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


1. Specialized assessment and service delivery techniques.

2. Recognition and utilization of the unique features of monocultural ("traditional"), acculturating ("transitional"), and multicultural and multiracial consumers and families.

3. Appreciation of culturally-based traditional healing systems and traditions in the Native American communities served.

4. Specialized engagement and therapeutic alliance building techniques, as well as culturally acceptable and therapeutic boundary setting.

5. Interdisciplinary team interaction and functioning to promote effective care.

6. Use of client’s preferred language in the treatment process.

7. Treatment of Native American sexual minorities, particularly the stress of "triple stigma"(mental illness, ethnic, and sexual).

8. Documentation and/or communication of specialized assessment and service delivery methods such that staff who are not culturally competent will be able to benefit from it.



9. Differences in symptom expression, symptom language, and symptomatic patterns in Native Americans with mental illness/emotional disturbance.

10. Differences in thresholds of individual and social distress in Native American consumers and tolerance of symptomotology by their natural support systems. This would include the individual, the family, their informal and formal social context.

11. Differences in the attribution of mental illness and issues around stigma specific to Native American cultures.

12. Differences in the acceptability and effectiveness of different treatment modalities in Native American populations.

13. Culture-bound syndromes associated with the Native American populations and subcultures being served.

14. Use of formally trained interpreters by clinicians who are not bilingual.

15. Effects of class and ethnicity on behavior, attitudes, and values.

16. Help seeking behaviors of Native Americans.

17. Self treatment behaviors of Native American which includes the abuse of alcohol and other substances as ‘medication.’

18. Role and manifestation of spirituality, traditionality, and faith in Native American families.

19. Role of verbal and nonverbal language, speech patterns, and communication styles in Native American communities.

20. Effects of human service policies on Native American and reduction of barriers through informed participation in systems change efforts.

21. Resources (agencies, persons, informal helping networks, research) that can be utilized on behalf of Native American consumers and communities.

22. Role and types of power relationships within the community, agency, or institution and their impact on Native American consumers.

23. Recognition of the ways that mainstream professional values may conflict with or be responsible to the needs of Native American consumers.



24. Historical factors which affect the mental health of Native Americans, such as racism, forced historical migration and current migration patterns.

25. Factors which define cultural differences between different Native American nations and communities, including differences related to history, traditions, values, belief systems, acculturation and migration history, reasons for immigration, and dialect and language fluency. This is particularly important for providers who serve multiple tribes.

26. Particular psychosocial stressors and traumas relevant for Native American consumers. These include war, trauma, migration, unique aspects of cultural survival and maintenance, and socioeconomic status.

27. Cultural variations within Native nations and communities.

28. Native consumers within a family life cycle and intergenerational conceptual framework in addition to individual identity development in relation to family and cultural developmental frameworks.

29. Differences between "culturally acceptable" behavior or psychopathological characteristics of Native Americans.

30. Indigenous healing practices and the role of belief systems (religion and spirituality) in the treatment of Native Americans.

31. A community-based system of mental health care for Native Americans, including appropriate, culturally relevant components and characteristics.

32. Public administrative issues in developing, implementing and evaluating programs for Native Americans.

33. Dynamics of language use and conceptual frameworks among monolingual and bilingual consumers.

34. The effects of the acculturation process on Native Americans.



35. Interview and assess minority clients and families based on psych/social/bio/ cultural/political/spiritual/environmental/economic models.

36. Communicate and listen effectively across cultures.

37. Assess Native American consumers with an understanding of cultural differences in psychopathology.

38. Formulate culturally competent service plans (case management and treatment) that are appropriate for the client and the family’s concept of mental illness.

39. Create and implement multidisciplinary service plan (case management and treatment) include culture, family and community.

40. Utilize culturally appropriate community resources (i.e. family, clans, societies, church, community members and other groups).

41. Provide psychotherapeutic and psychopharmacological interventions, with an understanding of the cultural differences in treatment expectations and biological response to medications.

42. Recognize the limitations of psychological tests and testing procedures when used with Native American consumers.

43. When conducting research, ensure that it is culturally sensitive.

44. Provide education and advocacy interventions which promote consumer and family voice and ownership in shaping the service delivery system.

45. When feasible, use client’s language to elicit the range and nuances of emotions, feelings, dynamics, etc.

46. Know when and how to use interpreters; understand the limitations of using interpreters. Need to be aware of how interpreters (knowingly or unknowingly) may censor and modify information during the process of interpretation.

47. Learn the particulars of social conventions (from engaging protocols to termination rituals) within Native cultures.

48. Cultural competence is a learning process, not a product. Be open to continually learn the cultures of Native American consumers and families through varied and multiple techniques (conferences, visiting in community, reading books, hanging out, attending community forums, etc.).

49. Be aware of racial and ethnic differences and know when to respond to culturally-based cues.

50. Assess the meaning race and ethnicity has for individual consumers.

51. Differentiate between the symptoms of intrapsychic stress and stress arising from the social structure.

52. Work toward empowerment of consumers and minority communities.

53. Able to use community resources on behalf of Native American consumers and their communities.

54. Able to use agency resources on behalf of Native American consumers and their communities.

55. Recognize and combat racism, racial stereotypes, and myths in individuals and in institutions.

56. Evaluate new techniques, exemplary practices, research, and knowledge as to their validity and applicability in working with Native Americans.



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

58. Acceptance of ethnic differences between people, and how these affect the treatment process.

59. A willingness to work with clients of various ethnic minority groups.

60. Respect for the immigrant, migration, colonization, dissolution of culture experience.


Recommended Performance Indicators

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


Recommended Outcomes

  1. Provider shall demonstrate ongoing assessment of behavioral health needs of Native American consumers and the community
    Benchmark: Documented annual assessment and service planning process
  2. Provider services and programs reflect the needs of the Native American consumer and community
    Benchmark: Implementation of services and program which are commensurate with the (changing) needs of the consumer and community using consumer and community assessment data
  3. Human Resources Development Plan to enhance culturally competent Native American mental health services is established and implemented
    Benchmark: Documented participation of all provider staff in annual training sessions