Data Matters: GUCCHD's National Technical Assistance Center for Children's Mental Health

Elimination of Disparities in Mental Health Care: At the Organizational and Systems Level
Call 2 in the Technical Assistance Call Series on the Elimination of Disparities in Mental Health Care

Read Comments | Post Your Own Comment

Additional Resources:

This report is available in full text online

Recommendations from SPAN- NJ

Jones, W. and Thomas, T. (2009). Growing Your Capacity to Engage Diverse Communities: by working with Community Liaisons and Cultural Brokers. Albuquerque, NM: National Center for Family Professional Partnerships, Family Voices. This booklet provides information about one approach to family and community engagement – working with community liaisons and cultural brokers. This booklet is grounded in the knowledge and experiences of the Family Voices network and family leaders around the country who have shared what they have learned in their efforts to serve the full range of families of children and youth with special health care needs and/or disabilities.

Harry, B., Kalyanpur, M., & Day, M. (1999). Using Cultural Reciprocity with Families. Baltimore, MD: Paul H. Brookes Publishing Co. The eight case studies reported in this book are the outcome of a 4-year research project funded by the U.S. Department of Education, Office of Special Education Programs. The purpose of the book is to offer personnel who are being prepared for careers in special education an opportunity to envision themselves working in a professional capacity with families from a wide range of cultural backgrounds and with children with varying types of abilities and disabilities.

The National Center for Cultural Competence (2004). Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs. Washington, DC. The goal of this collaborative effort, funded by the National Health Service Corps (NHSC) Bureau of Health Professions, is to encourage the use of cultural brokering as a key approach to increasing access to, and enhancing the delivery of, culturally competent care. The NHSC is embracing and promoting this concept as a viable and much-needed approach in the effective delivery of health care to culturally diverse populations. This guide is designed to assist health care organizations in planning, implementing, and sustaining cultural broker programs.

Getting Online Without a Computer or Internet Access at Home: A Parent's Mini-Guide to Accessing Internet Resources to Help Your Children. Ninety-five percent of public libraries offer free access to computers and the internet. Public library patrons use library computers to learn basic computer and internet skills. There is not reason to worry or be embarrassed about things like cost of lack of knowledge about how to use the internet. Use of library computers and internet services is free!

CONECTÁNDOSE EN LÍNEA SIN UN COMPUTADOR O SIN ACCESO AL INTERNET EN EL HOGAR: MINI-GUÍA PARA PADRES SOBRE COMO ACCEDER A LOS RECURSOS DEL INTERNET A FIN DE AYUDAR A SUS HIJOS. If you read and speak only Spanish, you may be wondering whether or not it's worth your while to try to get onto the internet. With the new Traducelo Ahora (Translation Now) program now available through a grant from IBM to the Statewide Parent Advocacy Network (SPAN), the answer is yes. This free program gives you the ability to translate e-mails and websites from English to Spanish and Spanish to English using any computer that has access to the internet.

Other Resources

Office of Minority Health, (2001). National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. Washington, DC: Office of Minority Health, US Dept of Health and Human Services. The national standards issued by the U.S. Department of Health and Human Services, Office of Minority Health, respond to the need to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. The standards are primarily directed at health and mental health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.

Annotated Bibliography: Policy Literature Relevant to Reducing Disparities in Mental Health Care by NCCC and NTAC This annotated bibliography, a joint project of the Georgetown University National Center for Cultural Competence and the National Technical Assistance Center for Children’s Mental Health, highlights policy literature relevant to reducing disparities in mental health care. The articles and reports converge around defining the problem of disparity, linguistic disparities, environmental disparities, and policy alternatives.

Institute of Medicine (2009). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. The Institute of Medicine formed the Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement to examine approaches to standardization. In this 2009 report, the subcommittee recommends collection of more granular ethnicity and language need according to national standards in addition to OMB race and Hispanic ethnicity categories. The presence of data on race, ethnicity, and language does not, in and of itself, guarantee subsequent actions to reduce or eliminate disparities. The absence of data, however, essentially guarantees that none of those actions will occur.

Center for Mental Health Services, Substance Abuse And Mental Health Services Administration (2001). Cultural Competence Standards in Managed Mental Health Care Services: Four Underserved/Underrepresented Racial/Ethnic Groups. Developed for States, consumers, mental health service providers, educators, and organizations providing managed behavioral health care, this volume provides state-of-the-science cultural competence principles and standards - building blocks to create, implement, and maintain culturally competent mental health service networks for our diverse population. This document melds the best thinking of expert panels of consumers, mental health service providers, and academic clinicians from across four core racial/ethnic populations: Hispanics, American Indians/Alaska Natives, African Americans, and Asian/Pacific Islanders.

To address disparities in behavioral health care, the National Network to Eliminate Disparities (NNED) in Behavioral Health was formed with support from the Substance Abuse and Mental Health Services Administration in partnership with the National Alliance of Multi-ethnic Behavioral Health Associations. The NNED supports information sharing, training and technical assistance among organizations and communities dedicated to the behavioral health and well-being of diverse communities. The NNED also identifies and links "pockets of excellence" in reducing disparities and promoting behavioral health equity.

Launched by the Office for Minority Health, the National Partnership for Action to End Health Disparities (NPA) focuses on health status and health outcomes among racial and ethnic minority populations. The mission of the NPA is to mobilize and connect individuals and organizations across the country to create a Nation free of health disparities, with quality health outcomes for all people.

Supported by the Substance Abuse and Mental Health Services Administration Center for Mental Health Services Transformation Agenda, the mission of the Eliminating Mental Health Disparities project is to ensure that services and supports are accessible, and culturally and linguistically competent to meet the mental health needs of culturally, racially and ethnically diverse populations. The project was designed to address three critical areas: disparities associated with racial and ethnic groups, disparities created by geography, and disparities inherent to special populations.

October 15, 2009 Call #1 of Series – Elimination of Disparities in Mental Health Care: An Overview

This month we take a special look at interventions to address the elimination of disparities in mental health care at the systemic and organizational levels. Last month’s Data Matters introduced us to the theme of creating organizations that are “compatible” with the service population. At a macro level, organizations and systems need to create policies, infrastructure and processes to promote the creation of compatible services. While our presenters offer descriptions of their processes to address these issues, our Data Matters contributors provide a sobering picture of the state of affairs within state mental health systems in general. What can you do to make a difference in your local community or state service system?

Kids jumping

Excerpts from, “Unclaimed Children Revisited: The Status of Children’s Mental Health Policy in the United States” (November 2008)
Janice L. Cooper, Yumiko Aratani, Jane Knitzer, Ayana Douglas-Hall, Rachel Masi, Patti Banghart, Sarah Dababnah, National Center for Children in Poverty, Mailman School of Public Health, Columbia University

Chapter 6: How Well Do States Respond to the Need for Culturally- and Linguistically-Competent Services and Systems to Meet the Needs of Children, Youth, and Their Families?

“Race, ethnicity, and culture of children play a major role in shaping the care provided to them by health institutions. Racial, ethnic, and cultural differences influence the expressions and identification of the need for services” Margarita Alegria, PhD, 2000, Conference on Children’s Mental Health: A National Action Agenda.

In 1982 Knitzer pointed to the disadvantage in access to care experienced by minority children and youth. For the subsequent 20 years, cultural competency became a mainstay of the rhetoric surrounding children’s mental health reform. Cultural competence is one of the principles of the system of care philosophy. For more than a decade, advocates and leaders in children’s mental health have also stressed the importance of linguistic competence. Linguistic competence, recognized and codified in Title VI of the Civil Rights Act in 1984, received renewed attention with the development and publication of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS).

Despite this extensive history, children, youth, and their families with mental health needs are less likely to get their needs addressed if they come from a diverse background, are part of an underrepresented minority group, or are from a family with limited English proficiency. Disparities in access and outcomes persist.

Of the many state and federal efforts over the last two decades to address racial and ethnic disparities, few in children’s mental health take the form of strategic approaches that involve specific expert-informed techniques that are linked to improved outcomes. For policymaking in particular, researchers point to the prominence of policy in a three-pronged approach that requires changes in attitudes and practice. Even for changes at the service-delivery level, researchers note that policy impacts systematic change. Specific agency-level techniques tied to system performance for cultural and linguistic competence identified in the research include cultural advisory bodies, implementation of a cultural competence plan, and linguistic competence training and education. Other research promotes the significance of workforce development strategies. Among policymakers, measurement and leadership emerge as factors instrumental to progress toward system cultural and linguistic competence.

NCC P used these policy indicators to develop a set of questions for states to gauge their progress they have made toward cultural and linguistic competence. This chapter describes the level of institutionalization of the policy-related cultural and linguistical competence strategies states designed and implemented to reduce racial/ethnic disparities.

Comprehensive and Intentional Policy Steps that States Reported

Overall, three states reported purposeful steps toward cultural and linguistic competence through policies, including the following:

Competency-based training for cultural and linguistic relevance;
Infrastructural support for developing and sustaining a culturally and linguistically competent workforce;
Regularly updated assessments of cultural and linguistic competence;
U p-to-date strategic plan for cultural and linguistic competence; and
Stakeholder involvement in policy and programming

Major Findings and Policy Implications

Despite data showing that African-American and Latino children and youth with mental health conditions are disproportionately represented in restrictive care settings, face obstacles to accessing mental health services and experience poor outcomes nearly half of the states reported that they serve African American children and youth well. Additionally, 12 states reported that they served Latino children and youth well. States may be referring to their successes with groups of children and youth in targeted programs since most of the literature suggests that many African-American and Latino youth are ill-served by the children’s mental health system and are disproportionately among those with poor mental health outcomes.

Only three states reported on systematic efforts to advance cultural and linguistic competence. This suggests that states have a long way to go in their attempts to reduce disparities based on race/ ethnicity or language access. Since policy research indicating that state leadership represents a driving factor necessary to improve cultural and linguistic competence in children’s mental health from a quality and access perspective, this is troubling.

Twenty-six states reported on policies that promote access to culturally and linguistically competent services. However, only three states reported that they have implemented a range of purposeful steps to promote cultural and linguistic competence including competency-based training, workforce development, assessment and strategic planning, and stakeholder involvement in policy and programming. This suggests that states may be employing diluted versions of what is needed and that a more comprehensive approach that engages a range of policy strategies may have greater impact on improving the cultural and linguistic competence.

Twenty states reported the use of statewide multicultural stakeholder groups but in only 13 states do these bodies hold policymaking or program responsibilities. However, if such groups are to become a force for change it appears that they will need more authority and responsibility.

Only 10 states reported that they regularly assess their system’s level of cultural and linguistic competence and only eight have statewide strategic plans to improve their systems’ cultural and linguistic competence. Overseeing system level changes to cultural and linguistic competence is difficult without base-line data and the ability to measure progress. States also will face challenges managing change without a vision and strategic plan.

Twenty-two states provide training to improve the state’s workforce’s level of cultural and linguistic competence but only eight of these states reported that these trainings are competency-based. States may have more success in disseminating knowledge on cultural and linguistic competence by using competency-based trainings.

States reported that underlying major access gaps are provider shortages, cultural and linguistic competence among providers and low levels of trust of providers, all which are factors amenable to policy fixes.

Stigma and low mental health literacy and cultural compatibility also emerged as major obstacles to access for children, youth and families from diverse racial/ethnic groups. This reinforces the need for a public health approach to mental health.

Recommendations

The federal government should:

Require states to report on their efforts to address disparities in access and outcomes for children and youth from diverse racial, ethnic and linguistic backgrounds;
Establish baseline data and outcomes for children and youth from diverse backgrounds and strategic plans to address disparities;
Develop and support technical assistance to states to improve their cultural and linguistic competence;
Develop models and provide guidance to states to bill Medicaid appropriately with the goal of improving the level of mental health-related interpreter services; and
Annually report on a state-by-state basis efforts to address disparities through the use of nationally-established benchmarks.

States should:

Develop multi-lingual, multi-cultural anti-stigma strategies and embed them in settings that individuals from diverse cultural groups frequent;
Review and inventory their training in cultural and linguistic competence and fund ongoing competency-based training;
Annually report on a county-by-county basis efforts to address disparities through the use of nationally-established benchmarks; and
Assess their state children’s mental health system’s level of cultural and linguistic competence, develop a strategic plan and publish regular updates of their progress.

What can you do to make a difference in your local community or state service system?

What are your thoughts (submit comments below)?