Best and Worst Practices In Private Sector Managed Mental Healthcare

Best (& Worst) Practices In Private Sector Managed Mental Healthcare Part I: Level-Of-Care Criteria May 1999 Cultural competence
As access and effectiveness of mental health treatment is greatly affected by the degree to which a managed care system is culturally competent, the panel discussed this area in great detail. The criteria sets varied tremendously in terms of attention to cultural issues, including three with no mention of the subject whatsoever, two with no more than two sentences superficially providing lip service on the topic, and two with more substantial text dedicated to this important issue. (Please note that for the purposes of this study, we used the following definition of a culturally competent managed care system: "It incorporates skills, attitudes and policies to ensure that it is effectively addressing the treatment and psychosocial needs of consumers and families with diverse values, beliefs, and sexual orientations, in addition to backgrounds that may vary by race, ethnicity, religion and/or language.") We offer the following two paragraphs contained in one of the criteria sets as a best practice in this area. This language was selected because, in addition to addressing cultural differences, it also pays homage to individual differences. "Unbiased knowledge of the individual's culture and language is a prerequisite for ethical and accurate assessment. Thus, cultural and linguistic competency are an integral part of all efforts to deliver services, and are a means of ensuring access, quality, cost effectiveness, and relevant outcomes. An understanding of the relationship between culture, health beliefs, health behaviors, help seeking, recovery, illness, rehabilitation, health policy, and social policy is necessary for timely, accurate and appropriate treatment planning and interventions. The importance of culture and language, the cultural strengths associated with people and communities, the assessment of cross-cultural relations, vigilance towards the dynamics inherent in cultural and linguistic differences, and the expansion of cultural and linguistic knowledge are critical. We strive to ease suffering amongst members of heterogeneous populations composed of many subcultures. The individual's qualities, characteristics, and choices must not be ignored in efforts to develop and implement standards and guidelines. Only consistent, quality-driven efforts toward cultural competency can lead to the establishment of best practices. A culturally and linguistically competent assessment incorporates, at all levels, the adaptation of services to meet the individual's culturally and linguistically unique needs. As such, the individual should have the opportunity to receive an assessment and the appropriate services in his/her primary language. When the individual's culturally specific customs and communication norms guide the information sharing process, the content and accuracy of the assessment and plan are enhanced." As we have so few examples of sufficient attention to cultural competency in the criteria sets we reviewed, the panel offers the following as additional best practices that we encourage managed care organizations to adopt: Linguistic support services, including sign language services, must be authorized at the beginning and throughout the course of care. Treatment modalities must be authorized that are culturally acceptable to the consumer to ensure the likelihood of acceptance of and compliance with the treatment plan (including sensitivity not only to linguistic and cultural factors, but also to religious beliefs and sexual orientation). Providers who are authorized to deliver services to a consumer must have an understanding of any applicable mono-cultural, multi-cultural, inter-faith, and/or multi-racial family dynamics.		Introduction Key findings "Report card" on information sharing Methodology Development process Comprehensiveness Corporate philosophy Access issues Compliance Child and family issues Substance abuse and co-occurring disorders Cultural competence Provider autonomy Coordination/ consultation among providers Denial notification and appeal processes More observations, recommendations and areas for further study Acknowledgments