Hogg Foundation for Mental Health

Cultural Competency Key to Effective Treatment

March 1, 2008

Growing racial and ethnic diversity in Texas and the U.S. is challenging mental health professionals to acquire training, knowledge and skills to work effectively with people of different cultures.

That's not an easy goal to accomplish. Obstacles include shortages in workforce diversity and fluency in languages other than English, lack of knowledge on how to implement cultural competency standards, and little or no collection of data on race, ethnicity, language and clinical information that could help address health care disparities.

But health care providers can overcome these obstacles and develop cultural and linguistic competency, as discussed during a live web seminar broadcast nationally in January. The National Council on Community Behavioral Health sponsored the discussion, led by mental health experts Rick Ybarra, Hogg Foundation program officer, and Guadalupe Pacheco, public health advisor in the Office of Minority Health, U.S. Department of Health and Human Services.

Information and training to reduce racial and ethnic disparities in mental health care are increasing as policy makers, agencies, nonprofits and universities recognize the need to effectively serve diverse populations.

The Office of Minority Health has adopted standards for culturally and linguistically appropriate services in health care. The standards address culturally competent care, language access and organizational supports, and they can be applied in public and private health care settings. Communities and cultural groups should be part of the process to integrate the standards.

The standards can help ensure that consumers receive effective, understandable and respectful health care, according to Pacheco. Culture and language are interconnected with a consumer's behavioral expression, symptoms and conditions. Diagnosis and treatment can be difficult if the provider doesn't understand the consumer's language or cultural perspectives.

"When cultural and language barriers exist, there simply won't be effective treatment," Pacheco said. "These standards are designed to help improve minorities' access to and quality of care and reduce disparities in the care they receive. The standards can be applied in any health care setting, including behavioral health."

"For example, it's helpful for providers to know that a mental health consumer of Mexican heritage may also seek alternative treatment from a traditional Mexican folk healer," he said.

First steps to develop cultural competency are to appoint a steering committee, assess organizational needs, identify opportunities to improve, and develop policies, a plan and a budget to move forward. Another critical step is to adapt best practices to effectively treat people of different cultures, then put them into practice.

"To be effective, cultural competency programs must have buy-in from the top and someone who owns the initiative and is responsible for design, implementation and measurement," Ybarra said.

A self-assessment can identify changes needed to achieve cultural competency. Demographic research can show the races, ethnicities and spoken languages in the communities being served.

Organizations can analyze census data and collect demographic data on consumers served, then compare this data to the workforce's linguistic and cultural diversity. This analysis can identify what languages, training and resources are needed to build capacity and move an organization toward cultural competency.

"Implementing the standards can be daunting at first, but you don't have to do it all at once. You may start with one group of standards, instead of taking on all 14 standards right away," Ybarra said. "Developing performance indicators is essential, though, to measure performance and provide feedback to the organization.

"It's critical to involve providers, stakeholders, consumers and their families in developing an initiative early on, no matter how large or small," he added. "There's not one solution that will make a difference every time, in every situation. You need multiple strategies to be effective."

National Standards on Culturally and Linguistically Appropriate Services (CLAS)*

Culturally Competent Care

1: Provide effective, understandable and respectful care to consumers, compatible with their cultural beliefs, practices and preferred language.

2: Implement strategies to recruit, retain and promote a diverse staff and leaders who represent the demographic characteristics of the service area.

3: Ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.

Language Access Services

4: Offer language assistance, including bilingual staff and interpreter services, at no cost to consumers at all points of contact in a timely manner.

5: Provide verbal offers and written notices to consumers in their preferred language informing them of their right to receive language assistance services.

6: Assure competence of language services provided by interpreters and bilingual staff. Family and friends should interpret only at a consumer's request.

7: Provide easily understood consumer materials and post signs in the languages of commonly encountered groups and groups in the service area.

Organizational Supports for Cultural Competence

8: Develop, implement and promote a written strategic plan that outlines clear goals, policies, operational plans, management accountability and oversight mechanisms to provide culturally and linguistically appropriate services.

9: Conduct initial and ongoing organizational self-assessments of activities and integrate cultural and linguistic competence measures into internal audits, performance improvement programs, consumer satisfaction assessments, and outcomes-based evaluations.

10: Collect and update data on consumers' race, ethnicity, and spoken and written language and integrate into management information systems.

11: Maintain a current demographic, cultural and epidemiological profile of the community and a needs assessment to plan for and implement services that respond to the cultural and linguistic characteristics of the service area.

12: Develop participatory, collaborative partnerships with communities and use formal and informal mechanisms to involve stakeholders in designing and implementing activities.

13: Ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by consumers.

14: Regularly make available to the public information about progress and successful innovations in implementing the standards and provide public notice in communities about the availability of this information.

* The Office of Minority Health: www.omhrc.gov