CONSUMER PERCEPTION OF CULTURALLY COMPETENT COMMUNITY SERVICES & TREATMENT OUTCOMES Carol Carstens, PhD, Scott Wingenfeld, MPA, Kwok Tam, MSocSci Ohio Department of Mental Health Office of Research & Evaluation First Meeting on Patient Reported Outcomes in Mental Health September 30, 2012 Washington DC
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Consumer Perception of Culturally Competent Community Services & Treatment Outcomes
Carol Carstens, PhD, Scott Wingenfeld, MPA, Kwok Tam, MSocSci Ohio Department of Mental Health Office of Research & Evaluation. First Meeting on Patient Reported Outcomes in Mental Health September 30, 2012 Washington DC. - PowerPoint PPT Presentation
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CONSUMER PERCEPTION OF CULTURALLY COMPETENT COMMUNITY SERVICES & TREATMENT OUTCOMES
Carol Carstens, PhD, Scott Wingenfeld, MPA, Kwok Tam, MSocSciOhio Department of Mental Health Office of Research & Evaluation
First Meeting on Patient Reported Outcomes in Mental Health
September 30, 2012 Washington DC
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ABSTRACTObjective: To look at the relationship between patient self-reported experience of care and measures of clinical care.Data Source/Collection: Data were collected in a mail survey of minority consumers (N = 311).Design/Methods: In this cross-sectional study, Likert-type scales were used to collect information on client perception of providers’ cultural competence and self-report measures of functioning, quality of life, and social connectedness. Hierarchical regression was used to examine the relationship between cultural competence and the independent variables.Principal Findings: After controlling for subject-related factors, consumer perception of provider cultural competence was significantly related to self-reported outcome measures.Conclusions: Cultural competence is a specific approach to patient centered care that can improve the outcomes of mental health services.
Ohio Department of Mental Health Office of Research & Evaluation
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OVERVIEW Research Question What is Cultural Competence? Measuring Cultural Competence Measuring Self-Reported Outcomes Adult Consumer Sample Linear Regression Models Limitations & Sources Cited
Ohio Department of Mental Health Office of Research & Evaluation
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RESEARCH QUESTION
Does consumer perception of the service providers’ cultural competence have any association with self-reported treatment outcomes?
Ohio Department of Mental Health Office of Research & Evaluation
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WHY IS CULTURAL PERSPECTIVE IMPORTANT?
Culture falls under the umbrella of person-centered care. It provides a framework for understanding human experience.Personal & Group IdentityBeliefs & ValuesCustoms & TraditionsLanguage & HistoryOtherness: Minority versus Majority
Ohio Department of Mental Health Office of Research & Evaluation
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CROSS-CULTURAL BARRIERS TO TREATMENT Ignorance Indifference Mistrust Fear Discrimination Difference
Beliefs & ValuesLanguageCommunication patterns
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DSM IV-TR GUIDELINES Inquire about cultural identity — race,
ethnicity, gender, sexual orientation, religion, spirituality, disability status & other self-defining characteristics
Explore cultural explanations of the problem
Consider cultural factors in psychosocial environment and level of functioning
Examine cultural elements in the client-provider relationship
Overall cultural assessment goes into diagnosis and individual treatment plan
Ohio Department of Mental Health Office of Research & Evaluation
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THE KNOWLEDGE BASE
Very little research looks at the relationship between
provider’s cultural competence & the patient’s symptoms, functioning or social support (Griner & Smith, 2006)
evaluates cultural competence from the consumer perspective (Cornelius et al, 2004)
Ohio Department of Mental Health Office of Research & Evaluation
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CONSUMER BASED CULTURAL COMPETENCE INVENTORY (CBCCI)Experimental 52-item Inventory developed by L.J. Cornelius & others in Maryland in 2002.
Awareness of patient culture Respectful behaviors Language interpreters Understanding indigenous practices Consumer involvement Acceptance of cultural differences Community outreach Patient-provider-organization interactions
Ohio Department of Mental Health Office of Research & Evaluation
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FOR STUDY PURPOSES 20 items from CBCCI tested & analyzed by ODMH-
MHSIP CLIENT-REPORTED OUTCOMESAS A DIRECT RESULT OF THE SERVICES I RECEIVED:
Domain Items
Outcomes of Services
• I deal more effectively with daily problems
• I am better able to control my life• I am better able to deal with crisis• I get along better with family• I do better in social situations• I do better in school and/or work• My housing situation has improved• My symptoms don’t bother me as
much
Ohio Department of Mental Health Office of Research & Evaluation
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MHSIP CLIENT-REPORTED OUTCOMESAS A DIRECT RESULT OF THE SERVICES I RECEIVED:
Domain Items
Functioning
• I am able to do things that are more meaningful to me
• My symptoms don’t bother as much• I am better able to take care of my needs• I am better able to handle things when they go
wrong• I am better able to do things I want to do
Social Connected-ness
• I am happy with the friendships I have• I have people with whom I can do enjoyable
things• I feel I belong in community• In a crisis, I would have the support I need
from family or friends
Ohio Department of Mental Health Office of Research & Evaluation
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SAMPLING Adult survey: 4,740 randomly selected
adult consumers with serious mental illness (SMI)
Minority subsample: 1,325 consumers selected if race code indicated person of color OR ethnicity code indicated hispanic origin
175 individuals selected where race = White without hispanic qualifier
Total subsample = 37% of adult consumer sample received cultural competence survey
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STUDY SUBSAMPLE ♀ = 61% ♂ = 39%
46.8 X Age Range 17.9 – 88.2 SD = 11.8 91% Medicaid 9% other public coverage 88% long term 12% new in 2011 87% still in treatment
6.5% terminated 7% unknown status
85%
9%6% Race
BlackWhiteOther
Hispanic = 7%
Ohio Department of Mental Health Office of Research & Evaluation
46%29%
19% 7% DiagnosesPsychotic DOMaj DeprBipolar DO
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CBCC SURVEY LEADING QUESTIONSome people belong to minority groups because their race, country of origin, history, language, religion, or sexual orientation is different than most people. Do you consider yourself a cultural, racial, ethnic, religious, or sexual minority group member?
Yes NoIf you answered YES, what is your minority group? (Specify cultural, racial, ethnic, religious and/or sexual identity)______________________
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MINORITY STATUS About 37% of the sample who were
people of color or hispanic ethnicity said No to the question about minority status. The US is becoming more racially and
ethnically diverse. Many people in the sample do not appear
to see themselves as “other” or set apart from mainstream society because of race or ethnicity.
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13 INDEPENDENT VARIABLESENTERED INTO REGRESSION MODELS
Age Race Gender Ethnicity Geographic Profile Diagnosis Service Longevity Service Continuity
Perception of Care General Satisfaction Access Quality &
Appropriateness Participation in
Treatment* Cultural Competence
Ohio Department of Mental Health Office of Research & Evaluation
Mental Health Interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training 43(4): 531-548.
Cornelius LJ, Booker NC, Arthur TE, Reeves I & Morgan O. 2004. The Validity and Reliability Testing of a Consumer-Based Cultural Competency Inventory. Research on Social Work Practice 14(3): 201-209.
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Ohio Department of Mental Health Office of Research & Evaluation