NYAPRS Note: The following news out of NKI presents a new tool to help care managers, providers, and caregivers assess cultural needs and viewpoints through a process of shared-decision making. This comes on the heels of last Friday’s cultural competence(CC) conference in NYC led by an advocacy coalition that includes NYAPRS and DOHMH. During the conference, agency representatives discussed the value of CC for recipients of behavioral healthcare and how it can be infused into expectations for managed care as of 2015. The Cultural Activation Tool from NKI would be a progressive way to include CC by training care managers in its usefulness, setting expectations around its use, and mandating its inclusion in electronic health records. It is one of NYAPRS’ top priorities to work with the agencies and other advocates to ensure that CC is represented in the transition to managed care.
Culturally Speaking: Consumer Cultural Activation
OMH Newsletter; Carole Siegel, Ph.D., Director of the Nathan Kline Institute Center of Excellence in Culturally Competent Mental Health, February 2014
Subscribing to the view that information gathering for the treatment encounter could benefit from a two-way process as is accomplished in shared-decision making, the New York State Office Mental Health and the Nathan Kline Institute’s Center of Excellence in Culturally Competent Mental Health (NKI CECC) has developed a tool to help consumers from cultural groups transmit their cultural views of their mental health challenges, their views of their illness and cultural supports and barriers they encounter directly to their providers and as early on in treatment as possible.
The Center has coined the words “Cultural Activation” to describe the amplification of the voice of consumers in care decisions by providing to caregivers information about themselves through a cultural lens on mental health challenges, and views and attitudes towards care. The notion is both a consumer empowerment concept as it promotes shared decision making through the revelation of specific views related to a person’s cultural identity, and a cultural competency concept as it increases the cultural competency of caregivers by enhancing their knowledge of what aspects of the consumer’s cultural identity matter to them in the care process.
The tool is called The Cultural Activation Prompts (CAPs). It is a set of cues on information that a consumer might benefit from communicating to a caregiver on: how he/she would like to be called, what name they give to mental health challenges, their perceived causes, and consequences. It also provides prompts on communicating what are group supports, stresses, coping strategies, and hindrances; and views on treatment including the usefulness of alternative treatments, attitudes towards main stream mental health treatments; and from a cultural perspective caregiver requirements and preferences. The tool draws on the domains covered in the Diagnostic Statistical Manual-5 (DSM) Cultural Formulation Interview (CFI) and on Arthur Kleinman’s “Three C’s” in his Explanatory Model of Illness (Call, Cause, and Course). The CFI administered by a clinician contains questions that work to elicit a cultural definition of the problem; cultural perceptions of cause, context, and support; cultural factors affecting self coping; and past and current help seeking.
Current research indicates better health outcomes are achieved with greater participation of care recipients in their health care encounters. Improving health literacy and activating consumers to participate in health care decision making are ways of achieving greater consumer participation, e.g., as accomplished with OMH’s MYPSYCKES shared decision making computer based tool on medication use or with the Cambridge Alliance The Right Question Project-Mental Health, a three-session health education intervention that teaches clients to participate effectively in mental health care.
Consumer “Cultural Activation” is a related notion. Persons from cultural groups have unique identities and subscribe to diverse world views, value systems and diverse ways of dealing with mental health challenges. Caregivers should know about this. It is highly recommended that a cultural assessment be made by a care-giver, and that the CFI be used by clinicians. The information elicited by the CFI is expected to enhance the cultural validity of the diagnostic assessment, facilitate treatment planning, and promote patient engagement and satisfaction. However, it is highly unlikely that the CFI will be widely mandated and currently may not be used by many caregivers.
The CAPs tool was recently presented to the New York City Multicultural Advisory Committee in a workgroup format in order to gain consumer and provider feedback. Useful suggestions have been incorporated into CAP particularly on language, and ways to disseminate it. MAC members supported the use of peer specialists to help consumers use the tool, and suggested the tool to be included in materials provided to consumers when they enroll in a program. Another suggestion was for a laminated hip-pocket card listing the prods. CAPs will be pilot tested in the spring. It will be posted on the NKI CECC website
http://omh.ny.gov/omhweb/resources/newsltr/2014/Feb/culturally_speaking.html