LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH   POLICY 200.09 CULTURALLY AND LINGUISTICALLY INCLUSIVE SERVICES     PROCEDURES

DMH providers partner with constituents, communities, and community-based organizations to better understand mental health needs, set appropriate service goals, implement culture and language-specific interventions, address service inequities, assess consumer satisfaction, and evaluate the effectiveness of service provision. (CCPR CR 1, CLAS Standards 13 and 15) DMH collects, tracks, and utilizes demographic and consumer service utilization data to: Regularly monitor service accessibility, engagement, retention of consumers in mental health services, and their treatment outcomes, and Evaluate the effectiveness and quality of cultural and linguistic adaptations in mental health interventions being employed to maximize the outcomes of treatment and toward the elimination of disparities. (CCPR CR 2, CLAS Standards 11 and 12) DMH staff should regularly monitor consumer information in their electronic health record to ensure that it is accurate and affirming.   This includes name, race, ethnicity, language, gender identity, sexual orientation. Consumer information should be accurately documented in progress notes. DMH staff should engage consumers in culturally sensitive collaborative treatment planning and monitoring. DMH staff should validate and integrate consumer's perspectives regarding their own successes and challenges in treatment. DMH implements strategies that take into consideration the constituents’ culture (e.g.  cultural frameworks, worldviews, linguistic preferences, communication needs, the impact of social determinants of health, community-based health inequities) in planning; delivery of outreach, engagement, and retention activities; direct clinical services, specialty mental health services; and quality improvement processes.  (CCPR CR 3, CLAS Standard 10) DMH staff should be familiar with the consumer’s cultural viewpoints regarding mental illness, treatment, traditional healing practices, healthcare providers, and healthcare facilities. DMH staff should be familiar with how histories of trauma and pathology including over diagnosing and misdiagnosing, and internalized stigma may impact the consumers' engagement in mental health services. DMH staff should implement culturally responsive, person-centered, and affirming practices to promote recovery and resilience.  The delivery of mental health services recognizes that culture impacts the following factors: Degree of acculturation/assimilation Help-seeking behaviors Verbal and nonverbal communication Variance in need for personal space Interpretation of symptoms Perception of mental illness versus mental health Cultural expectations about the role of staff providing services Accessibility to indigenous or alternative treatments Impact of cultural and socio-economic differences between staff providing services and the consumer Social experiences and obstacles (i.e., discrimination, racism) Economic and political conditions Experience of migration (i.e., migrant or refugee) Degree and individual characteristics of consumer’s acculturation process/experience English language proficiency level and educational background Family’s issues (i.e., cultural gap and generational gap within family systems) Utilization pattern of social and individual support systems Culturally based view about self, others, and the world Values, beliefs (i.e., religion and spirituality), and customs Racial, ethnic, and cultural identity Experience of historical and intergenerational trauma Collective cultural experience Other attributes (i.e., physical characteristics, mental health diagnosis) DMH staff should apply cross-cultural knowledge, cultural humility and sensitivity, cultural inclusiveness, and cultural safety to ensure consumers experience appropriate services and reach their recovery goals. DMH staff should be familiar with the techniques necessary to conduct clinical assessment and mental health services with the use of a language interpreter, which includes: A brief orientation by the staff to the interpreter about what is needed and expecte; Proper introduction of interpreter to the consumer and explanation of the language interpreter procedure; Soliciting consumer feedback and addressing consumer concerns about a language interprete; Obtaining the consumer’s permission to use a language interpreter; Speaking in clear, simple, and appropriately parsed phrases that are free of idioms and professional lingo; Asking for clarification from the language interpreter and/or consumer when communication becomes ambiguous; Appropriate physical arrangement of the room for interpreter-facilitated sessions with interpreter apart but completely visible to the consumer; Making appropriate eye contact with the consumer; and, Culturally appropriate conclusion of the session that is inclusive of thanking and dismissing the language interpreter before the consumer leaves. DMH staff should be aware of how sociocultural power and oppression can affect a consumer's lived experience, clinical presentation, coping strategies, and perceptions of the mental health care being provided to them. Within the context of psychosocial assessments and in the course of ongoing treatment, DMH staff should facilitate discussions about consumers' experiences with sociocultural and systemic discrimination, racism, historical and intergenerational trauma, and inclusion in treatment goal planning and satisfaction. DMH staff should incorporate discussions about culture-specific resources and strengths to integrate into the consumer's treatment. Affirm consumers' intersecting cultural and social identities through language and clinical practice. Respectfully ask about consumers' social and cultural identities at the first meaningful contact, including racial and ethnic identities, gender identity and preferred pronouns, sexual orientation, and other salient cultural identities. Regarding sexual identity, expression, and orientation: Use the names and pronouns that affirm and reflect a consumer's authentic identities. Remember that these may not be the same names and pronouns reflected in a consumer's legal identification documents or electronic health records. If a consumer's family members suggest that the consumer's gender is different from the consumer's self-identified gender, the consumer’s identities and perspectives should be honored. If a DMH staff member uses the incorrect pronouns when speaking to/about a consumer and is then corrected by the consumer, the DMH staff member should honor and use the consumer's stated pronouns. Transgender and gender diverse consumers should not be asked about surgical history, body parts, names given at birth, or other potentially invasive and traumatizing personal histories unless such information is directly relevant to the consumer's treatment.  For example: It is relevant to ask about the names listed on a consumer's identification documents if this information is needed for community resource linkage; however, asking whether a consumer has undergone specific surgical procedures is not relevant for most services rendered within DMH. Utilize intrinsic community strengths in treatment strategies, inclusive of consumer needs and perspectives regarding healing and recovery.  When cultural differences preclude useful treatment despite all attempts to resolve the differences, the consumer should be timely transitioned to a more appropriate clinician with complete documentation of reasons for the transfer. DMH staff should provide services in the consumers’ best interest. When cultural differences between a clinician and consumer pose an obstacle in the therapeutic process, the clinician should initiate a consultation with appropriate individuals. The giving or accepting of gifts in the context of the treatment relationship should be based upon an understanding of gift-giving customs in the culture of the consumer and adhere to any relevant DMH policies. DMH clinical and administrative programs support the activities of the Cultural Competency Committee by participating in monthly meetings and contributing toward the fulfillment of committee goals and activities, (i.e., delivering presentations, providing information regarding program outcomes, and implementing the committee recommendations in projects and initiatives).  (CCPR CR 4) DMH implements an annual cultural competence training plan for 100% of staff with the goal of enhancing the cultural and linguistic competence skills of management, direct clinical/specialty mental health service providers, and administrative staff. (CCPR CR 5, CLAS Standard 4) All DMH staff should have the skills to rapidly locate sources of cultural information regarding health and mental health via the Training Unit’s webpage DMH Program Managers utilize the Department’s Network Adequacy application to track and report the completion of annual cultural competence training to the Quality Assurance Division. DMH utilizes cultural and linguistic disparity data to strategize for the enhancement of a culturally and linguistically diverse workforce at all staff functions.  (CCPR CR 6, CLAS Standards 3, 4 and 11) DMH ensures that language assistance services are offered at different points of entry into the system, promotes bilingual certification of staff who have various language capabilities, and builds the language interpretation skills of bilingual certified staff. (CCPR CR 7, CLAS Standards 5 and 7) DMH contracts with vendors to translate written materials and field tests the quality and cultural meaningfulness of vendor-translated products with bilingual certified staff and constituents.  (CCPR CR 7, CLAS Standards 5 and 7) DMH makes available written materials (i.e., brochures, forms, signage, provider directories, beneficiary handbooks, appeal and grievance notices, denial, and termination notices) in threshold languages and in alternative formats (e.g., videos, audio versions, large print, and Braille.) that are easily understandable to meet the language and communication needs of constituents. (CCPR CR 7, CLAS Standards 5, 6, and 8) DMH ensures that staff working in initial points of contact (e.g.  24/7 ACCESS Center, Patients’ Rights Office, and front desk at service sites) receive training to enhance cultural sensitivity, cultural humility, customer service and responsiveness to constituents and their community. (CCPR CR 7, CLAS Standards 5, 6, and 7) Directly Operated, contracted, and administrative programs collaborate with the DMH Ethnic Services Manager (ESM) to implement the Cultural Competence Plan Requirements (CCPR) at the program level and submit the necessary program-specific information needed for updating the plan annually consistent with the CCPR and CLAS Standards. (CR 1) DMH designs and supports consumer-driven and wellbeing programs that focus on promoting hope, resilience, and recovery of constituents and provide opportunities for peer involvement. (CCPR CR 8, CLAS Standard 13) DMH promotes the integration of cultural and linguistic competence guidelines to appropriately serve constituents, measure consumer satisfaction, fairly resolve complaints and grievances, and engage the workforce in meaningful organizational assessments.  (CCPR CR 8, CLAS Standards 11 and 12) DMH promotes safe and culturally sound work environment for consumers, family members, and workforce members. Cultural words and symbols (i.e., political, religious, or social) displayed in clinics should be culturally sensitive to consumers and workforce members at all departmental facilities with special care taken to avoid the display of symbols that may have culturally specific negative connotation. Aesthetic objects and decorations displayed in clinics should, when possible, be welcoming and comforting within the cultural traditions of consumers and staff. Security personnel should interact with consumers in ways that are as minimally threatening as possible to consumers whose cultural background or refugee status includes negative connotations to individuals wearing police or military uniforms. Consumers and staff should be granted access to the restroom that corresponds with their gender identity; consumers should not be asked to "prove" their gender identity by showing identifying documentation reflecting their authentic gender. For additional education please refer to the DMH Clinical Practice Parameter Special Considerations - 02: Sexual and Gender Diversity Supervision of staff: Supervisors should engage in frequent self-reflection and examination of cultural factors that may be influencing communication dynamics and responsivity between supervisor and supervisee, among multidisciplinary team members, and between DMH staff and service recipients. Within the context of supervision, supervisors should attend to their own biases and assumptions to foster relational safety with supervisees. Supervisors should practice strengths-based and reflective approaches to working with supervisees.Supervisors should model and promote balance, boundaries, and self-care, with the recognition that these may be influenced by the supervisor's or supervisee's cultural identities and experiences. Supervisors should provide opportunities for DMH staff to examine their personal attributes (e.g., values, attitudes, and biases) as they pertain to clinical treatment.