Transcript CC can Predict Disparity Reduction

KEEPING THE PROMISE OF
CULTURAL COMPETENCE
A Collaborative Approach
NYS OMH ORGANIZATION CHART
Diversity Management
Emy Murphy
Chief Diversity Officer
Bureau Of Cultural Competence
Frances Priester Community Relations/MAC Coordinator
Elatisha Kirnon
Cultural Competence /Operations Coordinator
Hextor Pabon
Education /Training Coordinator
Deirdre Goss
Office Coordinator
Diversity Planning & Compliance
Marisol Nunez-Rodriquez
Director
Shelly Fiebich
Omer Jirdeh
Centers of Excellence For Cultural Competence
Nathan Kline Institute Director Carole Siegel
NYS Psychiatric Institute Director Roberto Lewis-Fernandez
3
Assistant Director
Info Tech/Data Analysis
Donna Swartout Office Manager/Secretary
Social Foundation of Disparities
Web Model
Community
Language
Gender
Ethnicity
Education
Religion
Culture
Drug Use
Economics
Social Support
SES
Employment
Disparities
Health &
Mental Health
Diet &
Lifestyle
Government &
Policies
Stress
Behaviors
Living
Conditions
Incarceration
Insurance Status
Income
Racism
Transportation
Genetics
New Yorkers Helping New Yorkers!
Team New York!
Why the Regional MAC
NYS Mental Health Consumers & Their Families
Those Directly Impacting Consumers
Advocacy
Groups
Facility Staff
MAC
Regional/State
Administrative Staff
(Mid-Managers)
Other State
Agencies
Executive Branch
Community
Providers
You !!
Commissioner
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).
• Assess state
operate facilities
• Assess county
providers
• Conduct language
survey
• Standardize
process for
language
accommodation
• Monitor services
for cultural
competence
Needs/Capacity
Assessment
Services
CC
Human Resources
• Hiring Attention
• Developed and
presented
training for Staff
Information
Exchange
• Gather and share cultural
Competence information
and best practices
• Initiate and maintain
stakeholder partnership
8
Information Exchange
Cultural Competence Website
Establishing Cultural Competence List serve
Conduct webinars for best practices
Need/Capacity Assessments
Children Assessment
Services
Revised 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
Outcomes
Conduct 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:
518-473-4144
http://www.omh.state.ny.us/omhweb/cultur
al_competence/index.html
HEALTH CARE REFORM AND
ORGANIZATIONAL LEVEL CULTURAL COMPETENCY
Carole Siegel
Gary 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).
Levels of a Mental Health System
In which CC needs to operate
ADMINISTRATIVE ENTITY
e.g., State Mental Health Authority,
Managed Care Organization
Agency A
Inpatient unit
Program
Caregiver
Caregiver
Caregiver
Agency B
Clinic
Program
Program
Program
Caregiver
Caregiver
Consumers
Agency C
Rehab
Program
Program
Caregiver
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
 Recorded
and service use of agency users
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


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


Communication competencies for Blacks need to be differently addressed.
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