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Cultural Competence Standards
in Managed Care Mental Health Services:
Four Underserved/Underrepresented
Racial/Ethnic Groups
Preface
We know that cultural values and traditions offer special strengths that should help guide health care messages and treatments. The Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) believe that mental health services often are more effective when they are provided within the most relevant and meaningful cultural, gender-sensitive, and age-appropriate context for the people being served. For each racial/ethnic population, programs need to be built from the local community level, not structured from afar. Moreover, the services to be provided cannot be based on a "one-size-fits-all" approach. Information must be relevant to the specific group intended to be reached.
The changing face of health care - particularly the rise of managed care as a cost-conscious delivery system - has had a significant impact on how behavioral health care is provided in general, and how it is provided to racial and ethnic populations, in particular. Not only are specialty mental health professionals and primary care practitioners often not providing culturally sensitive - much less culturally competent - care, but also the managed care environment as a whole often is insufficiently aware of how culture and race can be critical elements in treatment and recovery.
In response to the dearth of broad-based, culturally competent care within the behavioral managed care sector, CMHS sought to develop and disseminate cultural competence standards for managed care mental health services to improve the availability of high-quality services for "four underserved/underrepresented racial/ethnic groups" - notably, African Americans, Hispanics, Native Americans/Alaska Natives, and Asian/Pacific Islander Americans. To that end, it convened four national panels representing each of the four core racial/ethnic groups, and each comprised of mental health professionals, families, and consumers.
With the assistance of the Western Interestate Commission for Higher Education Mental Health Program (WICHE), individual panels were established for Hispanics, Native American/Alaska Native, and Asian/Pacific Islander American populations. The University of Pennsylvania helped form and coordinate a panel to develop similar standards for African American populations. Each panel reviewed the extant mental health research and services literature that focused on the subject population; each panel developed a consensus around how best to achieve culturally competent managed behavioral health care for its target population.
In June 1997, the four groups met together in Washington, D.C., to reach consensus around core cultural competence standards applicable to all four groups. In the deliberations, the convened experts recognized that the individualized nature of mental health services dictates that consumers be viewed and engaged within the context of their cultural group and their experiences as members of that group. Moreover, with accessibility to care mandated under both the Americans with Disabilities Act and Title VI of the Civil Rights Act of 1964, the panelists further concurred that both public and private providers of behavioral health care be staffed with culturally competent and appropriately qualified bi-cultural and bilingual personnel. To achieve that aim, the panelists recommended that training in cultural competence be provided not only to direct care staff, but also those with management responsibilities.
The end product is both a series of standards for culturally competent care in managed behavioral health care settings and an implementation plan. The former is a roadmap leading to the kind of relevant, culture-imbued, locally "built" mental health services that best - and individually - serve those in need. The latter addresses specific mechanisms through which the standards may be achieved, such as personnel hiring and management, marketing plans for community partnership-building, funding strategies, and quality assurance through monitoring and improvement.
This volume is not a static set of criteria. It represents collective thinking and consensus-building across a broad range of expert opinions by an equally broad range of concerned mental health providers, consumers, researchers, and academics. As such, this volume is but a starting place for the creation of managed mental health services that are responsive to the changing face of America.
Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health
Services Administration
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Bernard Arons, M.D.
Director
Center for Mental Health Services
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SMA00-3457
1/2001
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