transforming mental health services through cultural and ...

1. Transforming Mental Health Services through Cultural and Linguistic Competency Policies

2. Creating Leadership Through the Development of a Critical Mass: Challenges & Opportunities Creating Leadership Through the Development of a Critical Mass: Challenges & Opportunities

3. Transforming Mental Health Services through Cultural and Linguistic Competency Policies

4. The data is clear…

5. The cultural and linguistic diversity of the U.S., particularly the Latino population, is increasing There is a current shortage of Latino bilingual and bicultural mental health workforce (physicians, psychologists, social workers, nurses) There is a compelling need to establish policies and requirements by federal and state agencies, local communities, provider contracts, philanthropy, and through advocacy to build culturally responsive and linguistically competent service delivery systems

7. National Reports Related to Disparities in Access to and the Provision of Quality Mental Health Care for Racial and Ethnic Minorities U.S. Surgeon General’s first ever report on mental health, Mental Health: A Report of the Surgeon General (1999) http://www.surgeongeneral.gov/library/mentalhealth/home.html U.S Surgeon General supplemental report, Mental Health: Culture, Race ,Ethnicity (2001) http://www.mentalhealth.samhsa.gov/cre/default.asp Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) http://www.iom.edu/report.asp?id=4475 President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (2003) http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html

8. Federal Laws, Standards, and Initiatives Aimed at Eliminating Disparities in Access to and the Provision of Quality Mental Health Services Healthy People 2010 http://www.healthypeople.gov Title VI of the Civil Rights Act of 1964 http://www.usdoj.gov/crt/cor/coord/titlevi.htm Revised National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care – U.S. Office of Minority Health http://www.omhrc.gov/clas/finalcultural1a.htm National Network for the Elimination of Disparities in Behavioral Health USDHHS/Substance Abuse and Mental Health Services Administration http://www.samsha.gov/nned US Department of Health and Human Services Office of Minority Health’s Movilizandonos Por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos

9. Transforming Mental Health Services through Cultural and Linguistic Competency Policies

10. State Initiatives Aimed at Eliminating Disparities in Access to and the Provision of Quality Mental Health Services New Jersey’s Laws Concerning Mandatory Training in Cultural Competence by all Licensed Physicians (N.J.A.C. 13:35-6.25) and CEU Requirements for all Health and Mental Health Professionals State of New Jersey Department of Human Services Mini-grants - Office of Multicultural Services Funding for Bilingual and Bicultural Clinicians Regional Cultural Competence Training Centers Arizona OBHL Licensure Requirements – R4-6-804 Texas HB 2196

11. Changes in Focus of State Regulatory Bodies and Accrediting Organizations State Regulatory and Licensing Bodies Accreditation Bodies JCAHO – Joint Commission on Accreditation of Healthcare Organizations http://www.jcaho.org CARF – Commission on Accreditation of Rehabilitation Facilities http://www.carf.org

12. Reports Focusing on Policy Recommendations and/or Changes in Various Systems Related to Hispanic Mental Health United States Department of Health and Human Services Office of Minority Health and National Resource Center for Hispanic Mental Health - Movilizandonos Por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos Consensus Statements and Recommendations, March 2010. Time for Action: Improving Mental Health Services for the Latino Community, Hispanic Directors Association of New Jersey and New Jersey Mental Health Institute, Inc. (2005) - http://www.english.hdanj.org/dmdocuments/LP%20Rpt%20Sept05%20eng.pdf Mental Health Issues and Platform Committee Policy Report - National Hispanic-Latino and Migrant American Agenda Summit (2004) – http://www.hispanicagendasummit.org/home.htm The Status of and Proposed Future Direction of Mental Health and Substance Abuse for Hispanics in New Jersey – Mental Health Work Group, Health Subcommittee, Governor James E. McGreevey’s Hispanic Advisory Council on Policy Development Initiatives, November 2002 – Copy of Report Available Through Henry Acosta, (609) 838-5488, ext. 205 or hacosta@njmhi.org National Congress for Hispanic Mental Health Action Plan – http://www.mentalhealth.samhsa.gov/cmhs/SpecialPopulations/HispMHCongress2000/

13. Time for Action: Improving Mental Health Services for the Latino Community Developed by Hispanic Directors Association of New Jersey and the New Jersey Mental Health Institute, Inc.

14. Where Do You Fit In? Additional Local, State and National Efforts Truly Needed Strategies/Tactics for Creating Change Develop and/or participate in: Coalitions, Task Forces, Trade Associations Know what drives the person(s) in charge Gather and present strong evidence for your proposed solutions or present highly reasonable justification for proposed solutions – be flexible, reasonable and have patience Develop one unified voice and message Request Meetings with State Elected and Appointed Officials Telephone campaign Direct mail campaign Fact Sheets Rally’s Legislative/Leadership Breakfast Forums Media Support

15. Alliance for Latino Behavioral Health Workforce Development National Resource Center for Hispanic Mental Health National Alliance of Multicultural Behavioral Health Associations National Network for the Elimination of Disparities in Behavioral Health Newly Forming or Recently Formed Entities with a National Focus

16. Transforming Mental Health Services through Cultural and Linguistic Competency Policies

18. We are over 15% of the overall population, not including the four million residents of Puerto Rico. There is a crisis affecting Latinos in need of behavioral health services. and shortage of Latinos in the behavioral health workforce. Latinos are visibly absent from all areas of the behavioral health professions including medicine, nursing, psychology and social work. The Crisis in Latino Leadership

19. Percentage of Latino Health Care and Mental Health Providers in the U.S. Many Latinos have Limited English Proficiency (LEP)...although we now account for over 15% of the US population, there continues to be a dearth of culturally and linguistically proficient providers. In fact, although this chart indicate 4% of psychologists are Latino---ACTUALLY, only 1% of those 4% are clinical psychologists---and their Language capability is unknown! Latinos comprised less than: 4% of physicians 4% of psychologists 7% of social workers 3% of nurses This figure does not tell us who might speak Spanish.Many Latinos have Limited English Proficiency (LEP)...although we now account for over 15% of the US population, there continues to be a dearth of culturally and linguistically proficient providers. In fact, although this chart indicate 4% of psychologists are Latino---ACTUALLY, only 1% of those 4% are clinical psychologists---and their Language capability is unknown! Latinos comprised less than: 4% of physicians 4% of psychologists 7% of social workers 3% of nurses This figure does not tell us who might speak Spanish.

20. Smaller shares of racial and ethnic groups are proficient in science by 12th grade Source: U.S. Department of Education, NAEP 2005 accessed online at http://nces.ed.gov in October 2006 Source: U.S. Department of Education, NAEP 2005 accessed online at http://nces.ed.gov in October 2006

21. Hispanics still have higher dropout rates than non-Hispanic whites and blacks Source: U.S. Department of Education, NCES, Digest of Education Statistics, 2006 based on unpublished CPS (October) data. Accessed online October 2006. Despite increased education achievement in the past 40 years, Hispanics still have higher dropout rates than non-Hispanic whites and blacks.Source: U.S. Department of Education, NCES, Digest of Education Statistics, 2006 based on unpublished CPS (October) data. Accessed online October 2006. Despite increased education achievement in the past 40 years, Hispanics still have higher dropout rates than non-Hispanic whites and blacks.

22. Missing in Action Few Latinos are found in positions of leadership, or on national board and advisory committees. Issues pertaining specifically to the Latino behavioral health agenda go widely unnoticed and unaddressed because of the shortage of Latino professionals in behavioral health. Lack of coordinated advocacy for workforce development.

23. Lack of Hispanic Providers Lack of Latino health and mental health providers and leadership --- a barrier to care on multiple levels: Spanish speaking patients/consumers less likely to seek mental healthcare from non-Spanish speaker. Cultural understanding and competence of provider is correlated with patient/consumer follow through. Program, policy, research and funding targets not about Hispanic health and mental health.

24. Hispanic Workforce, Leadership Development and Its Role in Eliminating Disparities Greater investment needed to build a Hispanic health and mental health workforce. Latino bilingual and bicultural providers must be trained, recruited and retained in the workforce. Policy efforts must be in place to ensure Latino pipeline development. Commitment needed from leadership. Improve the role of training and mentoring. Provide opportunities for funding for advanced education and training

25. We Must become the Decision Makers Latino behavioral health leadership and workforce at the table is the only way to ensure for health equity and eliminating disparities, so that … Interventions designed and delivered are meaningful and useful to Latino communities.

26. Action Taken in 2009 by the Office of Minority Health, HHS Movilizandonos por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos Event served as the foundation for energizing and mobilizing national behavioral health leaders to address the behavioral workforce crisis that exists for Latinos. 50 experts and key stakeholders convened to discuss best practices in behavioral workforce development, Promoted new and emergent practices in Latino behavioral health workforce development. Formulated a set of CONSENSUS STATEMENTS on best practices and recommendations that will be utilized for improving the nation’s mental health leadership and workforce.

27. Consensus Statements 1. The Latino population in the U.S. is facing a public health crisis due to poor or unmet behavioral health needs. 2. The lack of a bilingual and bicultural behavioral health workforce plays a significant role in disparities in all three key areas of behavioral health care service delivery. 3. Meaningful access to behavioral healthcare for Latinos in the U.S. is a social justice issue. 4. Latinos deserve a diverse, multidisciplinary, bilingual and bicultural behavioral health workforce. 5. The time for action is NOW !

28. Activities That Need your Advocacy Engage Federal institutions to Advance a Latino Mental Health Workforce Development Agenda. 2. Expand Public and Private Partnerships. Implement National Cultural and Linguistic Competency Standards in Behavioral Health Training Program. Invest in Educational Initiatives at Local, State, and National Levels. 5. Invest in Sustaining Current and New Innovative Workforce Programs.

29. Create a Movement Build a reliable bilingual & bicultural workforce- need to establish Latino pipeline. Build multi-stakeholder partnership: National Latino Leadership Hispanic and other Minority Caucuses Invested political leadership Professional Guilds Hispanic Consumer Groups Hispanic MH community Requires the engagement of policymakers, purchasers, managed care, organizations, providers, and local communities. Requires the engagement of policymakers, purchasers, managed care, organizations, providers, and local communities.

30. What you can do now! Pass the Baton! Promote Latinos for political appointments and to other positions of leadership. Ensure for resources for educational and leadership training. Improve Latino representation on public private and national boards. Contact and meet with your elected leadership. Start email and phone campaigns.

32. Transforming Mental Health Services through Cultural and Linguistic Competency Policies