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Cultural Competence and African Americans with Mental Illness The Presidents Commission on Mental He

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Co-Chair of the National Leadership Council on African American Behavioral Healthcare, Inc. ... Asian-Pacific Islander, Latino, and Native American communities. ... – PowerPoint PPT presentation

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Title: Cultural Competence and African Americans with Mental Illness The Presidents Commission on Mental He


1
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.

2
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.

3
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.

4
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

5
Dilemmas of Mono-Cultural Service Design
Source Davis, King (2001). In Veeder
Peebles-Wilkins, London Oxford University Press.
6
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).

7
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.

8
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).
9
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).
10
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).
11
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

12
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).
13
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.
14
Admissions per 100,000 by Race, Ethnicity Type
of Facility
Manderscheid, R. (1985). Mental Health United
States. Rockville NIMH
15
Involuntary Admissions by Race
Source Ramm, D. (Fall, 1989). Overcommitted.
Southern Exposure, 14-17.
16
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).
17
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

18
National Planning Report
Source National Leadership Council on African
American Behavioral Health (2002). http//www.utex
as.edu/ssw/faculty/davis/naamh.pdf
19
Development of Standards
20
Quick Guide to Implementation
Source The Hogg Foundation for Mental Health,
University of Texas at Austin
21
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.

22
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.
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