The Science of Cultural Competency: Implementation

1
The Science of Cultural Competency Implementation

• Delia Saldaña, Ph.D.
• University of Texas Health Science Center
• at San Antonio

2
Translating Knowledge into Practice

• Culturally competent care is done on purpose
• Thats the point of having assessed needs and
  developed a plan for measuring outcomes
• Culturally competent care applies to psychosocial
  and pharmacological interventions
• Treatment guidelines have been developed
• Increasingly identified in the health care
  literature

3
Treatment Guidelines

• Access Translation and interpreter certification
  guidelines already exist
• Assessment Instrument validation has been
  developed for standardized instruments
• Engagement Attributes of effective clinicians
  are outlined
• Maintenance Rapport building communication
  techniques have been articulated
• Outcomes Provider-client match is identified as
  an important factor of retention adherence to
  treatment

4
Providers Need Basic Training Application is Key

• Adopt multi-media, multi-method approach in
  curriculums
• Use powerpoint, video case discussions, role
  plays, small group activities
• Use existing curriculum manuals
• Andrulis, Campinha-Bacote, Betancourt
• Tailor application of information to local
  realities
• Address population specifics such as Mexican v.
  Cuban, Vietnamese v. Chinese, multi-generational
  residents v. immigrants)

5
More Basic Elements Pragmatic Steps

• Address program-specific outcomes (e.g.,
  prevention or crisis intervention
• Develop materials for cross-discipline audiences
  to illustrate collaboration toward mutual aims
• Address multi-system behavioral impact of mental
  disorders on social functioning
• Develop primary care readiness provide
  prevalence information, benefits of cost
  containment through co-morbidity identification
  referral, and patient education tools methods

6
Administrative Support is Essential

• Supervisor training to understand support
  front-line staff skill development application
  is critical
• Use Train-the-Trainer models
• Personnel evaluations should be tied to cultural
  competence skills
• Supervisor evaluations of program performance
  must be tied to outcomes
• Organizational improvement in cultural competence
  as the way we do business should be tied to
  contractual competitiveness

7
Develop Appropriate Evaluation Tools

• Individual
• Pre- and post-comparisons of attitudes, knowledge
  skill acquisition are conducted at scheduled
  trainings
• Semi-annual refreshers precede annual performance
  evaluations
• Organizational
• Tools have been developed that provide
  quantitative baseline progress toward
  contractual requisites
• TDMHMR Facility Scorecard
• PEAT (Patient Education, Assessment Treatment)
• NIMH is funding a Cultural Competency Assessment
  Scale (Siegel Haugland) to be field-tested in
  NY
• CCAS (self assessment protocol for managed care
  organizations) Health Services Advisory Group
  Andrulis, Delbanco et al.

8
References

• Literature on Culturally Competent Assessment
  Treatment
• California Standards for Healthcare Interpreters
  Ethical Principles, Protocols and Guidance on
  Roles Intervention. (2002) The California
  Healthcare Interpreters Association, Funded by
  the California Endowment.
• Cromwell RE Ruiz RE (1979). The myth of macho
  dominance in decision making within Mexican and
  Chicano families. Hispanic Journal of Behavioral
  Sciences, 1 355-373.
• Escobar JI, Burnam A, Karno M, Forsythe A
  Golding J (1987). Somatization in the community.
  Archives of General Psychiatry, 44 713-718.
• Graham S (1992) Most of the subjects were white
  and middle class Trends in published research on
  African Americans in selected APA journals,
  1970-1989. American Psychologist, 47 629-639.
• Greene RL (1987) Ethnicity and MMPI performance
  A review. Journal of Consulting and Clinical
  Psychology, 55 497-512.
• .

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Literature Assessment Treatment

• Guthrie RV (1976). Even the rat was white A
  historical view of psychology. New York Harper
  Row.
• Haffner, L. (1992) Translation is not enough
  interpreting in a mdical setting. In
  Cross-cultural Medicine A Decade Later Special
  Issue. The Western Journal of Medicine, 157
  255-259.
• Lopez, SR 1994 (1994) Latinos and the expression
  of psychopathology A call for the direct
  assessment of cultural influences. In C Telles
  M Karno (Eds.) Latino Mental Health Current
  research and policy perspectives (pp 109-127).
  Los Angeles UCLA.
• Lopez SR Tausig IM (1991). Cognitive-intellectu
  al functioning of impaired and non-impaired
  Spanish-speaking elderly Implications for
  culturally sensitive assessment. Psychological
  Assessment, 3 448-454.
• Lopez, SR (1997) Cultural Competence in
  Psychotherapy A guide for clinicians and their
  supervisors. In CE Watkins (Ed.) Handbook of
  Psychotherapy Supervision (pp 570-588). NY John
  Wiley Sons, Inc
• Lopez, SR (2000) Teaching culturally niformed
  psychological assessment. In RH Dana (Ed.)
  Handbook of Cross-cultural/Multicultural
  Personality Assessment (pp 669-687).Hillsdale,
  NJ Erlbaum.
• Malgady RG (1996) The question of cultural bias
  in assessment and diagnosis of ethnic minority
  clients Lets reject the null hypothesis.
  Professional Psychology Research and Practice,
  2773-77.

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Literature Assessment Treatment

• Malgady RG Costantino G (1998) Symptom
  severity in bilingual Hispanics as a function of
  clinician ethnicity and language of interview.
  Psychological Assessment, 10 120-128.
• Murphy JM (1976) Psychiatric labeling in
  cross-cultural perspective, Science, 191
  1019-1028.
• Price CS Cuellar I (1981). Effects of language
  and related variables on the expression of
  psychopathology in Mexican American psychiatric
  patients. Hispanic Journal of Behavioral
  Sciences, 3 145-160.
• Telles C, Karno M, Mintz J, Paz, G et al (1995).
  Immigrant families coping with schizophrenia
  behavioral intervention v. case management with a
  low-income spanish-speaking population. British
  Journal of Psychiatry, 167 473-479.
• Tervalon, M. Murray-Garcia, J. (1998).
  Cultural humility versus cultural competence A
  critical distinction in defining physician
  training outcomes in multicultural education.
  Journal of Health Care for the Poor and
  Underserved, 9(2) 117-125.
• Velasquez RJ, Ayala GX Mendoza SA 1(1998).
  Psychodiagnostic assessment of U.S. Latinos
  MMPI, MMPI-2, MMPI-A results. Lansing, MI
  Julian Samora Research Institute, Michigan State
  University.
• Velasquez RJ, Gonzales M, Butcher JN,
  Castillo-Canez I, et al. (1997) Use of the
  MMPK-2 with Chicanos Strategies for counselors.
  Journal of Multicultural Counseling and
  Development, 25 107-120.

11
Literature Guidelines and Protcols

• Literature on Cultural Competent Guidelines and
  Protocols
• American Academy of Family Physicians. (2001,
  March). Cultural proficiency guidelines.
  http//www.aafp.org/x13891.xml.
• American Medical Association (1999). Cultural
  competence compendium. Chicago American Medical
  Association.
• American Psychological Association (2002).
  Guidelines on multicultural education, training,
  research, practice and organizational change,
  Approved as APA Policy by the APA Council of
  Representatives.
• Bureau of Primary Health Care. (n.d.) Cultural
  competence An essential ingredient for quality
  access, elimination of disparities,
  http//bphc.hrsa.gov/quality/wordocs_pdf_wp/cultur
  alcompetence.ppt

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Literature Guidelines and Protcols

• Cross, T.L., Bazron, B.J., Dennis, K.W.,
  Issacs, M.R. (1989). Towards a culturally
  competent system of care A monograph on
  effective services for minority children who are
  severely emotionally disturbed. Washington, DC
  National Technical Assistance Center for
  Childrens Mental Health, Georgetown University
  Child Development Center.
• The Cross Cultural Health Care Program (n.d.)
  Guidelines for providing health care services
  through an interpreter. http//www.xculture.org/tr
  aining/index.html
• Trivedi, A.N., Gibbs, B., Nsiah-Jefferson, L. et
  al. (2005). Creating a state minority health
  policy report card, Public Response. Project HOPE
  _ The People to People Health Foundation, Inc.
• Welch, M. (1998). Required curricula in
  diversity and cross-cultural medicine The time
  is now. Journal of the American Medical Womens
  Association, 53 (Suppl), 121-123.
• Zweifler, J. Gonzalez, A.M. (1998). Teaching
  residents to care for culturally diverse
  populations. Academic Medicine, 73(1) 1056-1061.