Linguistic Diversity of Public Mental Health Care in Jackson County, Missouri March 2009

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1 Linguistic Diversity of Public Mental Health Care in Jackson County, Missouri March 2009 Background Like much of the United States, the population of Jackson County is increasingly diverse. Reducing disparities in mental health care access, and increasing the cultural and linguistic competence of publicly-funded services, rank high among the articulated priorities of many local agencies and funding entities. Anecdotal reports and Mental Health fund grant proposals indicate that a growing number of Jackson County mental health agencies have increased their capacity to deliver mental health services in languages other than English. To better understand this development, and to draw attention to it, the Board of Trustees commissioned a brief survey of Levy grantees. The focus of the survey was on mental health care and other Levy-funded services for people with mental illness and their families. The survey was created by staff and members of the Education and (TM) Planning Committee using Survey Monkey, an online survey tool. A link to the survey was sent to each of 36 agencies under contract to the Jackson County Community Mental Health Fund. 1 Clinical directors, or staff responsible for overseeing mental health services (all are identified as clinical directors in this report), were asked to respond. Response to the Survey Thirty two of 36 clinical directors responded to the survey within a ten-day response period. One response was allowed for each agency. Two respondents did not complete any survey questions, 2 and their surveys were not included in further analyses. Two responses were received from one agency. The second (submitted after the survey deadline) not included in the analysis. Twenty nine surveys were analyzed; the completion rate was 81%. Respondents adequately represented the types of agencies funded by the Jackson County Community Mental Health Fund. Non-responding agencies were distributed across program categories and agency types. Several non-responding agencies were either not direct providers of clinical mental health services, or subcontracted Levy funds to other organizations. PREPARED BY THE JACKSON COUNTY COMMUNITY MENTAL HEALTH FUND 301 EAST ARMOUR BOULEVARD, SUITE 640 KANSAS CITY, MISSOURI Telephone: P

2 Services for Non-English Speaking Consumers Only 3 clinical directors reported that their agency had never served any consumers who either do not speak English, or who requested services in another language. Of the remaining agencies: 10 agencies (35%) serve about 1-5 non-english speaking consumers per year, 5 agencies (17%) serve about 5-25 non-english speaking consumers per year, 4 agencies (14%) serve non-english speaking consumers per year, and 7 agencies (24%) serve over 100 non-english speaking consumers per year. None of the responding clinical directors believed that the demand for non-english mental health services is decreasing. Instead: 48% believe that demand is staying about the same, and 52% believe that demand is increasing. Non-English Information More than half (55%) of the clinical directors said their agency had a non-english brochure. Other prevalent types of non-english information included: Description of Services (45%), Intake Form (45%), Mission Statement (41%), and Grievance Procedure (41%). Nine clinical directors (31%) reported not having some type of information in a language other than English. Non-English Mental Health Services Over half of the respondents (52%) said they provided mental health services in a language other than English. Services are shown in the chart below. 2

3 The majority of clinical directors (55%) said their agencies serve both children and adults. There were slightly more agencies who serve adults (28%) than children (21%). This is reflected in survey responses. Several non-english mental health services were more available for adults than for children. These included case management, psychoeducation, and individual therapy. Non-English psychiatry and group therapy were reported equally often for adults and children, but both were comparatively rare. No advanced practice nursing was available in a non-english language. People Delivering Non-English Services * Spoken Language. Eleven clinical directors (38%) reported that non-english mental health services were provided directly by clinical staff. More than four-fifths (85%) reported that mental health services were provided using spoken language interpreters. Several added that this is provided upon request or as needed. People who deliver these services included: Staff (46%), Telephone-based (42%), Family member of the client (27%), Contractor working on site (19%), and Unpaid volunteer (15%). All languages reported by clinical directors are summarized in the table below. Language Number Reported* Language Number Reported* Spanish 12 German 1 Language Line, or Many Languages reported 8 Russian 1 ASL/Sign 3 Serbian 1 Arabic 2 Japanese 1 Portugese 1 Polish (some) 1 Somali 1 Vietnamese 1 3

4 * Family Members as Interpreters. Fourteen clinical directors (58%) reported that family members do not provide spoken language interpretation at their agencies. For the remainder, family members who were involved in the delivery of mental health services included: Spouse or partner (33%), Minor Children (17%), Adult Children (17%), Parent of Minor Client (17%), and Parent of Adult Client (8%). Other Features of Spoken Language Services Wait Time for Services. Nearly all clinical directors reported that when non-english interpreter services are available, there is not a long waiting period to receive mental health services: No wait; services on demand (33%) Services within 24 hours (38%) Two days to one week (24%) Within one month (5%) Longer than one month (0) Cost. Two agencies indicated that consumers pay an additional cost for services using a spoken language interpreter. Services for People with Hearing Impairments Capacity. A majority of agencies have a capacity to provide services to people with hearing impairments. More than half (58%) use interpreter services. Four (13.8%) reported being able to deliver mental health services using signing clinical staff. Sign language services were unavailable at 7 agencies. Cost. At two agencies (7%) consumers with hearing impairments pay an additional cost for sign language interpreter services. Training and Technical Assistance Nineteen clinical directors (65% of those responding) indicated that training or technical assistance would be helpful in planning or delivering non-english mental health services. Three respondents provided general comments on the need for, or value of, training and technical assistance. For example: Any assistance would be appreciated. 4

5 Training. Three comments regarding training were of a general nature, indicating that training would be beneficial to the organization, for example: I think we can continue to learn more about ways to improve our language program. One clinical director reported a need for foreign language training. Financial Technical Assistance. Clinical directors also reported needs for technical assistance as related to financial resources. Four respondents reported needs which included: Lower-cost alternatives to telephone translation and contractors, and Locating funding for bilingual staff. Service -Related Assistance. The largest group of clinical directors (8 responses) identified needs for technical assistance related to services. These included: Translating written materials, Identifying community/agency resources for collaboration and referral, Getting quick response when a need is identified, Creating lists of interpreters or agencies that provide bilingual services, Understanding how to best use interpreters in mental health care, and Reaching out specifically to the Hispanic community. Conclusions and Recommendations Collaboration. A majority of the clinical directors in the survey reported serving consumers who do not speak English. Seven serve more than 100 non-english speaking consumers per year. At the same time, clinical directors often reported needs to identify community resources, develop funding for staff/contractors, and to reduce costs. These common interests, existing capabilities, and shared needs provide a good foundation for collaboration. Providers working in coalition, organized by population or funding program, should compile a list of multilingual resources, providers, and translators. Where possible, these resources should be shared to reduce costs. Training and Technical Assistance on Physical Disabilities. Physical disabilities were included among Board of Trustees education priorities, and in response, mental health services for persons with hearing impairments were included in the survey. We found that 7 clinical directors reported sign language services were unavailable through their agencies. Given the public nature of Levy funding, and the public accommodations stipulations of the Americans with Disabilities Act (ADA), continued attention to disability issues appears to be warranted. Disseminate Best Practice Information. Levy staff should continue their development of Culturally and Linguistically Appropriate Services (CLAS) A Compilation of Standards so that it can be disseminated. This document provides examples of best practices on a number of issues raised in survey findings, such as the use of minor children as translators and charging additional costs for interpretation/translation. 5

6 Content-Analyze Cultural Competence Plans. Levy staff should carry out a content analysis of the cultural competence plans that are submitted by grant applicants. A more detailed snapshot of the status of agency plans, and the areas they see as important would probably be helpful in targeting and fine-tuning training future information and technical assistance activities. 3 Limitation of the Survey: Age Disparities in Services. A local needs assessment found a severe shortage of child psychiatry locally. However this survey found no difference in availability between adult and child psychiatry, when only non-english services were considered. This finding should be interpreted with caution. The data appear to reflect that a small number of psychiatrists are being counted by multiple agencies. Limitation of the Survey: Cultural and Linguistic Competence. This brief study collected quantitative and nominal information. From it, we can make some informed conclusions about the linguistic diversity of mental health services in Jackson County at one point in time. However, it is important to emphasize several limitations of this information. This survey did not assess the linguistic competence of the individuals reportedly involved in non-english mental health services. This survey did not assess the clinical mental health acumen of interpreters or translators. Services provided in a given language may not necessarily reflect the cultural beliefs and mental health practices of individuals/families who speak that language. This survey did not assess agency social climate or accessibility of services from the consumers perspective. Therefore, while we have documented linguistic diversity in mental health services, conclusions about the cultural and linguistic competence of non-english mental health services in Jackson County cannot be made from this survey. Notes * Questions in which multiple responses were allowed (total of percentages 100%). 1. As of March, A list of all agencies currently under contract with the Jackson County Community Mental Health Fund available at on the Grantee Links page. 2. For these two respondents, non-completion of the survey may have been caused by limitations of agency computer networks, such as outdated software. 3. Rinck, C. & Graybill C. (2005). Jackson County Mental Health Needs Assessment: Race and Ethnicity. Kansas City, MO: UMKC Institute for Human Development. 6