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FORE MORE INFORMATION:
WWW.NMSOC.ORG
J. Martín Rodríguez
Cultural & Linguistic Competence Lead
New Mexico Communities of Care
Office: 505.827.9934
New Mexico Systems of Care
Organizational Cultural and Linguistic
Competency Self Assessment
A Users Guide
June 2013
"Improving Behavioral Health Access and Outcomes
for New Mexico's Diverse Communities"
Page 2 Introduction The movement to develop culturally and linguistically compe-‐
tent behavioral health services gained national prominence through the work of Terry L. Cross, et al, in a 1989 publication entitled, "Towards a culturally competent system of care". This work drew attention to the unique mental needs of di-‐
verse communities in the U.S. and the role that culture and race plays in serving minority children with serious emotional disturbances. The monograph helped to inform national dis-‐
cussions about what culturally and linguistically appropriate services are, how are they developed, accessed and provided. Several federal policies and reports emerged included the Cul-‐
turally and Linguistically Appropriate Services (CLAS) standards in 1999; Mental Health: Culture, Race and Ethnicity -‐ A Supple-‐
mental Report of the Surgeon General, USDDHS, 2001; and as well as the President's New Freedom Commission on Mental Health Report: Transforming Mental Health Care in America in 2003. The most recent is the new enhanced CLAS Standards (2013). All of which articulate that diverse communities experi-‐
ence greater disparities in care and suffer a greater disability burden from unmet health care needs. In order to determine, how agencies and providers could best develop the capacity to provide culturally and linguistically ap-‐
propriate services, a critical step involves conducting an organ-‐
izational self-‐assessment. As used in this summary, a self-‐
assessment is an inventory of an agency's policies, practices and procedures related to the provision of culturally and lin-‐
guistically appropriate services in health care. An assessment focuses on the capacities, strengths and weakness of the agency in providing such services (USDHHS, National Standards for Culturally and Linguistically Appropriate Services -‐ CLAS-‐ in Page 11 National Standards for Culturally and Linguistically appropriate Services in Health Care, 2001. United States Department of Health and Human Services Department. New Mexico Behavioral Health Purchasing Collaborative State-‐
wide Plan to Eliminate Disparities, 2009. New Mexico Systems of Care Organizational Cultural and Lin-‐
guistic Self-‐Assessment, 2011. New Mexico Systems of Care, Families and Organizations Col-‐
laborating for a United System (FOCUS), grant application to the Substance Abuse and Mental Health Services Administra-‐
tion, 2008. Optum Health New Mexico Cultural Competency Plan, 2008. The President's New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report, 2003. Towards a culturally competent system of care, Volume 1, A Monograph on Effective Services for Minority Children who are severely emotionally disturbed. Terry L. Cross, Barbara J. Baz-‐
ron, Karl W. Dennis, and Mareasa Issacs, 1989. Page 10 Citations A Guide for Using the Cultural and Linguistic Competency Pol-‐
icy Assessment Instrument, National Center for Cultural Com-‐
petence, Georgetown University Center for Child and Human Development, 2006. A System of Care Team Guide to Implementing Cultural and Linguistic Competence, Technical Assistance Partnership for Child and Family Mental Health, July 2010. Capacity for Delivering Culturally Competent Mental Health Services in New Mexico: Results of a Statewide Agency Survey, Rafael Semanksy, Deborah Altschul, David Sommerfield, Rich-‐
ard Hough, and Cathleen Wilging, 2009. Enhanced Culturally and Linguistically Appropriate Services (CLAS) Standards, United State Department of Health and Hu-‐
man Services, Office of Minority Health, 2013. Mental Health: Culture, Race and Ethnicity. A Supplemental to Mental Health: A Report of the Surgeon General, United States Department of Health and Human Services, 2001, Multicultural Health Care: A Quality Improvement Guide, Na-‐
tional Committee on Quality Assurance (NCQA) in collabora-‐
tion with Eli Lilly and Company, 2006. National Standards of Culturally and Linguistic Appropriate Ser-‐
vices (CLAS), United States Department of Health and Human Services, Office of Minority Health, 1999. Page 3 Health Care, 2001 and the Enhanced CLAS Standards, 2013). Such an assessment is not only a systematic method for col-‐
lecting information to determine an organization's current level of performance, but provides an opportunity for strategic and program improvement. Thus an assessment provides a mechanism for regular feedback and helps continuously im-‐
prove performance (National Committee for Quality Assur-‐
ance, 2006). The CLAS Standards call specifically for health care organizations to conduct initial and ongoing organiza-‐
tional self-‐assessments of CLAS-‐related activities and are en-‐
couraged to integrate cultural and linguistic competence-‐
related measures into their internal audits, performance im-‐
provement programs, patient satisfaction assessments and outcomes-‐based evaluations (USDHHS, Office of Minority Health, CLAS Standards, 1999 and the Enhances CLAS Stan-‐
dards, 2013). This guide briefly outlines the next steps in completing an or-‐
ganizational self-‐assessment through implementation of Sys-‐
tems of Care (SOC) model in New Mexico by the Children, Youth and Families Department (CYFD). How it all got started New Mexico has been making considerable strides to promote, develop and implement strategies to help reduce or eliminate behavioral health disparities through its behavioral health re-‐
design efforts and subsequent Mental Health Transformation grants. The current strategy to develop the cultural and lin-‐
guistic competency at the practitioner, organizational and sys-‐
tems level continues to move forward in a coordinated fashion Page 4 through the SOC model which emphasizes cultural and linguis-‐
tic competency as one its cornerstones. The Collaborative also adopted a statewide plan to Eliminate Behavioral Health Disparities in 2009 which was a result of on-‐
going planning efforts culminating in New Mexico's selection in the national Policy Academy to Eliminate Disparities which re-‐
quired states to complete plans specifically aimed at reducing disparities in their states. New Mexico's statewide plan calls for creating formal and in-‐
formal self, peer, and consumer evaluation procedures to as-‐
sess cultural and linguistic competency on the provider, organ-‐
izational and system level. One specific objective calls for com-‐
pleting organizational level self-‐assessments which aligns with the CLAS standard on the use of self-‐assessments (New Mexico Behavioral Health Purchasing Collaborative Statewide Plan to Eliminate Disparities, 2009) and the newly Enhanced CLAS Standards. The focus on developing organizational supports and language access related to cultural and linguistic competency at the practitioner, provider and systems level were also identified in a study entitled "Capacity for Delivering Culturally Mental Health Services in New Mexico: Results of a Statewide Agency Survey". The study reports the extent to which language ac-‐
cess and organizational supports are in place in New Mexico. Noteworthy is that agencies were more likely to adopt lan-‐
guage access to reduce language barriers in mental health de-‐
livery than organizational supports, for example, training, self-‐
assessments of cultural competency, and collection of cultural data (Semansky, et al 2007,2009). Page 9 To that end, the self-‐assessment helps bridge the gaps in pol-‐
icy and practice to ensuring improved outcomes in access clini-‐
cal interventions in a systematic fashion to strengthen the or-‐
ganization's capacity to meet the needs of diverse communi-‐
ties. Page 8 What do we do with the information? The findings of the self-‐assessment will help the CLC Manager showcase strength-‐based policies and practices found among CSAs and gaps where resources are needed to build organiza-‐
tional capacity . Each CSA will receive a copy of their respec-‐
tive findings and the CLC Manager will schedule individual meetings with each CSA to present, review and discuss the findings from the self-‐assessment. A CSA CLC committee will be established to, over time, review the findings and recom-‐
mend improvements to leadership. The CLC Manager will work with each CSA to develop a practi-‐
cal and short-‐term action plan to address the key findings in the agency's self-‐assessment report. Report and updates will be provided by the CLC Manager to the Governance Team and the committees most relevant to the assessment process. Outcomes resulting from annual action plans will help ensure that baseline data from Year One of the self-‐assessment can be documented to help make comparative assessment in subse-‐
quent years of completing future self-‐assessments. In Closing The self-‐assessment process is a stepping stone to improving the organization's ability to meet and serve the needs of di-‐
verse communities across the state. The unique characteris-‐
tics, demography, linguistic and cultural considerations impor-‐
tant to New Mexico's diverse communities can be formally in-‐
tegrated by incorporating, developing and/or expanding exist-‐
ing culturally and linguistic practices and policies. Page 5 New Mexico has most recently expanded its cultural and lin-‐
guistic capacity building efforts through a five year grant to establish a SOC model. With cultural and linguistic compe-‐
tency a cornerstone of the SOC model, New Mexico proposed to complete an annual cultural and linguistic competency self-‐
assessment of the Collaborative including an analysis of the target population, provider capacities, methods used to for-‐
mally promote cultural competency and consumer satisfaction with services (FOCUS Application, 2008). This has resulted in adoption of a Strategic Cultural and Linguistic Competency Plan, hiring of a full-‐time Cultural and Linguistic Competency (CLC) Manager and formalizing of a CLC Committee. Why this is important The purpose of an organization self-‐assessment is to identify key organizational cultural and linguistic competencies essen-‐
tial to meeting the needs of consumers, youth and families of diverse communities. The self-‐assessment is structured around four key organizational areas: Language Access, Policies, Prac-‐
tices and Training & Staff Development. Completion of the or-‐
ganizational self-‐assessment will contribute to, inform the quality and performance improvement processes that help reduce disparities and improve clinical outcomes for New Mex-‐
ico's diverse communities. The results and data from this self-‐
assessment will establish the basis for providing cultural and linguistic related training and technical assistance to provider agencies by CYFD. The findings from self-‐assessments then also inform on-‐going cultural and linguistic competency plan-‐
ning processes through the development of action plans to address key findings in Language Access, Policies, Practices, and Training & Staff Development. Page 6 The self-‐assessment process is intended to create a mutual learning experience with Core Service Agencies (CSA) and the SOC team to develop a shared understanding of how diverse communities seek, request and consume behavioral health services unique to their cultural belief system, help seeking patterns, preferences and acceptance of services offered, and the cultural and linguistic capacity of agency policies, practices and personnel. To this end, the self-‐assessment process rec-‐
ognizes the developmental nature in building cultural and lin-‐
guistic competencies over time. Identifying strengths and weaknesses is intended to focus on promoting positive prac-‐
tice and policy change; is non-‐judgmental; and is ultimately geared to inform the quality and performance improvement cycle of each organization. service and administrative support staff level. Who does what? In order to manage the size and scope of successfully complet-‐
ing organizational self-‐assessments, the CYFD CLC Manager will lead the statewide process for administering the self-‐
assessment of CSAs across the state. The self-‐assessment process will be coordinated by CLC Manager to ensure a cen-‐
tral method of communicating and managing the process. The MSAC (which serves as the Cultural Competency Committee for Systems of Care) will provide the CLC Manager with input to ensure the self-‐assessment process is widely administered and communicated and to ensure community stakeholder in-‐
put into the cultural appropriateness and use of the instru-‐
ment. Page 7 The CLC Manager will provide an update on progress in admin-‐
istering CSA self-‐assessments to the SOC Governance Team and to the MSAC on a regular basis. The CLC Manager will maintain regular contact with CSAs to ensure that adequate support, technical assistance and training is made available to agencies to help actualize their action plans. The CLC Man-‐
ager will ensure that CLC is integrated throughout the SOC Model and in the delivery of behavioral health services to youth and families. Taking the Self-‐Assessment The estimated time that it will take to complete the assess-‐
ment is approximately 7-‐9 minutes and is completed on-‐line. The CLC Manager provides an on-‐line web-‐based link to the self-‐assessment to each agency respondent along a brief set of instructions on how to complete the instrument, specific dead-‐
line and statement of anonymity. Respondents can complete their self-‐assessment from their respective work stations. A period of up to 14 days will be allowed to complete the self-‐
assessment to include an email alert agency staff person se-‐
lected. A follow up email notice will be sent to respondents to prompt completion of the self-‐ assessment on or before the deadline. The respondent will receive notice of his/her com-‐
pleted submission of the assessment. The self-‐assessment will be administered at several levels of provider agency to gauge the breadth and scope of cultural and linguistic competency capacity within the organization in-‐
cluding the governance, management, clinical supervision, di-‐
rect service and administrative support staff level.