II. Provider Competencies

Cultural Competence Guidelines in Managed Care for Latino Populations

Provider Competencies

Standard

The following areas of training, knowledge, skills, and attitudes should be essential components of continuing education for cultural competence for clinical staff and provider capabilities to effectively respond to the mental health needs of Latinos.

Training is needed in the following areas:

Specialized assessment and service delivery techniques;
Dynamics of monocultural ("traditional"), acculturating ("transitional"), bicultural and biracial consumers and families;
Understanding of culturally-based folk healing systems and traditions across different Latino subcultures and communities;
Specialized engagement and therapeutic alliance building techniques, as well as culturally acceptable and therapeutic boundary setting;
Interdisciplinary team interaction and functioning to promote effective care;
Use of language in the treatment process;
Treatment of Latino sexual minorities, particularly the stress of "triple stigma" (mental illness, ethnic, and sexual minority status);
Documentation of specialized assessment and service delivery methods such that staff who are not culturally competent will be able to benefit from it.

Knowledge of:

Differences in symptom expression and symptomatic patterns in Latinos with mental illness/emotional disturbance;
Differences in thresholds of distress in Latino consumers and tolerance of symptomology by their natural support systems;
Differences in the attribution of mental illness (religious, supernatural, etc.) and issues around stigma specific to Latino cultures;
Differences in the acceptability and effectiveness of different treatment modalities in Latino populations;
Culture-bound syndromes associated with Latino populations and subcultures;
Use of formally trained interpreters by clinicians who are not bilingual;
Effects of class and ethnicity on behavior, attitudes, and values;
Help seeking behaviors of Latinos;
Role of spirituality and faith in Latino families;
Role of language, speech patterns, and communication styles in Latino communities;
Effects of social service policies on Latinos and reduction of barriers through informed participation in systems change efforts;
Resources (agencies, persons, informal helping networks, research) that can be utilized on behalf of Latino consumers and communities;
Power relationships within the community, agency, or institution and their impact on Latino consumers;
Recognition of the ways that mainstream professional values may conflict with or accommodate the needs of Latino consumers;

Understanding of:

Historical factors which affect the mental health of Latinos, such as racism and immigration patterns;
Factors which define cultural differences between different Latino subgroups, including differences related to history, traditions, values, belief systems, acculturation and immigration history, reasons for immigration, and language fluency;
Particular psychosocial stressors relevant for Latino consumers. These include war, trauma, migration/acculturation stress and socioeconomic status;
Cultural variations (emic) between Latino subgroups;
Latino consumers within a family life cycle and intergenerational conceptual framework in addition to a personal development framework, which includes the acculturation levels within the individual;
Differences between "culturally acceptable" behavior or psychopathological characteristics of Latinos;
Indigenous healing practices and the role of religion in the treatment of Latinos;
A community-based system of mental health care for Latinos, including components and characteristics;
Public administrative issues in developing, implementing and evaluating programs for Latinos;
Dynamics of language use and conceptual frameworks among monolingual and bilingual consumers;
The acculturation process and its effects on Latinos.

Skills to:

Conduct ethnographic interviews;

Interview and assess minority clients and families based on psych/social/bio/cultural/political/spiritual model; ⁽²⁾

Communicate and listen effectively across cultures; ⁽²⁾

Assess Latino consumers with an understanding of cultural differences in psychopathology. Ability to avoid under-diagnosis, misdiagnosis or over-diagnosis; ⁽²⁾

Formulate culturally competent treatment plans that are appropriate for the client and the family’s concept of mental illness; ⁽²⁾

Create multidimensional treatment plans which include culture, family and community;

Utilize culturally appropriate community resources (i.e. family, church, community members and other groups); ⁽²⁾

Provide psychotherapeutic and psychopharmacological interventions, with an understanding of the cultural differences in treatment expectations and biological response to medications; ⁽²⁾

Know when to recommend culturally factored psychological assessment and testing procedures for Latino consumers and when not to use tests which are biased towards Latino consumers; ⁽²⁾

Conduct culturally sensitive community research; ⁽²⁾

Provide psychoeducational interventions which promote consumer and family voice and ownership in shaping the service delivery system; ⁽²⁾

Use client’s language to elicit the range and nuances of emotions, feelings, dynamics, etc.; ⁽²⁾

Know when and how to use interpreters; understand the limitations of using interpreters;(2)

Learn the particulars of the engaging protocols within Latino cultures. ⁽²⁾

Be humble and a student of your clients: cultural competence is a process not a product; ⁽²⁾

Use techniques for learning the cultures of Latino consumers and families;⁽³⁾

Communicate accurate information on behalf of Latino consumers and their communities; ⁽³⁾

Openly discuss racial and ethnic differences and issues and to respond to culturally-based cues; ⁽³⁾

Assess the meaning ethnicity has for individual consumers; ⁽³⁾

Differentiate between the symptoms of intrapsychic stress and stress arising from the social structure; ⁽³⁾

Interview using techniques reflective of an understanding of the role of language in the consumer’s culture; ⁽³⁾

Utilize the concepts of empowerment on behalf of Latino consumers and communities; ⁽³⁾

Use resources on behalf of Latino consumers and their communities; ⁽³⁾

Recognize and combat racism, racial stereotypes, and myths in individuals and in institutions; ⁽³⁾

Evaluate new techniques, research, and knowledge as to their validity and applicability in working with Latinos. ⁽³⁾

Attitudes:

Personal qualities that reflect "genuineness, accurate empathy, nonpossessive warmth" (Traux and Mitchell) and a capacity to respond flexibly to a range of possible solutions; ⁽³⁾

Acceptance of ethnic differences between people,⁽³⁾ and how that affects the treatment process;

A willingness to work with clients of various ethnic minority groups; ⁽³⁾

Respect for the immigrant experience.

Recommended Performance Indicators

Ongoing program planning and implementation of behavioral health services which meet the needs of the Latino consumer and community.
Human Resources Development Plan inclusive of recruitment, retention and development of staff at all levels to enhance and ensure quality culturally competent services to Latino consumers and community.

Recommended Outcomes

Provider shall demonstrate ongoing assessment of behavioral health needs of Latino consumers and the community

Benchmark: Documented annual assessment and service planning process
Provider services and programs reflect the needs of the Latino consumer and community

Benchmark: Implementation of services and programs which are commensurate with the (changing) needs of the consumer and community using consumer and community assessment data.
Human Resources Development Plan to enhance culturally competent Latino mental health services is established and implemented

Benchmark: Documented participation of all provider staff in annual training sessions.

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⁽²⁾ Romero, J.T. (1996, January). Managed Care and Its Implication for Services to the Latino Community. Santa Jose, CA: Santa Clara County Mental Health Department.

⁽³⁾ Cross, T.L., Bazron, B.J. (1994, June). Curriculum for: Train the Trainers Workshop on Towards a Culturally Competent System of Care. Washington, DC: Child and Adolescent Service System Program Minority Initiative, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center.

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