Cultural Competence Standards in Managed Mental Health Care

Guiding Principles


1. Principle of Cultural Competence

Cultural competence includes attaining the knowledge, skills, and attitudes to enable administrators and practitioners within systems of care to provide effective care for diverse populations, i.e., to work within the person's values and reality conditions. Recovery and rehabilitation are more likely to occur where managed care systems, services, and providers have and utilize knowledge and skills that are culturally competent and compatible with the backgrounds of consumers from the four underserved/underrepresented racial/ethnic groups, their families, and communities. Cultural competence acknowledges and incorporates variance in normative acceptable behaviors, beliefs, and values in:

*determining an individual’s mental wellness/illness, and
*incorporating those variables into assessment and treatment.


2. Principle of Consumer-Driven System of Care

A consumer-driven system of care promotes consumer and family as the most important participants in the service-providing process. Whenever possible and appropriate, the services adapt self-help concepts from the racial/ethnic culture, taking into account the significant role that mothers and fathers play in the life of consumers from the four groups.


3. Principle of Community-Based System of Care

A community based system of care includes a full continuum of care. The focus is on: including familiar and valued community resources from the minority culture; investing in early intervention and preventative efforts; and, treating the consumer in the least restrictive environment possible.


4. Principle of Managed Care

The costs of a public managed health care delivery system are best contained through the delivery of effective, quality services, not by cutting or limiting services. Effective systems provide individualized and tailor-made services that emphasize outcome-driven systems and positive results. Such systems acknowledge the importance of added-value inclusion of ethnic/cultural groups as treatment partners. The system includes an emphasis on managing care, not dollars. It recognizes that dollars will manage themselves if overall care is well managed. It recognizes racial/ethnic group-specific variables which have significant implications for individualized assessment and treatment.


5. Principle of Natural Support

Natural community support and culturally competent practices are viewed as an integral part of a system of care which contributes to desired outcomes in a managed care environment. Traditional healing practices are used when relevant or possible; and family is defined by function rather than bloodlines, as individuals from the four groups generally conceive of family much more broadly than mainstream individuals.


6. Principle of Sovereign Nation Status

Systems of health care for Native Americans who are members of sovereign nations shall acknowledge the right of those sovereign nations to participate in the process of defining cultural competent managed care.


7. Principle of Collaboration and Empowerment

Consumers from the four groups and their families have the capacity to collaborate with managed care systems and providers in determining the course of treatment. The greater the extent of this collaboration, the better the chances are that recovery and long-term functioning will occur and be sustained. The risk of psychological dependency and lower functioning increases with a decrease in collaboration with consumers and families. Empowering consumers and families enhances their self esteem and ability to manage their own health.


8. Principle of Holism

Consumers from the four groups are more likely to respond to managed care systems, organizations, and providers who recognize the value of holistic approaches to health care and implement these in their clinical work, policies, and standards. Where holistic approaches are absent, there is greater risk that consumers from the four groups will over-utilize mental health services, resulting in increased costs.


9. Principle of Feedback

Managed care systems, organizations, and providers shall improve the quality of their services and enhance desired outcomes of their service delivery to consumers from the four groups through legitimate opportunities for feedback and exchange. Where such opportunities for feedback are absent, there is a greater likelihood that the system of managed care services and policies will not be congruent with the needs of consumers from the four groups and will not result in high levels of consumer satisfaction. Managed care systems that lack opportunities for this feedback limit their chances of making culturally specific corrections in their approaches to services while simultaneously increasing their risks.


10. Principle of Access

In order for consumers from the four groups to seek, utilize, and gain from mental health care in a Managed Health Plan, services, facilities, and providers shall be accessible. Where services and facilities are geographically, psychologically, and culturally accessible, the chances are increased that consumers from the four populations will respond positively to treatment for mental illness. Inadequate access to services will result in increased costs, limited benefit to the consumer, and a greater probability that services will not result in the outcomes desired.


11. Principle of Universal Coverage

Populations of the four groups have higher than average frequencies of unemployment and receipt of transfer payments, along with lower disposable income. Where health care coverage, benefits, and access are based on employment or ability to pay, consumers from the four groups are more likely to be medically underserved. The greater the extent to which health care is universally available without regard to income, the greater the likelihood that the health status of consumers from the four groups will be enhanced.


12. Principle of Integration

Consumers from the four groups have higher than expected frequencies of physical health problems. Integrating primary care medicine, mental health, and substance abuse services in a Managed Care Plan increases the potential that consumers from the four groups will receive comprehensive treatment services and recover more rapidly, with fewer disruptions due to a fragmented system of care.


13. Principle of Quality

The more emphasis that is placed in managed care systems on ensuring continuous quality culturally competent service to consumers from the four groups, the greater the likelihood that relapse will be prevented; with sickness treated appropriately and costs lowered. The less emphasis placed on providing quality services to consumers from the four groups, the greater the chances that costs will increase.


14. Principle of Data Driven Systems

The quality of decision making, service design, and clinical intervention for consumers from the four groups in managed health care is increased where data on prevalence, incidence, service utilization, and treatment outcomes are used to inform and guide decisions.


15. Principle of Outcomes

Consumers from the four groups and their families evaluate services on the basis of actual outcomes relative to the problems that stimulated help seeking in a managed care environment. The greater the extent to which managed care plans, organizations, and providers emphasize and measure these outcomes in comparison to the expectations of consumers from the four groups, the higher the degree of consumer satisfaction.


16. Principle of Prevention

States, managed care organizations, and provider organizations should provide community education program about mental illness and the risk factors associated with specific disorders. The goal should be to increase the capacity of families to provide a healthy environment and to identify the early warning signs when mental health problems do exist. Early problem identification and intervention can prevent the exacerbation and reduce the disabling effect of mental illness.