1. Cultural Competence and Consumer Involvement: Practice and Theory
Lisa Magged, MA
November 5, 2007

2. Outline Cultural Competence and Consumer Involvement
Consumer Involvement in the Mental Health HIV Services Collaborative (MHHSC) Program
Implications of the MHHSC as a demonstration
Health Resources and Services Administration (HRSA) – Lewin Organizational Cultural Competence Assessment Framework
Consumer involvement

3. Cultural Competence and Consumer Involvement
Convergence in the late 1980s
Cultural Competence scope shift
Cross-cultural patient-provider interaction  organizational level
Address communities and health care systems in the context of issues such as racism, prejudice, and the social determinants of health
[Beach, M.C., Saha, S. & Cooper, L.A. (2006). The Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality. New York: The Commonwealth Fund.]
Federal government commitment
Proliferation of organizational cultural competence assessment tools
Consumer involvement identified as a key component of cultural competence

4. Mental Health HIV Services Collaborative (MHHSC) Program
Background: MHHSC followed on the heels of the HIV/AIDS Mental Health Demonstration Program – the first federal initiative to focus on the mental health needs of people living with or affected by HIV. [DHHS/SAMHSA/NIH/HRSA]
Purpose: To provide effective, cultural competence mental health services specific to the needs of HIV+ individuals in minority communities
20 Community-based organizations were funded by Center for Mental Health Services (CMHS) to provide mental health services to individuals with HIV or AIDS in underserved communities
From ,329 clients were served in total
50% African American; 28% Hispanic/Latino
Abt Associates served as Evaluator and Coordinating Center (3 years)

5. Consumer Advisory Board
MHHSC-specific CAB was a condition of funding
Reflective of target population for MHHSC program
Members: Individuals living with or affect by HIV who also had a mental illness
CABs were intended to:
function as formal entities within each MHHSC grantee organization
be characterized by an identifiable organizational structure, membership, and activities
facilitate cultural competence
10 of 20 MHHSC sites had a CAB prior to MHHSC, either for the agency overall or for a specific program

6. Methods Site visits were conducted in Years 1,3,5
2 full days; usually group interviews
Interviews with administrative, clinical, evaluation staff (including CAB liaison)
Interviews with Consumer Advisory Board representatives
Semi structured site visit protocol
Site visit reports written after each site visit
Site visit reports (Year 3 and 5) read into NVIVO; coded; and analyzed

7. Findings: Challenges to Developing a CAB
During the 1st two years of MHHSC few grantees could maintain a CAB; more than half disbanded  By Year 5, 14 sites were able to initiate and maintain a CAB
Establishing Infrastructure
Clear mission or set of goals
Governance (officer roles, membership criteria)
Recruitment and orientation processes
Membership criteria
CAB liaison to MHHSC Program staff
Recruitment and retention of CAB members and leaders
Training of CAB members and leaders
Organizational support (computer access, meeting space, agendas)
Incentives (monetary and non monetary)

8. Findings: CAB Infrastructure Years 3 to 5
Year 3
Year 5
Mission Statement
Yes 6
30% 14
70% No 11
55% 5
25%
Developing 3
15% 1 5%
Orientation Process 7
35% 2
10%
Recruitment Process 9
45% 15
75% 10
50% 0%
Membership Criteria 13
65% 4
20%
Unknown
Roles for Officers 12
60%

9. Findings: CAB Activities
Develop Infrastructure
Emotional and social support group
Education and Outreach
Advocacy
Input on MHHSC Organizational/Program Activities
Leadership Development

10. Findings: Institutional staff and CAB development
CAB site liaisons were integral to CAB activities by :
Assisting with meetings/organization and orientation/introduction of new members
Functioning as a mediator and advisor
Relaying concerns to staff
Very limited CAB development and activities in 5 years
7 CABs were unable to move beyond infrastructure development
3 CABs unable to move beyond emotional and social support
7 CABs provided input on organizational and program activities
3 CABs involved in advocacy (one-time events)
2 CABs with 2 to 3 members in leadership training

11. Discussion
How does this demonstration inform our understanding of cultural competence and consumer involvement in mental health?

12. HRSA-Lewin Organizational Cultural Competence Assessment Framework
Framework adopted by the MHHSC project (CMHS, Abt Associates, and site representation) to guide implementation
7 Domains
Organizational Values
Governance
Planning and Monitoring/Evaluation
Communication
Staff Development
Organizational Infrastructure
Services/Interventions

13. Insights from MHHSC Lack of specificity Does not account for:
HRSA-Lewin Framework and consumer involvement:
Lack of specificity
Does not account for:
Roles of institutional actors – e.g. Site Liaison
Needs assessment
Theory of change
Empowerment and service improvement spectrum
There are many reasons for involving consumers:
Implications of institutionalizing consumer involvement through CABs

14. Conclusion and Recommendations
Consumer involvement should be facilitated by:
Strategic Planning
Needs assessment
Capacity of organization to support consumer involvement (finances, human resources, operations)
Theory of Change
Accounts for purpose of consumer involvement
Means of the intervention
Processes
Outcomes
Evaluation and Evolution
Assessment frameworks – Include indicators to account for human resources to support consumer involvement

15. Questions or Further Information
Lisa Magged
Abt Associates Inc.