1. Consumer Perception of Culturally Competent Outpatient Services & Hospital Use Carol Carstens, PhD, LISW-S Meeting of the Ohio Community Support Planning Council Columbus, Ohio September 15, 2012

2. Abstract Objective: To look a the relationship between patient-reported perception of outpatient services and hospital use. Data Source/Collection: Data were collected in a mail survey of minority consumers ( N = 373). Design/Methods : In this cross-sectional study, Likert-type scales were used to collect information on client perception of providers’ cultural competence. Forms were matched with administrative data on hospitalization during the study period. Logistic regression was used to examine the relationship between cultural competence and the independent variables. Principal Findings: After controlling for subject-related factors, consumer perception of provider cultural competence was significantly related to likelihood of hospitalization. Conclusions: Cultural competence is a specific approach to patient centered care that can improve community tenure and reduce the likelihood of hospitalization.

3. Research Question Does a consumer’s perception of his or her outpatient provider’s level of cultural competence have any association with hospitalization?

4. ODMH Definition Cultural Competence is a continuous learning process that builds knowledge, awareness, skills and capacity to identify, understand and respect the unique beliefs, values, customs, languages, abilities and traditions of all Ohioans in order to develop policies to promote effective programs and services.

5. Why is Someone’s Cultural Perspective Important? Culture falls under the umbrella of person- centered care. It provides a framework for understanding human experience:  Personal & Group Identity  Beliefs & Values  Customs & Traditions  Language & History  Otherness: Minority versus Majority

6. Devilish Little Detail How do you measure a provider’s “knowledge, awareness, skills and capacity to identify, understand and respect” a consumer’s culture?  Very little research measures and evaluates the service providers’ cultural competence from the consumer perspective.

7. Consumer Based Cultural Competence Survey (CBCCS)  52-item Consumer-based Cultural Competence Inventory (CBCCI) developed by L.J. Cornelius & others in Maryland in 2002  20 items from CBCCI tested & analyzed by ODMH-ORE staff in Ohio administration in 2012  10 items from CBCC survey adopted to analyze risk of hospital service use  Conceptual and Statistical Considerations

8. Leading Question… Some people belong to minority groups because their race, country of origin, history, language, religion, or sexual orientation is different than most people. Do you consider yourself a cultural, racial, ethnic, religious, or sexual minority group member? Yes No If you answered YES, what is your minority group? (Specify cultural, racial, ethnic, religious and/or sexual identity)____________________

9. Minority Status  About 37% of the sample who were people of color or of Hispanic ethnicity said No to the question about minority status.  The US is becoming more racially and ethnically diverse.  Many people in the sample do not appear to see themselves as “other” or set apart from mainstream society because of race or ethnicity.

10. How Much Do you Agree/Disagree?  Staff listen to me and my family when we talk to them.  Staff who work directly with me on my mental health needs respect my belief in God, a supreme being or higher power.  Some staff at my agency understand the difference between their culture and mine.  Staff understand that people of my racial or ethnic group are not all alike.  When I first called or came to the agency, it was easy to talk to the staff.

11. Continued…  Most of the time, I feel I can trust the staff who work with me.  Staff understand some of the different ideas that I, my family, and others from my minority group have about mental illness.  Staff are willing to be flexible and provide alternative approaches or services to my cultural/ethnic treatment needs.  The agency waiting room has pictures or reading material that show people from my minority group.  The agency’s reading materials and handouts are in other languages as well as English.

12. Sampling  Adult survey: 4,740 randomly selected adult consumers with serious mental illness (SMI)  Minority subsample: 1,325 consumers selected if race code indicated person of color – OR – ethnicity code indicated Hispanic origin  175 individuals selected where race = White without Hispanic qualifier  Total subsample = 37% of adult consumer sample received cultural competence questionnaire

13. Response  430 completed CBCC surveys returned  25% of total subsample  373 CBCC Surveys in Hospitalization Analysis  37 Cases with Hospitalization in past 18 months  Provider at time of Hospitalization = Provider at time of Survey  334 Cases without Hospitalization  Medicaid and State Records

14. Who Participated? 61% Female 39% Male 7% Hispanic 9% Religious Identity 2% LGBT Identity 1% Other

15. Logistic Regression A statistical test that determines whether a low mean score on a scale like the CBCC has an association with hospital use… YES NO

16. Controlling for Other Factors After eliminating the possibility that  Age  Race  Ethnicity  Geographic Locale  Diagnosis might better explain risk of hospitalization

17. Study Finding