The Colorado Trust

EDUCATION AND DIRECT SERVICE DELIVERY RECOMMENDATIONS
Summit participants identified the need to enhance education and expand the cultural competency of the current and future workforce at all levels of care. Recognizing that Colorado’s cultural competency standards are limited, participants recommended:

• Re-introducing and strengthening the 2006 cultural competency legislation (Senate Bill 2006-111) by incorporating enhancements to higher education cultural competency curricula and developing markers for progress toward a more culturally-competent workforce.
• Forming a community-based cultural competency board to help develop legislation to minimize the negative implications for communities of color, and review and develop future legislation that is culturally-competent.
• Enhancing curricula and training related to cultural competency¹⁵⁵ and developing minimum standards for cultural and linguistic education competency. The research highlights the need to:
  • Recognize the historical and socio-political implications that are inextricably linked to the mental health and well-being of communities of color and the implications for diagnosis, treatment and delivery of culturally-appropriate care.^156,157
    • In Colorado, the mental health system is working to increase its understanding of the role trauma has on an individual and the communities behavioral health. This emphasis also includes the inter-generational transmission of trauma, especially cultural trauma such as slavery of African Americans, war/abuse/cultural displacement in the case of Native American Nations and immigrant traumas including homeland traumas, racism and abuse from the majority culture from this society as has been the case for many Jewish, Asian, African and Middle Eastern peoples. In 2005, the Colorado Community Mental Health Center System came together with the Division of Mental Health to develop the Colorado Hurricane Evacuee Support and Recovery Project that shed all traditional modes of mental health and took on an outreach, education and support model to meet the psycho-social needs of evacuees. This included working door to door to make contact with every evacuee possible to assess need and provide basic psycho-social education. The project also involved trainings with police to help them understand the impact of trauma so when domestic issues arose, the police could respond in appropriate ways. In addition, the mainstream system recruited counselors from within the community, including the evacuee community, to support this effort.¹⁵⁸
  • Recognize and incorporate the “importance of multicultural sensitivity/responsiveness, knowledge and understanding: of individuals from different racial and ethnic backgrounds.”¹⁵⁹ Cultural trainings should include self-assessments, where providers increase their understanding of their own culture and how others see them.¹⁶⁰
  • Ensure that minimum standards, certifications and regulations for cultural and linguistic competency are clearly articulated in contracts and other agreements between providers and funding agencies.^161,162 For example, Colorado currently has no certification or other regulation of interpretation and translation services, resulting in the quality and knowledge of interpreters and translators varying widely throughout the system.¹⁶³ One way to accomplish this would be to require continuing education requirements to help providers individualize care for the strengths, needs, abilities, and culture of their clients.
  • Assist immigrants’ adjustment to American society and the tremendous quality of life improvements that result from appropriate, early diagnosis and treatment of mental illnesses.^164,165
  • Adopt a consumer-centered approach recommends that diagnosis of an individual be based not only on symptoms, but also on the cultural identity of the individual, the cultural explanations of their illness, cultural factors related to the psychosocial environment of the individual and their level of functioning, and an explicit recognition of the cultural elements of the relationship between the individual and clinician.¹⁶⁶
  • Increase access to linguistically competent providers and interpreters, and ensure access to Limited English Proficiency (LEP) services through Title VI of the Civil Rights Act of 1964.^167,168
  • Create ongoing support networks for clinicians such as consultation hotlines to provide guidance on cultural issues.¹⁶⁹

Participants also felt that creating a more diverse workforce was necessary to enhance the mental health of communities of color. In addition to the integration of culturally-traditional and alternative providers into the mainstream mental health system, other recommendations to improve services for communities of color and decrease mental health disparities include:

• Recruitment of more psychiatrists, psychologists and other mental health practitioners from diverse racial and ethnic backgrounds¹⁷⁰ through efforts such as those that introduce payment mechanisms to reward increased participation and retention of Latinos in community-based mental health services and programs¹⁷¹ or examining policies for recruitment from other countries and University guest instructors. States such as Florida, Ohio and Virginia have developed effective recruitment programs for providers of color.¹⁷²
• Recruitment efforts that support the pipeline of people of color in behavioral health/social services such as by working with K-12 education and schools; community colleges, colleges and universities; graduate and doctoral degree-granting universities with well-established research programs and centers; and partnering with community-based education programs. (i.e: mentorship programs, internships, etc). To ensure pipeline and retention efforts, mental health services should also have a presence in community colleges which are often the pathway to college for many people of color.^173,174
• Creating more flexible use of non-physician providers via “any willing provider laws” and expanded state practice acts that allow professionals to maximize the use of demonstrated skills and competencies to expand the number of racial and ethnic minority and female mental health workers.¹⁷⁵
  • For example, 14 states granted independent prescription privileges to nurse practitioners, over 35 states have created flexibility in independent practice laws and other states with varying success have introduced legislation to allow doctoral psychologists prescriptive privileges.¹⁷⁶

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