CULTURAL COMPETENCY AND DIVERSITY PLAN

Cambridge Counseling Center

Cultural Competency and Diversity Plan

2016 Update

Approved by the Executive Team

INTRODUCTION

Cultural competence has been defined as a continuous learning process that builds knowledge, awareness, skills and the capacity to identify, understand and respect the unique beliefs, values, customs, languages and traditions of all Ohioans in order to provide effective programs and services. This continuous learning process is necessary to support recovery and to deliver consumer-driven, person-centered mental health services. The Cambridge Counseling Center, Inc. is a provider of behavioral health services. We seek to improve the quality of life of all persons served through a dynamic and diverse environment. We are committed to cultural competency and diversity. The need to provide mental health services to persons from many, diverse cultures has been acknowledged throughout the Cambridge Counseling Center.

The Cambridge Counseling sees the creation of a truly culturally competent system as a developmental process. The groundwork has been laid through the creation of policies and procedures and requirements for staff and we have been building upon this framework ever since.

The Cambridge Counseling Center recognizes that a person’s cultural norms, values and beliefs shape how they approach and utilize behavioral health care services. Numerous cultural variables including, but not limited to, ethnicity, race, sexual orientation, gender, age, socio-economic status, primary language, English proficiency, spirituality and religion, country of origin, literacy level, employment status, geographic location, cognitive and physical ability level, immigration status and criminal justice involvement influence the way in which a person seeks and utilizes behavioral health services and the manner in which a person approaches and manages recovery.

The Cambridge Counseling Center serves a mostly Appalachian population. Group differences are vast across the state of Ohio and include variations in values, behavior styles and health risk indicators. Similarly, consumers differ widely in how they participate and respond to mainstream office settings and service delivery models. It is imperative that Cambridge Counseling Center employees and providers can readily identify, understand and respect the unique interplay of cultural and linguistic factors that impact consumers and their families.

Cambridge Counseling Center recognizes that cultural competency plays a vital part in realizing our goal of supporting consumer recovery and resiliency in ways that are meaningful for individuals in their communities, and appropriate and relevant to their unique cultural experiences. Our role as an organization is to give our employees and providers the key skills they need to support each consumer in their individualized recovery and to engage and support consumers in a way that is culturally appropriate. Accordingly, we ensure that all aspects of our hiring, training, services, and quality improvement emphasize cultural competency.

The Cambridge Counseling Center is located in southeastern Ohio at the largest intersection in the U.S. where I-70 meets I-77. Our community motto is "Together for a Better Tomorrow". The city of Cambridge in Guernsey County, Ohio has a rich history of early pioneers. Immediately after the Northwest Territory was proclaimed, coupled with Zane Trace, and the building of the Old National highway – Now U.S. Route 40 – immigration followed. The immigrants were English, Scotch, Irish, Welsh and men and women from the Balkans and the foundation of the culture of our stakeholders. Cambridge occupies 16 square miles and the approximate number of families is 5,770.

We are known as the Appalachian field which is the greatest coal field in the world. The coal fields served as an economic base for Guernsey County and who have multiple small rural communities that rose during the "coal boom" and most of these communities remain – some as small as 100 people. With societal trends most of this employment base has been lost with current mine operations at a minimum. Oil and natural gas increase employment opportunities in the late 1950’s to 1980’s.

In 1945 an act of legislation established a statewide system for treatment of persons in the early stages of mental illness. An Army hospital in Cambridge was transferred to the state for use as a psychiatric facility and by 1951 this facility employed over 700 people creating positive employment opportunities for the residents of Cambridge and the surrounding rural areas. In 1968 the trend toward a community-based system of county and multi-county boards were initiated to plan and coordinate care. In 1988, Ohio moved to the national forefront of mental health reform with passage of the Mental Health Act. This landmark legislation had two primary goals: to move toward community based treatment rather than institutionalization and to emphasize local direction rather than state control. Ranked 26th among the states in a 1986 survey Ohio moved to 7th place in 1988 and by 1990 Ohio was rated as the 4th best in the country. This trend impacted the local community with the loss of employment opportunities, the community adjusting to new residents within local communities, and untrained persons to sustain these new residents in the community.

Cambridge Counseling Center has become a working factor in the long range plan to prove this care to persons served and to assist the community in becoming a working factor through collaboration, education, community involvement, support and advocacy for all stakeholders. Currently we are experiencing a trend to continue down-sizing Appalachian Behavioral Healthcare – the group that acquired the former state hospital. In October 2005 a Transformation State Incentive Grant (TSIG) was awarded to Ohio by the Substance Abuse and Mental Health services Administration of the US Department of health and Human Services. The five year grant supported research planning, and initial improvements to Ohio’s system. The direction noted is person-centered care in the domain of addictive disorders and mental health services providing a more holistic approach to persons served. The majority of persons served are at or below poverty level. Transitioning our economic base from primarily farming to a technical base has been difficult. Education is valued, however our educated young generally move to the larger urban areas when completing college.

The Appalachian culture is rich in the tradition of hard working, self-reliant, an independent people. We are spiritual with a strong Christian base of beliefs. We are military minded and supportive of our troops. We are family oriented, conscious of the needs of others less fortunate, we are prideful, and humor is appreciated. Cambridge has survived and still surviving societal trends that affect us socially and economically. Drawing upon the strengths of our culture, we hope to positively meet these new challenges to better serve all stakeholders within our catchment area. The Appalachian community maintains a rich and enduring culture and we are a contributing viable resource within a much larger system.

ASSESSMENT OF CULTURAL CHARACTERISTICS OF THE COMMUNITY

Cambridge Counseling Center assesses the cultural characteristics of the community we serve through the use of demographic data obtained from persons served and family members involved in our programs and services, and additionally from local and regional demographic data available as public information. Based on these information sources the following is an overview of the cultural characteristics of the persons we serve:

Cambridge Counseling Center serves a mostly Appalachian population. Cambridge is a city located in the foothills of the Appalachian Mountains with a population of approximately 10,635. The Labor Force is 4,653. Total unemployed: 1,500 and Median Age for women is 40 and median age for men is 38.

Cultural Characteristics of Zanesville

Cambridge Counseling Center Zanesville Office is located in Zanesville, Ohio. The city in Muskingum County has a population of 25,586. 16.5% of the labor Force is unemployed. The median family income is $27,284.

Zanesville was named after Ebenezer Zane, who had constructed Zane's Trace, a pioneer road from Wheeling, VA to Maysville, KY through present-day Ohio. He gave, in payment, in 1797 to his son-in-law, John McIntire1747-1811, at the point where Zane's Trace met the Muskingum River. With Zane's help, McIntire platted out the town and opened an inn and ferry by 1799. In 1801, Zanesville was officially renamed from Westbourne (Zane's chosen town name).

From 1810-1812, the city was the second state capital of Ohio. The National Road runs through Zanesville at U.S. Route 40. Over 5000 Union soldiers, along with hundreds of town folks were stationed in the Zanesville area to protect the city in 1863 during the raid of Morgan's Raider. Novelist Zane Grey, a descendant of the Zane family, was born in the city.

The city has two engineering landmarks: the Muskingum River Canal, designated a National Historic Civil Engineering Landmark; and the Zanesville Y-Bridge, the only such structure in the United States still in use. It is listed on the National Register of Historic Places.

According to the United States Census Bureau, the city has a total area of 12.14 square miles of which, 11.77 square miles is land and 0.37 square miles is water.

The area has important deposits of clay which were exploited by a number of pottery companies in the first half of the twentieth century. Famous companies included Roseville pottery, Weller pottery, the J.B. Owens Pottery Company, the Zanesville Stoneware Company, the Mosaic Tile Company, the American Encaustic Tiling Co., and the T.B. Townsend Brick Yard under the ownership of T.B. Townsend.

Cultural Characteristics of Barnesville

Barnesville is a village in Belmont County, Ohio, United States. It is located in the central portion of Warren Township in Belmont County and is part of the Wheeling, West Virginia Metropolitan Statistical Area. The population was 4,193 at the last census.

The village is the host of the Barnesville Pumpkin Festival every September, attracting tourists from the area.

The village of Barnesville is served by the Barnesville Exempted Village School District. There are three main schools in the village: Barnesville Elementary School, Barnesville Middle School, and Barnesville High School. Also located in the village is Olney Friends School, a small co-educational boarding high school affiliated with the Religious Society of Friends (Quakers).

Population Characteristics of County, Center and Staff by Office

Cambridge Office

County Population Center Population Staff Population

African American 6.11% 2% 4.8%

Caucasian 92.68% 97% 95.2%

Other 1.21% 1% 0%

Zanesville Office

County Population Center Population Staff Population

African American 11% 2% 0%

Caucasian 85% 97% 100%

Other 4% 1% 0%

Barnesville Office

Village Population Center Population Staff Population

African American 2% 0% 0%

Caucasian 96% 100% 100%

Other 2% 0 % 0%

Cambridge Office

County Population Center Population Staff Population

Male 49% 42% 23.8%

Female 51% 58% 76.2%

Barnesville Office

County Population Center Population Staff Population

Male 47% 35% 12.5%

Female 53% 65% 87.5%

Zanesville Office

County Population Center Population Staff Population

Male 46% 60% 53.8%

Female 54% 40% 46.2%

Cambridge Office

County Population Center Population

0-17 25% 29%

18-65 58% 67%

65 and up 17% 4%

Zanesville Office

County Population Center Population

0-17 29% 35%

18-65 56% 63%

65 and up 15% 2%

Barnesville Office

County Population Center Population

0-17 25% 47%

18-65 61% 52%

65 and up 14% 1%

CULTURAL COMPETENCY GOALS

The following eight goals document the methods we use to promote culturally competent and culturally responsive care. The corresponding objectives assist us in developing, monitoring and evaluating our level of success in achieving goals related to cultural competency.

Goal I: Identify policies and procedures that ensure cultural responsiveness is integrated and reflected throughout Cambridge Counseling Center.

Monitor existing customer service, quality management, utilization management and provider relation policies and procedures for compliance with CLAS (Culturally and Linguistically Appropriate Services) requirements and recommendations.

The Cambridge Counseling Center’s Cultural Competency Committee will meet to review actions taken to ensure the plan is continuously implemented.

Goal II: Ensure Cambridge Counseling Center actively recruits, retains and promotes a diverse staff at all levels of the organization.

Ensure open communication and collaboration by encouraging the sharing of thoughts and ideas clearly and effectively with colleagues, leadership, and persons served, family members, local and state agencies, providers, and community programs.

Provide ongoing training, educational prospects, and promotion through tuition reimbursement plans, internship opportunities, professional development and a comprehensive training program.

Provide a competitive hiring package from an Equal Opportunity Employer that includes above-average salaries.

Advertise open positions through cultural organizations, culture-specific media outlets and cultural professional organizations.

Goal III: Ensure staff have ongoing education, training and clinical consultation in culturally and linguistically appropriate service delivery and dispute resolution.

Providers will receive ongoing education, training and clinical consultation in culturally appropriate service delivery and dispute resolution. Training will be provided through a variety of methods, including face-to-face, and Essential Learning, a national provider of continuing education.

Goal IV: Implement quality improvement activities to monitor cultural competency within the agency, customer satisfaction, and identify service gaps in the system.

Cambridge Counseling Center will…

Provide a quantitative and qualitative analysis of the population on which consumer focused quality improvement efforts are based, including, but not limited to: age, gender, sexual orientation, geographic location, language/s spoken, presence of disability (i.e., intellectual, physical and/or visual/hearing).

Assess the diversity of the providers and Cambridge Counseling Center in representing and addressing the linguistic, cultural and ethnic demographic needs and preferences of consumers.

Provide a summary analysis of the populations’ clinical and risk characteristics for targeting current and future quality improvement efforts and to identify appropriate supportive education and prevention activities.

Integrate cultural competent-related measures into their internal audits, performance improvement programs, consumer satisfaction assessments, and outcomes-based evaluations.

Goal V: Identify diversity best practices and promote these strategies and supports throughout Cambridge Counseling Center.

The Cultural Competency Committee will meet and discuss Hispanic, Tribal, LGBT (lesbian, gay, bisexual and transgender) and disability in order to identify best practices in serving the identified communities. These groups will generate policy, outreach and training recommendations which will be forwarded to the Cambridge Counseling Center Executive Team.

The Cambridge Counseling Center Cultural Competency Committee will meet to review the Cambridge Counseling Center cultural competency plan, the statewide plan on eliminating behavioral health disparities, and review data.

The team leader will collaborate with stakeholders to identify and address behavioral health disparities unique to each region.

Cultural competency and diversity awareness will be integrated into the Cambridge Counseling Center website. The website will provide information for consumers, families, providers and community stakeholders. Diversity and inclusion fact sheets, community resources, training opportunities and other relevant supports will be posted.

Cultural competence and diversity initiatives will be communicated via the Cambridge Counseling Center website and via the provider and consumer newsletter.

Goal VI: Provide language assistance services that are relevant to the needs of persons served including those who (a) speak a language other than English, (b) are deaf or having hearing impairments, (c) are blind or have visual impairments, and/or (d) have limited reading ability.

Cambridge Counseling Center will…

Employ a Language Line which provides live and immediate translation capabilities for 170 languages using interpreters trained in medical terminology.

Offer Telephone Device for the Deaf (TDD) services.

Assure interpreter proficiency via a structured process for the initial and ongoing assessment of staff hired to provide language assistance to consumers.

Provide all written materials and website information in English and any other language spoken by 10% or greater of the population.

Ensure all written member materials are worded at a 6th grade reading level.

Make available all written materials in alternative formats to persons with special needs, including large print and audio.

Authority, Structure and Responsibility for the Integration and Coordination of the Cultural Competency Plan

The Cambridge Counseling Center’s Executive Team has the authority and responsibility to integrate cultural competency throughout Cambridge Counseling Center’s operations.

The Role of the Cultural Competency:

To ensure cultural and linguistic responsiveness and competency is interwoven throughout organizational and provider systems, Cambridge Counseling Center employs a Team Leader who is responsible for collaborating with consumers, families, service providers, communities and state agency and Collaborative representatives to ensure that Cambridge Counseling Center’s behavioral health care services are culturally affirming and linguistically responsive. Additionally, the Leader maintains the cultural competency plan, works with the Performance Improvement Team to monitor, evaluate, and address diversity initiatives within Cambridge Counseling Center and the delivery system. The team leader is also responsible for implementing cultural community support system activities and will provide technical support to providers relating to cultural competency and evaluation and treatment performance indicators.

CULTURAL COMPETENCY COMMITTEE

The purpose of the Cambridge Counseling Center’s Cultural Competency Committee is to improve Cambridge Counseling Center’s cultural and linguistic competence at the organizational, staffing and provider levels. The committee monitors the Cambridge Counseling Center Cultural Competency plan and identifies training needs, educational materials, and consultation services relevant to the needs of diverse populations.

Structure/Relation to Organization: The Cambridge Counseling Center’s Cultural Competency Team serves as a key resource to the Performance Improvement Team as it reviews performance data and develops and implements plans for diverse and culturally competent services.

Function/Key Responsibilities:

Development and monitoring of a Cultural Competency Plan which incorporates specific goals and timelines for achieving compliance with ODMH and CARF Accreditation Standards;

Receipt and review of all reports and information distributed by State and local agencies on cultural issues and distribution of this information;

Identification of training needs related to enhancing cultural diversity within the service system;

Identification of training needs related to enhancing culturally competency service delivery to consumers;

Consultation regarding the development of cultural competence trainings;

Distribution of educational materials and notices of community events that pertain to cultural diversity to service system organizations and staff;

Identification of resources and interventions for high-risk behavioral health conditions found in certain cultural groups;

Development of outcome measures for access and utilization for each of the cultural groups for reporting to the Collaborative;

Designing tools for on-site review of providers;

Assuring that Utilization Management Team, Clinical Director (CD), Site Supervisors and Case Management Program Director receive up-to-date information and training;

The committee serves as a resource to the Performance Improvement Team as it reviews performance data and develops improvement plans for culturally competent services;

Ensures that Cultural Competency and Diversity within the Cambridge Counseling Center is based on the consideration of Culture. Age, Gender, Sexual orientation, Spiritual beliefs, socioeconomic status, and Language.

Cambridge Counseling Center’s Cultural Competence and Diversity Update 2016

Goal 1: To develop a greater understanding of the culture of the Appalachian population we serve to benefit the Barnesville, Cambridge and Zanesville Office.

Objective: Provide comprehensive in-service training to employees regarding the specific cultural characteristics of Appalachian persons.

Measure: Percent of staff who completed in-service training (number of persons who attended), total number of employees; data source/attendance lists).

Responsibility: Cultural Competency Team

Target Date: December 2016

Review: The Cultural Competency Team will monitor the Cultural Competency and Diversity Plan on a regular basis.

Goal 2: To increase the percentage of male staff members to align with county population in the Barnesville Office.

Objective: Increase by 50 percent recruitment of employees within media and advertising outlets and publications that target males;

Measure: Review of advertising at end of fiscal indicating a 30 percent increase in alternative advertising outlets and publications;

Responsibility: Cultural Competency Team

Target Date: December 10, 2016

Review: The Executive Team will monitor the Cultural Diversity and Competency Plan and Team.

Goal 3: To Increase the senior center population to align more with the county senior population in both the Barnesville, Cambridge and Zanesville office.

Objective: Provide comprehensive in-service training to employees regarding the specific cultural characteristics of Appalachian alcohol addiction by a recognized authority on this population’s cultural characteristics.

Measure: Percent of staff that complete in-service training or EL (number of persons who attended total number of employees; data source/attendance lists).

Responsibility: Cultural competency Team

Target Date: May 30, 2016

Review: The Cultural Competency Team will monitor the Cultural Diversity and Competency Plan on a bi-monthly basis.

Goal 4: To improve staff awareness of resources available related to cultural diversity and competency in the Barnesville, Cambridge and Zanesville office.

Objective: Identify, obtain, review, and disseminate articles and other materials related to cultural diversity and competency through consultation with community groups representing diverse cultures.

Measure: Completion of a section of materials in our resource library related to cultural diversity and competence

Responsibility: Cultural Competency Team

Target Date: December 15, 2016

Review: The Cultural Competency Team will monitor the materials placed in the library.