Changing Institutional Values and Diversifying the Behavioral Health Workforce

Abstract

Meeting the health care and behavioral health needs of the USA requires a diverse and culturally competent behavioral work force. With the US census projecting that minority persons will constitute the majority populations by 2044, there is an urgent need to close gaps in the recruitment into and retention in medical schools and doctoral programs in clinical, consulting, and health psychology. Intersectional models of engagement and mentoring exist. Training and service delivery programs that consider the whole person, including the cumulative impact of bias across identity parameters, offer the promise of reducing health disparities while supporting the conditions that are likely to attract a diverse behavioral workforce. This chapter describes workforce trends in behavioral health, reviews the gains and challenges of previous efforts to diversify science, technology, engineering, and mathematics (STEM) fields (which are also pathways to medical, psychiatry, and psychology training), and discusses best-practice exemplars that might enable behavioral health to serve an increasingly diverse America.

Appendices

Appendix

National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care

The national CLAS standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations.

Principal Standard

• 1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Governance, Leadership, and Workforce

• 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.

• 3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.

• 4. Educate and train governance, leadership , and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

Communication and Language Assistance

• 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

• 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

• 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

• 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability

• 9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.

• 10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.

• 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.

• 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.

• 13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness .

• 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.

• 15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

The Case for the Enhanced National CLAS Standards

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

—Dr. Martin Luther King, Jr.

Health equity is the attainment of the highest level of health for all people [72]. Currently, individuals across the USA from various cultural backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of health, or those conditions in which individuals are born, grow, live, work, and age [73], such as socioeconomic status, education level, and the availability of health services [74]. Though health inequities are directly related to the existence of historical and current discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals.

Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but also a public health concern. In the USA, it has been estimated that the combined cost of health disparities and subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion [75]. Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care and services [76, 77]. By providing a structure to implement culturally and linguistically appropriate services, the enhanced national CLAS standards will improve an organization’s ability to address health care disparities.

The enhanced national CLAS standards align with the US Department of Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities [78] and the National Stakeholder Strategy for Achieving Health Equity [79], which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the enhanced national CLAS standards are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these standards will help advance better health and health care in the USA.