Cultural Competence Standards in Managed Mental Health Care

Cultural Competence Planning

A Cultural Competence Plan for both public and private sectors shall be developed and integrated within the overall organization and/or provider network plan, using an incremental strategic approach for its achievement, to assure attainment of cultural competence within manageable but concrete timelines.


Implementation Guidelines

The Cultural Competence Plan shall include:

  1. Participation and representation of top and middle management
  2. administrators, front-line staff, consumers and/or their families, sovereign tribal nations, and community stakeholders in developing and integrating the cultural Competency Plan.
  3. An individual at the executive level who shall take responsibility for and have authority to monitor implementation of the Cultural Competence Plan.
  4. Accountability by each individual manager for the success of the Cultural Competence Plan based on his/her level within the organization.
  5. A process for integrating the Cultural Competence Plan into the overall state and/or department plan, and for including the principles of cultural competency in all aspects of organizational strategic planning and in any future planning process.
  6. A process for determining unique regionally-based needs and ecological variables within the communities/populations served using existing agency databases, surveys, community forums, and key informants.
  7. Identification of service modalities and models which are appropriate and acceptable to the communities served (i.e., urban, frontier and rural), population densities and targeted population subgroups, (e.g., children, adolescents, adults, elders, sexual minorities, and individuals with co-occurring conditions).
  8. Identification and involvement of community resources, (e.g., tribal and community councils or governing bodies, family members, clans, native societies, spiritual leaders, churches, civic clubs, and community organizations) and cross-system alliances (e.g., corrections, juvenile justice, education, social services, substance abuse, developmental disability, primary care plans, public health, and tribal health agencies) for purposes of integrated consumer support and service delivery.
  9. Identification of natural supports (e.g., family members, religious and spiritual resources, traditional healers, churches, civic clubs, community organizations) for purposes of reintegrating the individual within his/her natural environment, keeping in mind that for some, this may also include migratory patterns to and from a reservation or reservations, state to state, or country to country.
  10. Working to assure cultural competence at each level of care within the system (e.g., crisis, inpatient, outpatient, residential, home-based, health maintenance, community health liaison services).
  11. Stipulation of adequate and culturally diverse staffing and minimal skill levels (including gender, ethnicity, and language as well as licensing, certification, credentialing, and privileging) for all staff, clerical through executive management.
  12. The use of culturally competent indicators, which are adapted for specific minority cultural values and beliefs, in developing, implementing, and monitoring the Cultural Competence Plan.
  13. Development of rewards and incentives (e.g., salary, promotion, bonuses) for cultural competence performance, as well as sanctions for culturally destructive practices (e.g., discrimination). Cultural competence performance shall be an integral part of the employee-provider performance evaluation system, and provider organization performance evaluation system.
  14. Development of a plan to integrate ongoing training and staff development into the overall Cultural Competency Plan.

Development and ongoing plan monitoring of indicators to assure equal access, comparability of benefits, and outcomes across each level of the system of care and for all services provided through the Health Plan.


Recommended Performance Indicators

  1. Presence of a Cultural Competence Plan and defined steps for its integration at every level of organizational planning.
  2. Presence, within the Cultural Competence Plan, of related policy/procedure changes.
  3. Percentage/number of staff receiving initial and ongoing cultural competence training.
  4. Presence of established links with community resources.
  5. Demonstration of staff knowledge and skills regarding group values, traditions, expression of illness, cultural competence principles (e.g., credentialing and performance based testing).
  6. Demonstration of a cultural competence system evaluation (e.g., Mason, 1995, Cultural Competence Self Assessment Questionnaire: A Manual for Users).
  7. Demonstration of staff and consumer awareness and acceptance of the Cultural Competence Plan.
  8. Presence of a plan for recruitment, retention, and promotion of staff of racial/ethnic backgrounds representative of target population served.

Recommended Outcomes

  1. Final disposition of grievances and appeals for consumers from the four groups.
    Benchmark: Comparable to overall service population.
  2. Percent of consumers from the four groups receiving blended, coordinated, or wrap-around services.
    Benchmark: Comparable to overall service population and increasing over time.
  3. Percentage of reports of unethical practitioner behavior for practitioners serving populations of the four groups.
    Benchmark: Comparable to overall service population.
  4. Sanctions and incentives reinforce progress toward the delivery of culturally competent services.
    Benchmark: Decreased rates of sanction over time.
  5. Composition of the governing board, advisory committee, other policy-making and influencing groups, and consumers served reflects service area demographics.
    Benchmark: 90% of expected representation.
  6. Consumer awareness of plan.
    Benchmark: 80% of surveyed respondents aware of plan.
  7. Culturally-based policies shaping practitioner behaviors and measuring performance.
    Benchmark: Presence of policies.