Academic journal article Journal of Mental Health Counseling

Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives

Academic journal article Journal of Mental Health Counseling

Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives

Article excerpt

Practitioners in two federally qualified health centers (FQHCs) were interviewed to explore how their organizations carried out best practices in cultural and linguistic competence (CLC) when integrating mental health services into primary care. Archival data and data from interviews with eight clinical services providers were analyzed using exploratory cross-case synthesis. To highlight best practices in integrated health care (IIIC), clinical, systemic, and organizational themes were identified: patient-centered care for underserved populations, building and sustaining a successful midtidisciplinary team, and increasing capacity and adapting to changing circumstances. CLC did not emerge as a distinct interview theme, though it was present in subthemes and was discussed by both mental health and medical practitioners as central to effective healthcare delivery. The results underscore the need for culturally-tailored research and training that examines how IHC can best serve diverse groups and communities.


That there are health and mental health disparities between ethnically diverse individuals is well-established (Blanco et al., 2007; Harris, Edlund, & Larson, 2005; Institute of Medicine, 2003; U.S. Department of Health and Human Services, 2001). Integration of mental health services into primary care has been advanced as a way to reduce mental health disparities (Blount, 2003; Sanchez, Chapa, Ybarra, & Martinez, 2012a) because members of racial and ethnic minority groups are more likely to seek mental health care in primary care than in specialized mental health settings (Chapa, 2004). However, primary care providers have been less likely to detect the mental health problems of racially and ethnically diverse patients (Borowsky et al., 2000). To provide effective mental health services to diverse populations in primary care settings, it is critical to adopt best practices in both integrated healthcare (IHC) and cultural and linguistic competence (CLC).

IHC is the "systematic coordination of physical and mental health care" (Hogg Foundation for Mental Health, 2008, p. 7). Medical and mental health services can be integrated in a range of ways, from minimal collaboration between separate sites to full integration at a single site (Doherty, McDaniel, & Baird, 1996). This article uses the classification scheme developed by Blount (2003) to describe IHC programs (see Table 1 for a summary).

While IHC increases access to mental health services for diverse groups, research on its effectiveness with racial and ethnic minorities is limited (Butler et al., 2008; Sanchez et al., 2012a). Two studies have suggested that IHC outcomes are equivalent across groups (Butler et al., 2008). Several recent studies of collaborative care models (a type of IHC in which a mental health provider is incorporated into a primary care practice) have demonstrated effectiveness in reducing the depression symptoms of Latino and African-American patients in the continental U.S. and with Puerto Rican patients in Puerto Rico (Davis, Deen, Bryant-Bedell, Tate, & Fortney, 2011; Dwight-Johnson et al., 2010; Vera et al., 2010). However, in a study of collaborative care among older patients, non-Hispanic Whites benefited more than did racial and ethnic minority patients; the authors suggested that culture-specific strategies are needed to improve minority outcomes (Bao et al., 2011).

The Office of Minority Health (OMH) has defined CLC as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations," with culture reflecting "integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups" (OMH, 2001, p. 4). Linguistic competence has been described as the provision of culturally competent services to individuals with limited English proficiency via bilingual staff or qualified interpreters and translators (Agency for Healthcare Research and Quality, 2003). …

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