1. Keeping the Promise of Cultural Competence
A Collaborative Approach

2. NYS OMH Organization Chart
(Go To Next Slide)

3. Diversity Management Emy Murphy Chief Diversity Officer
Diversity Planning & Compliance
Marisol Nunez-Rodriquez
Director
Bureau Of Cultural Competence
Frances Priester Community Relations/MAC Coordinator
Elatisha Kirnon Cultural Competence /Operations Coordinator
Hextor Pabon Education /Training Coordinator
Deirdre Goss Office Coordinator
Shelly Fiebich Assistant Director
Omer Jirdeh Info Tech/Data Analysis
Donna Swartout Office Manager/Secretary
Our job is to provide leadership to embed CC and to strengthen collaborations with internal and external stakeholders. Most important external stakeholders are consumers and family members. Need better state, county, community stakeholder collaboration with consumers/family members at the helm.
Centers of Excellence For Cultural Competence
Nathan Kline Institute Director Carole Siegel
NYS Psychiatric Institute Director Roberto Lewis-Fernandez

4. Social Foundation of Disparities
Web Model
Community
Language
Government &
Policies
Ethnicity
Gender
Education
Economics
SES
Religion
Social Support
Employment
Disparities
Culture
Income
Health &
Mental Health
Racism
Living
Conditions
Trainer Lecture Points:
All individuals and family members have their “Own Disparity Web” based on their interactions and connections they have within and outside their environment.
By looking at the “ Social Foundation of Disparity Web” one can easily see the challenges that individuals, and each of us face with regards to Disparities.
Within: means individual & family relationships/connections.
Outside: Outside of the family; involving community, work, friends, or other social and/or institutional relationships/connections. (Most Connections, Social Influences & Diversity)
These relationships and connections can be negative or positive; or be present or not present. Every individual or family member experiences may not be the same with regards to relationships/connections, and disparities. (Keep this in-mind) Health Disparities are very complex, even after controlling for obvious confounders, there are still disparities in terms of care, access, and outcome among racial and ethnic minorities.
When We Talk about Social Foundations of Disparities We Need to Include:
lack of access to services, poverty, lack of CC professionals, lack of CC providers, lack of resources, lack of CC knowledge, lack of evidence-base practices and person centered care, lack of diversity and racial knowledge, institutional barriers, policy barriers, privilege, literacy, educational and socio-economical barriers, and lack of effective communication styles.
Audience Discussion Exercise: (Brief Feedback & Discussion)
How can We Eliminate or Dismantle “Marginalization”, “Racism”, “Oppression”, “Privilege, & “Social Foundation of Disparities” (Show “Lunch Date” DVD minutes)
Answer: Cultural Competence!!! (Go to Next Slide)
Stress
Diet &
Lifestyle
Behaviors
Transportation
Incarceration
Genetics
Drug Use
Insurance Status

5. New Yorkers Helping New Yorkers!
Team New York!
We know that disparities exist and we know that it’s complicated as we’ve discovered. How do we solve healthcare disparities… together. New Yorkers have to start helping. The New York State Office of Mental Health can not do it alone.

6. Why the Regional MAC NYS Mental Health Consumers & Their Families
Those Directly Impacting Consumers
Advocacy Groups
Facility Staff
MAC
Regional/State
Administrative Staff
(Mid-Managers)
Other State Agencies
Executive Branch
EMY
Community Providers
You !!
Commissioner

7. Definition of CC
An integrated set of behaviors, attitudes and skills, policies and procedures that come together to enable caregivers to work effectively and efficiently in multicultural situations.
It is an attribute of a system, an agency or an individual
(New York State Office of Mental Health 1998, adapted from Cross et al. 1989).

8. NYS OMH Statewide Cultural Competence Strategic Plan
Needs/Capacity Assessment
Assess state operate facilities
Assess county providers
Conduct language survey
Services
Standardize process for language accommodation
Monitor services for cultural competence
Information Exchange
Gather and share cultural Competence information and best practices
Initiate and maintain stakeholder partnership
Human Resources
Hiring Attention
Developed and presented training for Staff CC
Overall Functions

9. Need/Capacity Assessments
Information Exchange
Cultural Competence Website
Establishing Cultural Competence List serve
Conduct webinars for best practices
Need/Capacity Assessments
Children Assessment
Services
Revised our translated website in Russian, Chinese Mandarin, Haitian(Creole)
Collaborated with Quality Management to develop Cultural and Linguistic Policy

10. Human Resources Outcomes
Increasing staff cultural and linguistic skill sets through training and education
Attend cultural specific events to endorse employment opportunities at NYS OMH
Outcomes
Conduct a cultural competence survey
Collaborating with Citer to revised our admission form to gather pertinent demographic information about the population served

11. Bureau of Cultural Competence
For additional information contact:

12. Health Care Reform and Organizational Level Cultural Competency
Carole Siegel
Gary Haugland
Eugene Laska
Lenora Reid-Rose
Dei-In Tang
Joseph Wanderling
Ethel Chambers
Brady Case
NKI Center of Excellence in Cultural Competency
NYAPRS: April 27, 2011

13. Acknowledgments New York State Office of Mental Health
Nathan S. Kline Institute Center of Excellence in Culturally Competent Mental Health.

14. Outline Cultural Competency (CC) at the Organizational Level
What it covers/what it does not
NKI Cultural Competence Assessment Instrument: Organizational Level
Can we show that organizational level CC reduces disparities?
Partial successes
Study results
Integration with health care reform
Where should it operate
How to ensure that it operates

15. Definition of CC
An integrated set of behaviors, attitudes and skills, policies and procedures that come together to enable caregivers to work effectively and efficiently in multicultural situations.
It is an attribute of a system, an agency or an individual
(New York State Office of Mental Health 1998, adapted from Cross et al. 1989).

16. Levels of a Mental Health System In which CC needs to operate
ADMINISTRATIVE ENTITY
e.g., State Mental Health Authority,
Managed Care Organization
Agency A
Inpatient unit
Agency C
Rehab
Agency B
Clinic
Program
Program
Program
Program
Program
Program
Caregiver
Caregiver
Caregiver
Caregiver
Caregiver
Caregiver
Caregiver
Consumers

17. NKI Cultural Competency Assessment Scale (CCAS) Organizational Level
Organizational commitment to CC
Collecting needs assessment data
Receiving community input
Infusing CC throughout an organization
Training staff
Making language accommodations
Interpreters
Bi-lingual Staff
Key Forms, Service Descriptions, Educational Materials
Hiring and retention policies
Adapting and creating new services

18. Study design Agencies studied: Agency CC data: Client data:
25 contract outpatient mental health service agencies
Monroe County Office of Mental Health
Agency CC data:
Assessed from CCAS instrument
Client data:
Characteristics and service use of agency users
Recorded in County mental health information system.

19. Measures and Models Service Event Measures
Engagement: Second visit occurs in first month post admission.
Retention: At least 4 visits in 6 months post admission
Statistical Model: Hierarchical logistic model on service outcomes.
Level 1 person regression: on dx, age, gender, race/ethnicity, interaction terms.
Level 2 agency regression: on size, ethnic mix and CCAS score.
Disparity measure
Odds ratio: odds of event for Whites divided by odds of event for racial/ethnic group.

20. What CC items predicted lower disparity rates between Hispanics and Whites ?
For Hispanics with mood, anxiety, other non-psychotic disorders: at least one of following
Agency has
Interpreters
Bilingual staff
Hiring, retention policies
Translated forms, educational and service material
Modifies and/or has new services
For Blacks with mood disorders
Agency has interpreters

21. What CC items did not predict disparity reduction?
Administrative items
Agency commitment, plan, CC committee, CC integrated in agency, having data
Comment: Items are distant from direct care. However, they are necessary prerequisites
Training
Comment: Mixed quality of training materials has been cited.
Materials are not relevant to direct care
Often unrelated to populations being served.

22. Why was disparity reduction predicted for Hispanics and not for Blacks?
Language related items more relevant to Hispanics than Blacks
Communication competencies for Blacks need to be differently addressed.
Modified programs for Blacks may not have been in place in studied agencies.
Difficulties in adapting services when adaptation is more than ‘translation’
Scale may not contain organizational items of relevance to Blacks
E.g., transportation and hours
Disparity reduction for Blacks may be more related to program delivery and therapeutic alliances
E.g, trust building, stigma reduction

23. Ensuring CC under State Health Care Reform
Reimbursements to participating organizations should take into account dollars required to set up CC activities,
e.g., for interpretation services
e.g., to support a CC specialist
Participating Managed Care Organizations: Medicaid or Other
Contracts should require
MCO has a CC Plan
MCO has financial commitment to CC
MCO conducts annual CC assessment
Participating Agencies under Managed Care
Agency has a CC Plan
Agency has financial commitment to CC
Agency conducts annual CC assessment

24. Conclusion
The business case still needs to be made for CC, since it can be expensive to implement.
Cost Benefit Ratios
CC Costs/Disparity Reduction Savings

25. For your interest
Siegel C, Haugland G, Laska E, Reid-Rose L, , Tang D-I, Wanderling J, Chambers ED, Case B. (2011) The Nathan Kline Institute Cultural Competency Assessment Scale: Psychometrics and Implications for Disparity Reduction Adm Policy Ment Health 38:120–130, DOI /s  
Siegel C, Haugland G, Reid-Rose L, Hopper K. Program Components of Cultural Competency, to appear Psychiatric Services, June 2011.
NYS OMH Nathan Kline Institute Center of Excellence in Culturally Competent Mental Health
Website: