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


Case management should be central to the operation of the interdisciplinary treatment team. Case managers for Native Americans require special skills in advocacy, access of community-based services and systems, and interagency coordination. Case management should also be consumer- and family-driven. Case managers should be accountable for the cost and appropriateness of the services they coordinate.


Implementation Guidelines

1. Urban/Suburban and Rural/Reservation:

Case managers working with Native consumers and families should be able to demonstrate their level of cultural competence as a condition of their employment.

2. Urban/Suburban and Rural/Reservation:

Case managers should be knowledgeable about the community, its resources, and natural supports.

3. Urban/Suburban and Rural/Reservation:

Case managers should have access to flexible funds for the provision of wrap-around services.

4. Urban/Suburban and Rural/Reservation:

Case management should be continuous and proportional to the degree of the consumer’s need, level of impairment, and person/family resilience. The case manager should act as a single point of contact and have responsibility across all levels of the system of care.

5. Urban/Suburban and Rural/Reservation:

The Health Plan should define and enforce caseloads for case managers consistent with industry standards, accounting for severity of consumer impairment/case mix and associated cultural stressors. These should enable case managers (especially ethnic minority) to effectively serve consumers and prevent burnout and unacceptable levels of turnover.

6. Urban/Suburban and Rural/Reservation:

Access and advocacy support should be afforded to case managers across the entire system of care including settings such as inpatient facilities.


Recommended Performance Indicators

  1. Cultural competence requirements commensurate with level of responsibility and supervision provided for case managers who serve Native Americans.
  2. Cultural competence training for all case managers as part of a credentialing process.
  3. Community resources and natural supports included in all care plans.
  4. Use of flexible funding for Native American consumers, comparable to others.
  5. Sufficient numbers of case managers to support caseload standards for Native American consumers.
  6. Consumer and case manager involvement in level of care and other treatment decisions.


Recommended Outcomes

  1. Consumer and family satisfaction with selection of services
    Benchmark: 90% satisfaction
  2. Reduction in utilization and lengths of stay for more restrictive levels of care
    Benchmark: Comparable to overall community and decreasing over time