Elizabeth Stork

Monitoring and Enforcing Cultural Competence in Medicaid Managed Behavioral Health Care

In recent years cultural competence has expanded beyond language provisions to include understanding and factoring into services provision the cultural perspectives clients may have that are different from the majority culture. The federal government requires state Medicaid programs to offer culturally competent services, but little is known about how states implement such mandates and monitor and enforce them. We reviewed the origins and implications of cultural competence mandates and conducted a brief case study of 5 states to learn about the implementation of cultural competence provisions in behavioral managed care contracts. We found that states and managed behavioral health organizations (MBHOs) vary in their definitions and implementation of standards to ensure mental health care access for vulnerable populations. Although states had a variety of oversight mechanisms, varying contractual requirements ranging from optional to required, vague contract language, no existing standardized indicators or definitions, and scant data on the cultural characteristics of the populations enrolled in Medicaid managed care hamper monitoring and enforcement of cultural competence by states. Implications for MBHOs, states, and the federal government, as well as services researchers, follow.

Understanding High-Stakes Decision Making: Constructing a Model of the Decision to Seek Shelter From Intimate Partner Violence

ABSTRACT Violent events, options considered, commitment influences on the generation of options, and decisions to stay or leave for shelter were extracted from interview transcripts of 25 women living in a shelter. The purpose was to create a graphic representation of the model of the decision to seek shelter from intimate partner violence (IPV). Sequential decision problem models were constructed to illuminate the complexity of such a high-stakes, poorly structured decision involving conflicting goals and time pressure. The sequential structure of this behavioral decision problem is significant, partially explaining the many violent episodes and multiple attempts to leave that many abused women experience.