Efforts to Reduce Disparities in Behavioral Health

Projects and Technical Assistance and Training Resources

Projects

Community Mental Health Equity Project

Assembly Bill (AB) 74 (Chapter 23, Statutes of 2019) authorized funding to provide training and technical assistance to county behavioral health departments. The goal is to increase their expertise in cultural humility, health equity, stakeholder engagement, language access, workforce diversity, and trauma-informed care. This expertise will be instrumental in the development of population-specific and community-driven approaches designed to reduce disparities and improve access to culturally-responsive care.
The funding created a collaborative relationship between the California Department of Public Health's Office of Health Equity (CDPH-OHE) and DHCS' Medi-Cal Behavioral Health Division (DHCS-MCBHD). The collaboration is known as the Community Mental Health Equity Project (CMHEP) and addresses strategies and interventions aimed at reducing disparities in access to health and behavioral health care.
The goals of the CMHEP are:
1. Development of new DHCS guidance regarding cultural competence plans that are in alignment with the National Culturally and Linguistically Appropriate Services (CLAS) standards published by the Office of Minority Health in 2013. The guidance will be applicable to both Mental Health Plans (MHPs) and counties operating under the Drug Medi-Cal Organized Delivery System (DMC-ODS).
2. Improving access to culturally and linguistically relevant and aligned behavioral health services within Medi-Cal through expanded contracting between county behavioral health plans and community-based organizations (CBOs) with expertise in community-defined practices targeted at underserved and/or inappropriately served communities with a goal of improving health equity and reducing disparities among Medi-Cal beneficiaries.
3. Creation of a functional integrated network between county behavioral health departments so that culturally appropriate services are provided to previously unserved and underserved communities from different cultural, racial, and ethnic backgrounds.
4. Targeted stakeholder engagement to improve cultural humility of all project participants, with the goal to understand each other's backgrounds, and ultimately build a collaborative and trusting working relationship.

DHCS-MCBHD hired a Technical Assistance Contractor to:

Assist with updating the current cultural competence plan requirements;
Provide technical assistance and training (TTA) sessions, consultation services and collaborative earning networks to county, CBO, and state staff;
Develop TTA programs focused on data-driven, culturally-responsive, trauma-informed and community-defined practices to reduce behavioral health disparities and ensure equitable care.
Develop a Performance Measurement Framework to determine the success of the CMHEP.

More information about CARS can be found on the CARS Webpage. CARS created a webpage specific to the CMHEP at the CMHEP Webpage interested stakeholders may sign up to receive periodic news and updates about the CMHEP.

Cultural Competence Plan Requirements (CCPRs)

DHCS develops, implements and oversees the Cultural Competence Plan Requirements (CCPRs) and annual updates that are required by all Mental Health Plans (MHPs) per California Code of Regulations, Title 9, §1810.410 (9 CCR §1810.410). This requirement is also a contractual requirement between the counties and DHCS, and has been extended to counties participating in the Drug-Medical Organized Delivery System (DMC-ODS) Waiver since its implementation in 2017.

The CCPRs require counties to identify, analyze, and report disparities in behavioral health services for unserved and underserved communities and to develop a plan with strategies to address these disparities.

Per former Department of Mental Health (DMH) Information Notices 10-02 and 10-17 (small county modification), counties are instructed to submit information to the department on the following eight criteria:

Criterion 1: Commitment to cultural competence
Criterion 2: Updated assessment of service needs
Criterion 3: Strategies and efforts for reducing racial, ethnic, cultural, and linguistic mental health disparities
Criterion 4: Client/family member/community committee: integration of the committee within the county mental health system
Criterion 5: Culturally competent training activities
Criterion 6: County's commitment to growing a Multicultural workforce: hiring and retaining culturally and linguistically competent staff
Criterion 7: Language capacity
Criterion 8: Adaptation of services

These eight criteria constitute a mechanism for counties to inform the development and use of culturally and linguistically appropriate strategies and interventions that allow timely access to behavioral health services. Counties submit their cultural competence plans (CCPs) to the department annually at MCBHD.CCPR@dhcs.ca.gov. In addition, counties post their CCPs on their respective county behavioral health department's website.

Technical Assistance and Training Resources

Community Mental Health Equity Project (CMHEP):

Assembly Bill (AB) 74 (Chapter 23; Statutes of 2019)
For information regarding CBOs and CMHEP grants, please contact the Office of Health Equity at OHE@cdph.ca.gov. You may also refer to their webpage at Community Mental Health Equity Project (CMHEP)
Information regarding CMHEP grants awarded to 34 CBOs can be accessed below:

African American

Asian and Pacific Islander

Latino

LGBTQ

Native American

Cultural Competence Plans and Requirements

Information Notices

DMH-Information Notice 10-02

DMH-Information Notice 10-02 Enclosure 1

DMH Information Notice 10-17

DMH-Information Notice 10-17 Enclosure 1

Threshold Languages Behavioral Health Information Notice: 20-070

Below please find the links to counties' CCPs:

The National Association of State Mental Health Program Directors (NASMHPD) Project

Subcommittee on Racial Equity and Systemic Racism in Healthcare:

The National Association of State Mental Health Program Directors (NASMHPD) Children, Youth, and Families (CYF) Division partnered with the National Council for Behavioral Health to address repairing behavioral health care disparities and racism within the behavioral health care system. A subcommittee was formed to discuss racial equity and systemic racism at the national level.
The group looked internally within state agencies' hiring practices and office culture and externally to improve the state agencies' value within the communities to best serve beneficiaries and their families.
Members of the subcommittee represented multiple states, including Vermont, Delaware, Virginia, West Virginia, Ohio, Kentucky, South Carolina, Louisiana, Utah, Washington, California, and Hawaii. The subcommittee met monthly from July 2020 through April 2021.
Based on a foundation of cultural humility and sensitivity, the subcommittee's goal was to generate actionable items to present to the parent committee on approaches to root out and address the insidious forms of systemic racism and health disparities interwoven into the behavioral health care system.
List of ideas presented to parent committee (coming soon).

Resources:
NASMHPD website
NASMHPD – Children Youth Families Division website
The National Council for Behavioral Health website

Office of Minority Health (OMH): Culturally and Linguistically Appropriate Services- (CLAS) Standards:

The National CLAS Standards describe a framework to deliver services that are culturally and linguistically appropriate and respectful, and that respond to individuals' cultural health beliefs, preferences and communication needs. They are intended to advance health equity, improve quality, and help eliminate health care disparities and constitute a comprehensive series of guidelines that inform, guide, and facilitate practices related to culturally and linguistically appropriate health services.

Resources:

The National CLAS Standards website

If you have any questions, please submit them to our mailbox MCBHD.CCPR@dhcs.ca.gov.

For more information on the department's efforts regarding the reduction of disparities, please refer to Eliminating Health Disparities in the Medi-Cal Population website.

Last modified date: 2/13/2023 2:05 PM

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