Cultural Competence Standards in Managed Care Mental Health Services For Native American Populations

From the WICHE Project Archive

Triage and Assessment



Assessments should include evaluation of individual, family and community strengths, assets and resources. As indicated, consumers should receive a comprehensive assessment which includes a multi-dimensional focus, functional assessment, physical health review, psychiatric status, and social and family supports, in addition to evaluation of cultural and socioeconomic stressors and factors affecting their problems.


Implementation Guidelines

1. Urban/Suburban and Rural/Reservation:

Cultural factors relating to age, gender, sexual orientation, and relational roles should be addressed in the assessment of Native American consumers. In some Native cultures, it is not appropriate to ask about sexual orientation.

2. Urban/Suburban and Rural/Reservation:

The cultural component of the assessment should identify the beliefs and practices, family organization and relational roles, history of migration and assimilation/acculturation, effects of ethnically related stressors such as poverty and discrimination, beliefs related to health/mental health, attribution of their condition (spiritual, supernatural), and previous attempts at help-seeking.

3. Urban/Suburban and Rural/Reservation:

Where indicated, the cultural component of the assessment should be family-oriented, and system-oriented, incorporating key members of the nuclear and extended family (especially family decision makers), as well as significant community stakeholders. The assessment should also utilize collateral informants where indicated.

4. Urban/Suburban and Rural/Reservation:

Clinical and functional assessment scales should be culturally competent and validated for Native American populations. This may be a problem for multi-cultural and multi-tribal settings where scales may not have been validated on every Native subgroup.

5. Urban/Suburban and Rural/Reservation:

Systemic cultural and ethnic factors should be addressed to ensure accurate assessment and service planning (e.g., linguistic barriers, differences in symptom expression, culture-bound syndromes).

6. Urban/Suburban and Rural/Reservation:

Native American Mental Health Specialists should be involved, where possible either directly or via consultation, in triage and assessment processes, especially at the time of care determination and prior to more restrictive placements, particularly with involuntary placement and treatment. In small reservations/rural areas, this may be especially difficult to enact logistically.


Recommended Performance Indicators

  1. Presence of specialized assessment procedures for Native American consumers.
  2. Inclusion of cultural factors in the assessment of Native American consumers.
  3. Inclusion of family members, as appropriate, and significant community stakeholders in the assessment process for Native American consumers.
  4. Inclusion of culturally competent functional assessment within the overall assessment process for Native American consumers.
  5. Involvement of Native American Mental Health Specialists in assessment and treatment planning process.
  6. The recognition of not missing pathology by culture.


Recommended Outcomes

  1. Consumer, family and stakeholder satisfaction with the assessment process
    Benchmark: 90% satisfaction
  2. Consistency of service authorizations with utilization management practice for Native American consumers
    Benchmark: Comparable across ethnic groups and in general increasing over time
  3. Frequency of diagnostic revisions resulting from failure to respond to treatment
    Benchmark: Comparable across ethnic groups and decreasing over time