for Disparity Reduction Adm Policy Ment Health 38:120–130, DOI 10.1007/s10488-011-0337-0
Siegel C, Haugland G, Reid-Rose L, Hopper K. Program Components of Cultural Competency, to appear Psychiatric Services, June 2011.
NYS OMH Nathan Kline Institute Center of Excellence in Culturally Competent Mental Health
Website: http://cecc.rfmh.org