Cultural Competence and African Americans with Mental Illness The President

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Cultural Competence andAfrican Americans with
Mental Illness The Presidents Commission on
Mental HealthAugust 6, 2002

• King Davis, Ph.D.
• Robert Lee Sutherland Chair in Mental Health
  Social Policy
• School of Social Work, University of Texas at
  Austin
• Co-Chair of the National Leadership Council on
  African American Behavioral Healthcare, Inc.

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Introduction

• I am here today representing the National
  Leadership Council on African American Behavioral
  Health. The Council is an organization of African
  American consumers, family members, providers,
  professional associations, government staff,
  ministers and university professors that was
  formed close to one year ago. Each of the mental
  health disciplines is represented.

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Introduction (cont.)

• The Leadership Council is the first non-profit
  organization of its kind in our community that
  brings so many African American groups, involved
  in behavioral health, to the same table under a
  single umbrella. We work collaboratively with
  similar organizations from the Asian-Pacific
  Islander, Latino, and Native American
  communities.
• Our interest today and focus is cultural
  competence as a tool for change.

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Why is Cultural Competence Important?

• Potential Cost Savings people dollars
• a. Excess use of inpatient d. gtDiagnostic
  error
• b. High rates of recidivism e. gtInsurance
  rates
• c. Under-use of outpatient f. LOS
• Ethical Base of Professions
• Quality of Care Demands it
• Potential Improvement in Diagnosis
• Potential Improvement in Treatment
• Potential for Prevention
• Potential for Increasing Participation in Policy

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Dilemmas of Mono-Cultural Service Design
Source Davis, King (2001). In Veeder
Peebles-Wilkins, London Oxford University Press.
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What is Culture?

• Ways of behaving shared by human groups, which
  taken as a whole, constitute their culture. Each
  human society has its own culture, distinct in
  its entirety from that of any other society
  (Beals Hoier, 1959)
• The learned patterns of behavior and thought
  characteristic of a societal group (Harris, 1985).

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Basic Assumption

• Culture is an important variable in determining
  how people (consumers providers) see and
  interpret (know) the world around them and the
  basis of how they make decisions.

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Defining Cultural Competence

• Clinical Based Definition
• Cultural competence is a set of behaviors,
  attitudes, and policies that come together in a
  system, agency, or among professionals that
  enable them to work effectively in cross-cultural
  situations.

Source Cross et al. (1989).
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Defining Cultural Competence (2)

• Need-Based Definition
• Cultural competency is the acceptance and
  attention to the dynamics of difference, the
  ongoing development of cultural knowledge, and
  the resources and flexibility within service
  models to meet the needs of minority populations.

Source Cross et al. (1989).
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Defining Cultural Competence (3)

• Market-Based Definition
• Cultural competence is the integration and
  transformation of knowledge, information, and
  data about individuals and groups of people into
  specific clinical standards, skills, service
  approaches, techniques, and marketing programs
  that match the individuals culture and increase
  the quality and appropriateness of health care
  and outcomes and lowers costs.

Source Davis, King (1997).
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Applying Cultural Competence

• Domains
• 1. Needs Assessment
• 2. Information Exchange
• 3. Service Design Standards
• 4. Human Resource Development
• 5. Policies and Plans
• 6. Measurement of Outcomes

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Historical/Current Disparities1760 -2002

• gtDiagnosis of Severe Illness
• Frequency of Re-Admissions
• Frequency of Involuntary Admissions
• Utilization of Inpatient Services
• Death Rates in Hospitals
• Length of Stay
• Higher Dosages of Medication
• Knowledge/Information
• Stigma/Fear/Myth
• Use of Outpatient Services
• ltUse of Standard Treatments

Workforce Composition Epidemiological
Study Voluntary Participation Involvement in
Policy Shortage of Outcome Studies Research
Involvement (directors) Location of Services Help
Seeking Utilization Patterns Homelessness Dual-d
iagnosis Errors in Diagnosis Family/Consumer
Experiences in System Theory Training Foci
Immunity/Over-use
Sources Neighbors et al (2002) Snowden et al
(2001) and others (see bibliography).
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Prospective Frequency Of Illness
Source Davis, King., Johnson, Toni,
McClendon,A. (2002). Guidebook. Baltimore Casey
Foundation Mental Health A Report of the Surgeon
General, DHHS, 1999.
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Admissions per 100,000 by Race, Ethnicity Type
of Facility
Manderscheid, R. (1985). Mental Health United
States. Rockville NIMH
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Involuntary Admissions by Race
Source Ramm, D. (Fall, 1989). Overcommitted.
Southern Exposure, 14-17.
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Policy Actions Needed

• Priority on MH of Populations of Color National
  Action Conference
• Cultural Competence Standards Licensure
  Requirements
• Consumer/Family Participation Participation on
  Panels
• Shift to a Disability Model New Research Scales
• Involvement in Research Church Linkages
• CC in Federal Agency Policy Alternative Theory
• Family Education Programs Consumer Education
  Programs MH Services in Jails Priority on
  Prevention
• Parity Legislation Newsletters/Clearinghouse
• Revisions of Execution Policies and MI MH Policy
  Study Centers
• Continuing Education Requirements Stigma
  Reduction Studies
• Funded Demonstration Projects Revised University
  Curricula
• Focused Distribution of Research Funds Services
  for Children
• Enhanced primary care Online Sources

Source National Planning Meeting on African
American Mental Health (in press) Report
of National Leadership Council on African
American Behavioral Health (2002).
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Who Uses Cultural Competence?

• Coca Cola/Pepsi Cola Department of Defense
• Budweiser NCQA
• General Motors JCAHO
• IBM Managed Health Care
• Time Warner California DMH
• HMOs Texas DMHRM
• Disney Europe Virginia DMHMR

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National Planning Report
Source National Leadership Council on African
American Behavioral Health (2002). http//www.utex
as.edu/ssw/faculty/davis/naamh.pdf
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Development of Standards
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Quick Guide to Implementation
Source The Hogg Foundation for Mental Health,
University of Texas at Austin
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Future Research

• Conceptualization of cultural competence
  determination of working concepts
• Outcomes from studies in which cultural
  competence is applied and where it is not
• Cost of applying cultural competence potential
  budgetary savings
• Differences in outcomes from different approaches
  to cultural competence.

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Conclusions

• Medical and psychiatric assessments have a high
  error rate when applied to minority populations
• Cultural competence appears to approve assessment
  quality and accuracy
• Contributions of cultural competence require
  additional research
• Adoption of cultural competence will require
  extensive continuing education and revisions in
  professional education.