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