Carol Carstens, PhD, Scott Wingenfeld, MPA, Kwok Tam,
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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

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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

Consumer Perception of Culturally Competent Community Services & Treatment Outcomes


Abstract

Objective: 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

Abstract


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

Overview


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

Research Question


Why is cultural perspective important

  • Culture falls under the umbrella of person-centered care. It provides a framework for understanding human experience.

    Personal & Group Identity

    Beliefs & Values

    Customs & Traditions

    Language & History

    Otherness: Minority versus Majority

Ohio Department of Mental Health Office of Research & Evaluation

Why isCultural Perspective Important?


Cross cultural barriers to treatment

  • Ignorance

  • Indifference

  • Mistrust

  • Fear

  • Discrimination

  • Difference

    Beliefs & Values

    Language

    Communication patterns

Ohio Department of Mental Health Office of Research & Evaluation

Cross-Cultural Barriers to Treatment


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

DSM IV-TR Guidelines


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

The Knowledge Base


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

Consumer Based Cultural Competence Inventory (CBCCI)


For study purposes

  • 20 items from CBCCI tested & analyzed by ODMH-ORE staff in 2012 Ohio administration

    Reduced administrative burden

    Conceptual & statistical considerations

  • 10 items from CBCC survey adopted to analyze consumer-reported treatment outcomes

    Factor loadings > .4

    Two factor solution explains 59.4% s²

    Staff level (8 items)

    Organizational level (2 items)

    Cronbach’sα = .91

Ohio Department of Mental Health Office of Research & Evaluation

For Study Purposes


Consumer perception of culturally competent community services treatment outcomes

Ohio Department of Mental Health Office of Research & Evaluation


Mhsip adult consumer survey

Self-rated

  • Perception of Care

    General Satisfaction (3 items)

    Access to Care (4 items)

    Quality & Appropriateness (8 items)

    Participation in Treatment (2 items)

  • Outcomes (8 items)

  • Functioning (5 items)

  • Social Connectedness (4 items)

    http://www.nri-inc.org/projects/SDICC/TA/Ganju.Smith_1.pdf

  • Ohio Department of Mental Health Office of Research & Evaluation

    MHSIP Adult Consumer Survey


    Mhsip client reported outcomes as a direct result of the services i received

    Ohio Department of Mental Health Office of Research & Evaluation

    MHSIP Client-Reported OutcomesAs a direct result of the services I received:


    Mhsip client reported outcomes as a direct result of the services i received1

    Ohio Department of Mental Health Office of Research & Evaluation

    MHSIP Client-Reported OutcomesAs a direct result of the services I received:


    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

    Ohio Department of Mental Health Office of Research & Evaluation

    Sampling


    Study subsample

    Ohio Department of Mental Health Office of Research & Evaluation

    Study Subsample

    • ♀ = 61% ♂ = 39%

    • 46.8 XAge

      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


    Cbcc survey leading question

    Some 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 No

    If you answered YES, what is your minority group? (Specify cultural, racial, ethnic, religious and/or sexual identity)______________________

    Ohio Department of Mental Health Office of Research & Evaluation

    CBCC Survey Leading Question


    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.

    Ohio Department of Mental Health Office of Research & Evaluation

    Minority Status


    13 independent variables entered into regression models

    Ohio Department of Mental Health Office of Research & Evaluation

    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


    Dv treatment outcomes n 311 13 independent variables

    Ohio Department of Mental Health Office of Research & Evaluation

    DV: Treatment Outcomes (N = 311; 13 Independent Variables)

    R² = .422, F = 11.9018,293, p < .000


    Dv functioning n 317 13 independent variables

    Ohio Department of Mental Health Office of Research & Evaluation

    DV: Functioning(N = 317; 13 Independent variables)

    R² = .381, F = 10.2218,299, p < .000


    Dv social connectedness n 305 13 independent variables

    Ohio Department of Mental Health Office of Research & Evaluation

    DV: Social Connectedness(N = 305; 13 independent variables)

    R² = .325, F = 7.7318,287, p < .000


    Limitations

    Ohio Department of Mental Health Office of Research & Evaluation

    Limitations

    • Cultural Competence: Confounded Construct

      • Minority status

      • Race & Ethnicity

      • Group vs Individual identity

    • Scale Development:

      • Limited psychometric testing on CBCC

    • Dependent Vars:

      • Post-hoc outcome measures

    • Diversity of Service Population Unknown:

      • Sample religious/spiritual identification = 8%

      • Sample GLBT identification = 2%


    Sources cited

    Griner, D, & Smith, TB. 2006. Culturally Adapted Mental Health Interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training43(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.

    Ohio Department of Mental Health Office of Research & Evaluation

    Sources Cited


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