(PS5-C73) Policy for Equity: Associations Between Community Mental Health Agency Policies and Clinicians’ Cultural Competence

Objective: Systemic reform is needed to address racism as a root cause of mental health inequities, such as understanding how community mental health agencies’ policies and procedures may impact care provided to racially minoritized populations. This study described and examined associations between community mental health (CMH) clinicians’ multicultural knowledge and awareness and agency practices and policies to improve care for Clients of Color.

Methods: CMH clinicians (N=119) across Washington reported on their multicultural competence and agencies’ practices and policies in an online survey. Multicultural competence was assessed with the Multicultural Counseling Knowledge and Awareness Scale (MCKAS), which asks respondents to rate agreement with items across two subscales: 1) knowledge of multicultural counseling frameworks; and 2) awareness of multicultural counseling issues. Agency policies were examined with an adapted version of the Multiculturally Competent Service System Assessment Guide (MCSS), which asked respondents to endorse the degree to which their agencies had taken specific steps to better serve minoritized racial and ethnic populations across 11 domains, including policies, linguistic diversity in services, and quality monitoring and improvement.

Results: Multicultural knowledge and awareness were generally high across the sample. On average, white clinicians had lower MCKAS scores (M = 5.43, SD = 0.66) than Clinicians of Color (M = 5.73, SD = 0.63), t(49.21) = -2.18, p = 0.03. These findings were driven by the knowledge subscale, where white clinicians had significantly lower knowledge (M = 5.06, SD = 0.87) than Clinicians of Color (M = 5.43, SD = 0.72), t(55.80) = -2.26, p = 0.028. There was no significant difference in awareness subscale scores between white clinicians (M = 6.02, SD = 0.76) and Clinicians of Color (M = 3.21, SD = 0.61), t(63.50) = -1.35, p = 0.18. Regarding agency policy, clinicians most highly endorsed items in the multiculturally competent policies, procedures, and governance domain, such as having a mission statement committed to cultural competence (M = 4.0, SD = 1.3). There was less endorsement of items in the services for non-English speaking clients domain, such as offering forms in clients’ preferred language (M= 3.1, SD = 1.4). There was the lowest endorsement of the multiculturally competent quality monitoring and improvement domain, which included items such continually monitoring, evaluating, and rewarding the cultural competence of staff. (M = 2.4, SD = 1.4). Endorsement of concrete steps to improve services for non-English speaking clients was associated with greater MCKAS scores (ß=0.23; p=0.009), and practices to monitor and improve care provided to Clients of Color were associated with lower scores (ß= -0.19; p=0.01).

Conclusions: Addressing mental health inequities requires multifaceted solutions. Though future research is needed to further understand the impact of specific policies and actions, results suggest that specific practices to improve care for Clients of Color, such as providing services in different languages, may have greater impact on clinician multicultural knowledge and awareness than other non-specific policies and practices.