DRAFT DEPARTMENT OF MENTAL HEALTH & SUBSTANCE ABUSE

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1 DRAFT DEPARTMENT OF MENTAL HEALTH & SUBSTANCE ABUSE SUBJECT: Cultural Competency REFERENCE: Interpreter P&P CLAS Standards Number: Effective Date: History: New Page: 1 of 5 APPROVED: Title: PURPOSE To ensure that the organization has a systematic approach to providing culturally competent services responsive to the cultural diversity of its consumers. POLICY The Department of Mental Health & Substance Abuse (DMHSA) shall ensure that services are responsive to and respectful of consumers racial and ethnic cultural histories, traditions, beliefs, values, sexual orientation, and primary language (see attachment A, CLAS Standards). DEFINITIONS Cultural competency is a set of congruent policies, behaviors, and attitudes embedded within DMHSA, provider agencies, and mental health practitioners which result in appropriate and effective services for all consumers. Cultural refers to integrated patterns of human customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. PROCEDURE 1. As part of the assessment, diagnosis, and treatment planning processes, the following shall be considered: a. The assessment, diagnosis, and treatment planning processes are responsive to and respectful of the consumer's racial and ethnic cultural traditions, beliefs, and values, and primary language. Therefore, as part of the assessment, diagnosis, and treatment

2 Page: 2 of 5 planning processes (e.g., during the intake process, or specific service areas such as Forensics), the following should be considered: 1) a systematic review of the consumer's cultural background; 2) the role or dynamics of the cultural context in the expression and evaluation of symptoms; 3) the effect that cultural differences may have on the relationship between the consumer and the clinician, and/or other care coordinators/providers; and 4) a formulation on how cultural considerations specifically influence diagnosis and treatment. b. Treatment Planning: Concerning cultural competency, treatment planning should "Be recovery-focused, culturally-informed and appropriate" (Community Plan, p. 10). To ensure "culturally-informed and appropriate" services the treatment team shall: Consider the consumer's preference for therapeutic linkages with traditional healers, religious and spiritual resources, alternative or complementary healing practices, natural supports, bilingual services, self-help groups, and consultation from culturally and linguistically competent independent practitioners, except when clinically or culturally contraindicated. c. Data Collection: As consumers enter the system, DMHSA shall ensure that data on race, age, ethnicity, and primary language are collected in health records and integrated into DMHSA s Management Information System (MIS). 2. Personnel Development. The DMHSA shall implement strategies to recruit, retain and promote at all levels of the organization a diverse staff that are representative of our community. a. Advertising of positions will be disseminated in places, organizations frequented by identified cultural groups. b. All DMHSA personnel, including, DMHSA Community based Mental services and contractors) shall participate in an annual, DMHSA-approved, cultural competency education training. 3. Organizational Supports. The DMHSA will incorporate a written strategic plan that outlines clear goals, policies, operational plan and management accountability within their comprehensive plan.

3 Page: 3 of 5 a. Advertising of positions will be disseminated in places, organizations frequented by identified cultural groups. b. All DMHSA personnel, including, DMHSA Community based Mental services and contractors) shall participate in an annual, DMHSA-approved, cultural competency education training. Attachment to DMHSA Policy # CLAS Standards Date of Review: / / ; / / ; / / ; / / Initials: [ ] [ ] [ ] [ ]

4 Page: 4 of 5 Attachment A NATIONAL STANDARDS ON CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE (CLAS) In December 2002, the U.S. Department of Health and Human Services Office of Minority Health (OMH) issued National Standards on Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards). The 14 CLAS Standards were organized into three areas: Culturally Competent Care 1. Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language. 2. Health care organizations should implement strategies to recruit, retain and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area. 3. Healthcare organizations should ensure that staffs at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery. Language Access Services 4. Health care organization must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. 5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services. 6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer). 7. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area. Organizational Supports for Cultural Competence 8. Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans and management

5 Page: 5 of 5 accountability/oversight mechanisms to provide culturally and linguistically appropriate services. 9. Health care organizations should conduct initial and ongoing organization selfassessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments and outcomes-based evaluations. 10. Health care organizations should ensure that data on the individual patient's/consumer's race, ethnicity, and spoken and written language are collected in health records, integrated into the organization's management information systems, and periodically updated. 11. Health care organizations should maintain a current demographic cultural and epidemiological profile of the community as well as a need assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area. 12. Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLASrelated activities. 13. Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers. 14. Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.

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