VALUES AND ATTITUDES

Appreciate, respect different cultures

Checklist from the NCCC on Values and Attitudes. Indicate A= things I do frequently B= things I do occasionally C= Things I do rarely or never.

•  I recognize and accept that folk and religious beliefs may influence a family's reaction and approach to a child born with a disability or later diagnosed with a disability or special health care needs.
•  I understand that traditional approaches to disciplining children are influenced by culture.
•  I understand that families from different cultures will have different expectations of their children for acquiring toileting, dressing, feeding, and other self help skills.

X

Georgetown University Child Development Center-National Center for Cultural Competence  (NCCC) Checklist on Values and Attitudes. Tawara Goode. June 1989. Revised 1993, 1996, 1999 and 2000

•  I accept and respect that customs and beliefs about food, its value, preparation, and use are different from culture to culture.
•  Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs and expectations which are unique to families of specific cultures and ethnic groups served by my program or agency.
•  I seek information from family members or other key community informants, which will assist in service adaptation to respond to the needs and preferences of culturally and ethnically diverse children and families served by my program or agency. 
•  I advocate for the review of my program's or agency's mission statement, goals, policies, and procedures to insure that they incorporate principles and practices that promote cultural diversity and cultural competence.

X

Values and Attitudes.

Appreciate, respect different cultures

Checklist from the NCCC on Values and Attitudes. Indicate A= things I do frequently B= things I do occasionally C= Things I do rarely or never.

•  I avoid imposing values that may conflict or be inconsistent with those of cultures or ethnic groups other than my own.
•  In group therapy or treatment situations, I discourage children from using racial and ethnic slurs by helping them understand that certain words can hurt others. 
•  I screen books, movies, and other media resources for negative cultural, ethnic, or racial stereotypes before sharing them with children and their parents served by my program or agency. 
•  I intervene in an appropriate manner when I observe other staff or parents within my program or agency engaging in behaviors that show cultural insensitivity or prejudice.

X

Georgetown University Child Development Center-National Center for Cultural Competence (NCCC) Checklist on Values and Attitudes. Tawara Goode. June 1989. Revised 1993, 1996, 1999 and 2000

•  I understand and accept that family is defined differently by different cultures (e.g. extended family members, fictive kin, godparents).
•  I recognize and accept that individuals from culturally dive backgrounds may desire varying degrees of acculturation into the dominant culture. 
•  I accept and respect that male-female roles in families may vary significantly among different cultures (e.g. who makes major decisions for the family, play and social interactions expected of male and female children). 
•  I understand that age and life cycle factors must be considered in interactions with individuals and families (e.g. high value placed on the decisions of elders or the role of the eldest male in families). 
•  Even though my professional or moral viewpoints may differ, I accept the family/parents as the ultimate decision makers for services and supports for their children. 

X

•  I recognize that the meaning or value of medical treatment and health education may vary greatly among cultures. 
•  I accept that religion and other beliefs may influence how families respond to illnesses, disease, and death.

Mission, vision

X

Mission, vision

MCO self-certification that its mission statement/strategic vision support diversity and cultural competence

X

CULTURAL SENSITIVITY

Non verbal communication

Translate and make available signage and commonly used written patient education  and other materials for members of the predominant language groups in their service area

X

Non verbal communication

Number of pertinent written and oral and symbolic consumer and family materials (including consent forms, statement of rights forms, posters, signs, and audio tape recordings) provided to consumers from various racial/ethnic groups and their families that are interpreted from the appropriate cultural perspective, as measured by consumer satisfaction surveys.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Visual representation

Ensure that posters, magazines, signs are in languages of the community.

X

Culturally sensitive encounters

Conduct assessment of patient/parent beliefs using the following checklist:

• Identification of beliefs that affect clinical care

• Suggest alternatives to harmful home remedies

•  Explain etiology and treatment rationale for given biomedical condition

X

Progress Notes (December 1999). A Model of Cultural Competency in Health Care. A Newsletter of the Massachusetts Chronic Disease Improvement Network. Vol.3, No.3

Culturally sensitive clinical and non-clinical encounters

Use the following set of questions to assess folk illnesses and remedies:

•  Indicate awareness of the existence of a folk illness that doctor may not know about
•  Ask whether the patient has the illness now
•  Ask what treatment the patient is receiving for the condit.

X

Progress Notes (December 1999). A Model for Cultural Competency in Health Care. A Newsletter of the Massachusetts Chronic Disease Improvement Network. Vol.3, No.3

Culturally sensitive clinical and non-clinical encounters

Conduct health beliefs inventory of patient to understand the patient’s explanatory model for illness. 

X

Progress Notes (December 1999). Practicing Culturally Sensitive Pediatrics. A Newsletter of the Massachusetts Chronic Disease Improvement Network. Vol.3, No.3

COMMUNICATION

Communication styles

Checklist from the NCCC on Communication style. Indicate A= things I do frequently B= things I do occasionally C= Things I do rarely or never.

•  For children who speak languages or dialects other than English, I attempt to learn and use key words in their language so that I am better able to communicate with them during assessment, treatment or other interventions.
•  I attempt to determine any familial colloquialisms used by children and families that may impact on assessment, treatment or other interventions. 
•  I use visual aids, gestures, and physical prompts in my interactions with children who have limited English proficiency.
•  I use bilingual staff or trained volunteers to serve as interpreters during assessment, meetings, or other events for parents who would require this level of assistance.
•  When possible, I insure that all notices and communiqués to parents are written in their language of origin.
•  I understand that it may be necessary to use alternatives to written communications for some families, as word of mouth may be a preferred method of receiving information

X

Georgetown University Child Development Center-National Center for Cultural Competence  (NCCC) Checklist on Communication Styles. Tawara Goode. June 1989. Revised 1993, 1996, 1999 and 2000

COMMUNICATION

Communication styles

Checklist from the NCCC on Communication style. Indicate A= things I do frequently B= things I do occasionally C= Things I do rarely or never.

•  When interacting with parents who have limited English proficiency I always keep in mind that:
•  Limitations in English proficiency is in no way a reflection of their level of intellectual functioning.
•  their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin.
•  they may or may not be literate in their language of origin or English.

X

Georgetown University Child Development Center-National Center for Cultural Competence  (NCCC) Checklist on Communication Styles. Tawara Goode. June 1989. Revised 1993, 1996, 1999 and 2000

Interpreter

Yearly updated directory of trained interpreters available within 24 hours for routine situations and within one hour or less for urgent situations. 

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/Underrepresented Racial/Ethnic Groups

 Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Interpreter

Percent decrease in the use of interpreters as a result of increased numbers of professional staff competent in the communication styles of consumers from the ethnic/racial groups. 

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups

 Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Interpreter

Patient survey:

•  How often is an interpreter present during your office visits?(never, sometimes, frequently, always, doctor speaks my language)
•  If your primary language is other than English, which of the following services does your health plan offer in your primary language? 
•  Interpreter of bilingual staff in the emergency room
•  Interpreter or bilingual staff in the laboratory
•  Interpreter of bilingual staff in X-ray
•  Interpreter or bilingual staff in EKG
•  Interpreter for visits to authorized non-Plan providers 
  
•  How satisfied are you with the language interpreter you receive under your health plan? 
•  Have you ever had to wait more than 2 days to see a plan physician for attention to a condition which you felt required immediate attention due to the unavailability of a plan provided interpreter? 
•  Who usually interprets during your office visit?

X

Munoz, R.H., Sanchez, A.M.  Developing Culturally Competent Systems of Care for State Mental Health Services.  Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Prepared for the Substance Abuse and Mental Health Services Administration under contract No. 94MF113927

Interpreter

Percentage of clients with limited English proficiency (LEP) who have access to bilingual staff or interpretation services. 

X

Interpreter

•  Percentage of bilingual staff and interpreters certified or having formally demonstrated their linguistic competence.
•  Number of trainings provided to clinicians in the use of interpreters for consumers from the various racial/ethnic groups and their families.
•  Percentage of translators working with consumers from various  racial/ethnic groups and families who are trained in formal interpretation techniques and supervised by culturally competent specialist.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Translated materials

Activities and material, including an updated listing of community resources, are provided in the language(s) of the population(s) being served.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/Underrepresented Racial/Ethnic Groups

 Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Translated materials

X

Maternal and Child Health Bureau. (April 30, 2000). Title V Block Grant Measure. Health Resources and Services Administration. 

Translated materials

Percent of clients who receive oral and written notices, including translated signage at key points of contact, in their primary language informing them of their right to receive no-cost interpreter services.

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

Translated materials

Translate and make available signage and commonly-used written patient educational material and other materials for members of the predominant language groups in service areas.

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

Translated materials

•  Policies and procedures regarding the translation of patient consent forms, educational materials, and other information in formats that meet the literacy needs of patients.
•  Policies and procedures to evaluate the quality and appropriateness of interpretation and translated services.
•  Policies and procedures to periodically evaluate consumer and personnel satisfaction with interpretation and satisfaction services that are provided.

X

National Center for Cultural Competency (Winter, 2000) Policy Brief 2: Linguistic Competence in Primary Health Care Delivery Systems: Implications for Policy Makers.

Translated materials

Information on rights is available in languages of community

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. 

Linguistically competent organization

•  Percent of racial/ethnic customers receiving linguistically competent services
•  Percentage of consumers from diverse ethnic/racial groups served in their preferred language

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Linguistically competent organization

•  Language and dialects of community available at the point of first contact
•  # of trained translators and interpreters available
•  # staff proficient in languages of the community

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Linguistically competent organization

Interpreters and bilingual staff demonstrate bilingual proficiency and receive training that includes the skills and ethics of interpreting, and knowledge in both languages of the terms and concepts relevant to clinical or non-clinical encounters

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

Linguistically competent organization

Linguistically and culturally factored consumer satisfaction surveys are independently administered and include health plan drop-out rates and short-term recipients.

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

Linguistically competent organization 

Patient Survey

•  If your primary language is other than English, which of the following services does your health plan offer in your primary language?

-      Health plan forms and brochures describing benefits

-      Answers by phone or in person to questions about plan benefits and procedures

-      Telephone access to doctors 24 hours a day in case of urgent need

-      Making appointments with your doctor

-      Assistance getting authorization to see a specialist

-      Identification of doctors who speak your language and/or understand your culture

-      Health education and health prevention programs in your community

·       Handling complaints about your care or treatment by the health plan

·       On-going updates on plan information 

X

Munoz, R.H., Sanchez, A.M.  Developing Culturally Competent Systems of Care for State Mental Health Services.  Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Prepared for the Substance Abuse and Mental Health Services Administration under contract No. 94MF113927

Linguistically competent organization

Percentage of consumers from diverse ethnic/racial groups served in their preferred language.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Linguistically competent organization

Items from Patient Satisfaction Survey Tool:       How well can you communicate with your doctor in English?       How often is an interpreter present during your office visits       Who usually interprets during your office visit?       If your primary language is other than English, which of the following services does your health plan  offer in your primary language?       How satisfied are you with the language interpreting you receive under your health plan?       How understandable are the written communications you receive from your health plan?       Are the instructions for using the drug prescribed for you which are on the labels of the pill bottles written in your native language?       Does the pharmacist explain the instructions for taking prescriptions to you in your native language?

X

Tirado, M. (January, 1996). Tools for Monitoring Cultural Competence in Health Care. Latino Coalition for a Health California. San Francisco, CA

Linguistically competent organization

X

Maternal and Child Health Bureau  (1990) State Children with Special Health Care Needs Title V Directory Workshop: Improving State Services for Culturally Diverse Populations. 

Linguistically competent organization

Comprehensive management strategy to address culturally and linguistically appropriate services, including strategic goals, plans, policies, procedures, and designated staff responsible for implementation.

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

Linguistically competent organization

Availability of cultural competent policies in different languages.

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Linguistically competent organization

X

Maternal and Child Health Bureau (April 30, 2000). Title V Block Grant Measure. Department of Health and Human Services.

Linguistically competent organization

MCO complies with current law and regulation regarding interpreter services as measured by whether MCO meets all requirements or in a weighted average of compliance ratings for individual items

X

Linguistically competent organization

Consumer education information respects cultures, reflects literacy levels and is in different formats

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Linguistic capacity of provider

Conduct audit of provider network which includes the following components:       Languages and dialects of community available at points of first contact       # trained translators and interpreters available       # clinicians and staff proficient in languages of the community

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Linguistic capacity of provider

Policies to support community outreach to persons with limited English proficiency

X

National Center for Cultural Competency (Winter, 2000) Policy Brief 2: Linguistic Competence in Primary Health Care Delivery Systems: Implications for Policy Makers.

Linguistic capacity of provider

Use of language fluency examinations to determine the level of competence of clinicians and interpreters to provide comprehensive clinical and preventive care

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Linguistic capacity of provider

Procedures to periodically review the current and  emergent demographic trends for the geographic area served in order to determine interpretation and translation service needs

X

National Center for Cultural Competency (Winter, 2000) Policy Brief 2: Linguistic Competence in Primary Health Care Delivery Systems: Implications for Policy Makers.

Language ability, oral and written of consumer

Consumer reading, writing levels of primary language and dialects recorded.

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Provide information, education

X

Provide information, education

-       Respects cultural values

-       Is in different formats       Information is available in the languages of the community.       Material is reviewed by local key informants.       Information is disseminated to provider network.

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Provide information, education

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. 

Administration and staff should be able to translate, cultural brokering

Promote and support the attitudes, behaviors, knowledge, and skills necessary for staff to work respectfully and effectively with patients and each other in a culturally diverse work environment.

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services.

POLICIES AND PROCEDURES

Choice of health plan network

Contract continuation and renewal with health plan is contingent upon successful achievement of performance targets which demonstrate effective service, equitable access and comparability of benefits for populations of racial/ethnic groups

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Choice of providers, provider network

Health plan contracts with, and utilizes local racial/ethnic community-based organizations and independent practitioners in its network and includes them in the provider’s network or panel.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Choice of providers, provider network

MCO self-certification regarding specific requirements(e.g., designation as an AA/EEO employer, job descriptions include requirements for cultural competence, performance evaluations measure and reward culturally competent behaviors)

X

Grievance and conflict resolution

Organization has structures and procedures to address cross cultural ethical and legal conflicts in health care delivery and complaints or grievances by patients and staff about unfair, culturally insensitive or discriminatory treatment, or difficulty in accessing services, or denial of services

X

Office of Minority Health (1999) Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda Recommended Standards for Culturally and Linguistically Appropriate Health Care Services. 

Grievance and conflict resolution

There are feedback mechanisms in place that track # grievances and complaints and # incidents.

X

The New York State Office of Mental Health. The Research Foundation for Mental Hygiene. (September 1998) Cultural Competence Performance Measures for Managed Behavioral Healthcare Programs.  In Collaboration with the Center for the Study of Issues in Public Mental Health. Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Grievance and conflict resolution

Patient complaints and grievances (e.g., differences in the per capital number of complaints or grievances filed by members of each patient group)

X

Grievance and conflict resolution

Racial/ethnic consumer awareness of and participation in Health Plan benefits, appeals procedures, and ombudspersons, as demonstrated by the comparability of the rate of grievances and complaints.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Grievance and conflict resolution

The percentage of complaints and grievances of individual practitioners is tracked and factored into performance evaluations.

X

Center for Mental Health Services  (Nov, 1998)) Cultural Competence in Managed Care. Overall System Standards and Implementation Guidelines.  Mental Health Services for Four Underserved/ Underrepresented Racial/Ethnic Groups Prepared for Substance Abuse and Mental Health Services Administration. Purchase Order No. 97MO4762401D

Policy development

Incorporation of cultural values and priorities in services planning/implementation/evaluation activities.

X

Nelkin, V.S. I (1994) To Improve access to Care and Quality of Life for all Children with Special Healthcare Needs and Their Families. 

Policy development

Provider Survey:       As a matter of formal policy, does you agency: (no policy, considering policy, currently writing formal policy, policy in place)

-      Use culture-specific assessment instruments for diagnosis

-      Use culture-specific treatment approaches

-      Envision community empowerment as a treatment goal

-      Review case practices on a regular basis to determine relevancy to client of color

-      Provide or facilitate transportation 

-      Allow access after regular business hours

-      Specifically