Stars <Behaviora[Hea[tfi Qroup

Cultural Competency Plan for
Starlight Adolescent Center
FY 2005 to 2006

TABLE OF CONTENTS
L

MISSION

o Program and Mission STatctncnt
o Definirlon of Cultural Competency
o (MItural Competency Planning Process

o

Client and Family Outcomes (Program Goals)
Analyses

II. CLIKNTS

o
o

C'l'F Client Demographics
Demographic Comparisons
Analyses

III. SHRVICFS AND S'l'AFI'
o

C’FF Services

o

CPF Staff

alyscs

lAF CULTUICAL COMPK’i'ENCY OBjHCTIAElS
o Twelve specific objectives
V. APPF.NDICHS

Appendix A: Planning Documents

o

OiCtumfCompetency Steering Committee Potential Areas of Focus

o SBHG Strategics to Increase Cultural Competenc)’
o SBHCj Program Cultural Competency Objectives
o
o
o

Appendix B: Tables
Starlight Client Demographics
Comparative Data
Starlight Staff Demographics

Stars(BedavioraCSfeaCtU Qroup

Cultural Competency Plan for
Starlight Adolescent Center
FY 2005 to 2006

1. MISSION

Program and Mission Statement

Within the SBHG continuum, Starligbl Adolescent (.enter has the important distinction of
offering to California the first Community treatment Facility (C,TF) for youth. Started in year 2000,
the original C'l'F mission was to provide local and cost-effective treatment as an alternative to
expensive state hospitalization, this mission was accomplished as state hospital populations declined
and youth moved into community care. Subsequently, Starlight began to play a unique role m the
continuum of sendees at'ailablc throughout the state by providing a step-up for clients unable to
succeed within an RCL Level 12-14 group home. CTFs also offer treatment - as distinct from
detendon — to juvenile offenders with mental illness. Starlight’s CTF and Non-Public School (NPS)

make step-down and sustained safety, structure, treatment and education possible for youth coming
from acute or sub-acute psychiatric facilities.

More recently. Starlight stepped up to the need for more services in Santa Clara County and
now offers mtensive day treatment, specialty outpatient mental health services, and therapeutic
behavioral sendees to community clients in order to prevent the need for higher level placements
hospitaEzations in the first place. As these arc new programs,“ramping” up service delivery capacity,
the community sendees client and staff data will not be analyzed at this time. ITierefore, the current
cultural competency plan focuses primarily on the services that arc part of Starlights’ Community
or

cultural
Treamient Facility. Starlight’s non-residential sendees will be included in the SBHG

competency planning process described below.

Starlight Adolescent (ienter expresses the distinctive mission and vision of residential and
community outpatient treatment within the larger mission of Stars behavioral Health Group (SBHG).
'i'he organizational mission is to...

“Develop and operate a full continuum of mental health services that reflect clinical excellence and continuous quality
mental illness to achieve and
improvements, to maintain an unconditional commitment to assisting clients with
maintain their optimum level of functioning and quality of life, and to provide effective mental health treatment and
cost-efficient services that involve and nspect the diverse resources and talents available within the client,family, staff,
and community”.

Additionally, the Starlight p<SSc\j on cultural competency(ADM 1.30) sets forth;
“\'o assure that the facility operates in eveiy aspectftvm aframework ofcultural competency recognising the importance

ofawareness and respect for the cultural background of the clients we serve, the community we live in, and the staff who
workfor us.”

Finally, the Starlight Professional Services Plan (jjrogram statement, under revision) articulates
features of our servdee delivcty model including culmral competency:

‘Gulture. is the context in which youth andfamilies develop identity and meaning. It is critical that Starlight's services
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sensitive and responsive to the diverse cnllnres represented in the service population which includes African
American, Caucasian, Vtltpino, HispanicIiMtino, and Vietnamese people amongother culturalgroups."
are

Definition of Cultural Competency

llic working definmon of cultural competency is sourced from the seminal NIMH

monograph Toward a Culturally Competent System ofCare, Vol I, 1998, consistent with the framework of
the California Mental Health Master Plan: A Vision for California (March, 2003) and referenced in the

California Department ofMental Health Mental 1 lealth Sendees Act(IVIHSA) DRAIAT (02/15/05) planning
document:

“Cultural competence is a set ofcongment behaviors, attitudes, and policies that come together in a system, agency, and
among professionals and enables that system, agency or those professionals to work effectively in cross-cultural
situations.”

SBHG Cultural Competency Planning Process

Starlight Adolescent Center is part of an SBFIG state-wide planning process committed to

providing services for clnldren, youth and families tliat arc driven by the values and principles of
culmral competency- Starlight’s Executive Director, who is Latino, will serve as a member of the
SBHG Cultural Competemy Steering Committee that is to proitide overall direction, focus, and
organization to cultural competency planning and quality improvement throughout SBHG
companies. Potential areas of focus of the steering committee are presented in Appendix A.
Client and Family Outcomes fProgtam Goals’)

The program goals and related outcome objectives of SBPIG programs are for clients to be:
1. Safe in home or family like settings - including avoiding out-of-home placements,

returning to knver levels of care, fostering pernianency, positively impacting family
functioning, and sustaining as family-hke an environment as safely possible for youth
during placement;

2. Attending and progressing in school or vocational endeavors - including improving
school/vocational attendance and engagement, improving grades and grade-level
advancement, and enhancing standardized achievement test scores;

3. Recovered and resilient - including improving access to needed health/mental health
care, improved functioning in mulriple life domains, reduced psycltiatric risk (risk
factors and risk behaviors^ and building community supports around each client;
and,

4. Out of trouble with the law - including reducing arrests, criminal detentions, and
probation involvement.

The Santa Clara Counti- mandated Program hvaluation Profiles proitide an overview' of services
and desired outcomes related to the client population, jointly negotiated among like providers in the

county for inclusion in program contracts. Additionally, Starhght’s leaderships select at least

one

indicator from each of the four domains above to track and monitor client outcomes and related
program performance on an annual basis.
Analyses

The SBHG/Starlight mission statement, while not specifically usmg the term cultural
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competency, describes values consistent with cultural competency as

well as with both host and

referring counties’ mission statements. Reviewing and updating the SBHCt mission statement will be
an initial task of the SBl IG Cultural Couipetency Steering Committee.

'I'hc Starlight culuiral competency policy statement and Professional Services Plan (program
statement) further articulate, underscore, and operationally translate values of cultural competency
applied to clients, communip-, and staff.

The NIMH monograph and state/county MH/MHSA plans, provide both broad and
specific theoretical and practical guidelines for assessing, promoting, and implementing cultural
competency. These arc key resource documents for cultural competency planning from which
SBHCt derives their planning document: SBhIG Strategies to Increase Cultural Competent(Appendix A).
I'he steering committee should commence as soon as possible in order to conduct planning
for the next fiscal year. The planning process might include a standard program assessment tool and

identify' a set of culmral competency objectivcs/projects (with latimde for other good ideas) that
programs select to enact. Draft criteria for such tools are provided in Appendix A. Starlight will be
ahead of the overall SBHG planning curve, having developed and submitted this plan to the county.

Subsequent information that comes from the SBHG planning process, (including more detailed
demograpliic and sendees research findings) may compel a fine-tuning of the current Starlight plan.
The SBHG outcome indicators are consistent with system of care, .state/county master

plans, and MHSA themes and are selected precisely because tliey have broad currency to multiple
stakeholders including agency partners, diverse client/family populations, and the taxpayer
(unportant for advocacy and ultimately, to resource availability’ for underserved and minority
populations). SBHG organizations are committed to outcomes tracking and informing practice

through empirical evidence. Both quantitative and qualitative methods are embraced. Outcomes and
cHent satisfaction data, collected at the individual level over an adequate period of time, and

m

combination across like programs, can be analyzed further for subgroup (e.g., age, gender, ethnicity’,
diagnoses, etc.) variation in response to treatment, the process of service, and desired outcomes.
Outcome and other quality’ assurance data arc applied to continuous quahty improvement widiin the
SBHG Total Quality’ Management (I'QM) system. Leadership strongly believes data should not be
collected unless it is applied to understanding and improving the quality of services.
II.

CLIENTS

The youth sen’ed in the Starlight Community Treatment T'acility (GTh) suffer from

severe

emotional disturbance and must meet medical necessity criteria for enrollment in a struemred

The youth entering the CTF residential program have a liistory of troubled
behavior including aggressive, oppositional, provocative, impulsive, and self-destructive behaviors,
often accompanied by intense negativism and social withdrawal. Along with these behaviors, the
youth ty’pically suffer from strained or impaired interpersonal and family relationships, resulting in
treatment environment.

an

absence of vital social support. The residential youngsters have experienced one or

more

treatment failures in outpatient, extended care management, or less restrictive settings. If not in the
stable and intensive treatment environment of the Starlight GIT, the youth would be in psycliiatric

hospitals or continue to move among placements, treatment settings, shelters, and juvenile
detention. Their behavior may represent a potential danger to self, others and/or property’, and their
treatment requues comprehensive evaluation, close staff supershsion, intensive therapy, remedial
education, and monitoring of the need for psychopharmacological intervention.
CTF Client Demographics

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Starlight Adolescent Center scn-cs adolescents of both genders that come from a variety of
backgrounds. Dunng program FY 0.3-04, youth were 53% male and 47% female. The majority of
youth (78%) were ages 13 to 17 years old; tlic rest were 18 to 21 years old at enrollment. I’he
ethnicities of clients (Appendix B, I'ablc One) arc: 41% European ancestry, 29% Latino, 22%
Afncan American,6% Asian (3% Vietnamese, 3% Other Asian), and 1% each Native American and
Other/Unknown. .Y little over SO'Fo of clients come from Santa Clara County and 34% come from
Alameda.

Demopraphic Comparisons

At Starlight, in-county- youth are more diverse and have a Irighcr portion of Latino youth
compared to out-of-county- youth (Appendix B, lable Two). Starlight’s out-of-county youth are
predominately European and /Xfrican j\merican. They come primarily from Alameda County which
has a higher proportion of African Americans in the school age, as well as general population
(iVppendix B, Table Six) when compared to Santa Clara and statewide. (California statistics are:
46.0% Hispanic, 32.5% ISuropean, 8.1% African America,8% Asian, 2.5% Filipmo, 1.4% Unknown,
.8% American Indian.).

In comparison to other contexts of mental health sendee delivery to youth in Santa Clara
county- (Appendix B, Table 'Three), the Starlight CTT’(which includes day treatment and outpatient
billing for sendees provided in a residential context) delivers care to more European and African
American youth and fewer Asians and Latinos. ’The Starlight CTF client profile approximates that of
Santa Clara Day Sendees with respect to the high numbers of European youth served. Generally,
except for Vietnamese clients. Starlight has not served tire numbers and variety' of Asian groups
represented in Santa Clara County-’s mental health programs (Appendix B, 'Table Four) or the
county'’s school age population (Appendix B, Table Six). Starlight’s gender breakdown matches
Santa Clara Day Sen'ices, whereas males are more often seen in Santa Clara’s outpatient and 24-hr
sendees.

Analyses

The ven' disturbed climeal profile of the Starlight CTF population’ underscores the central
importance of helping these youth build strong, positive, pro-social identities that integrates and
helps them come to peace with aU aspects of their personhood. Starlight clients are on a path to
rccover

from trauma and move beyond adverse life events. Gender, ethnicity, family, commumty,

sexual identity and the exercise of choice around identity' issues are all building blocks of resiliency

and higher functioning that need to be explored and mined during treatment. While there is no one

way to do this (in fact there are very many), a common foundation is respect and tolerance coupled
with the expectation that eveiy person can unprovc themselves and no one. has to do it alone.

Starlight’s demographic data show an increase in Asian youth serv'ed in FY 03-04 compared

to the prior year (from 1% to 6% combined, 3% being Vietnamese). This is consistent with the

shifting demographics of Santa Glara County’ (Appendix B, lable Five) which now reports 4
threshold language groups (Spanish, Mandarin, Tagalog and Viemamese). In light of tire
demographics of Starlight’s home county', as well as statewide, it wiT become more and more
important for Starlight staff to master an understanding of different Asian cultures and the crossgenerational acculmration dynamics of Asian youdi and famihes, starting witlr Viemamese. It will
also be required that Starlight have staff language capacity in the Santa Clara threshold languages,
and/or capacity to bring in interpreters when needed (see next section on sendees and staff).
'The Starlight Annual Report to be published soon provides more information about the client clinical profile.
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Half of Starlight (111- clients come from Santa Cilara County (Appendix B, Table Two).
Other counties refer and contract with Santa Clara County so their adolescents can also be admitted
and treated at Starlight C IT'. The mix of clients from different counties is a unique challenge

Starlight faces, different from most county programs that provides services in only one county. Staff
must safely manage group living/schooling dynamics among youth from different age, gender and
etlinic groups who are mentally ill and whom do not usually know each other before admission to
Starlight. Added to the basic inter-group dynamics of the CTh’ is the fact that one ethnic group
(I.atino) comes primarily from one county (Santa Clara) and another (African American) comes
from a different county (.^llameda). One of the arts of milieu management is assisting each individual

and group to forge a positive identity while at the same time minimiTiing inter-group rivalty^ (avoiding
us/them thinking and inter-group aggression). Much thought must be given constantly to
therapeutic, rehabilitative and recreational programming.

Effecting outreach, family building, and transition planning is always challenging with a highend sendee population (and is even more challenging with out-of-county youth). Permanency or

emancipation planning is difficult and requires every- ounce of staff resourcefulness. Many families
ni-equippcd and need much help to receive and maintain troubled youth in the home. Poor and
mentally disturbed young adults struggle with a shortage of safe, low-cost housing in the Bay iVrea.
Educational options arc often limited and ongoing support may be needed to help youdi stay

arc

focused and on track with educational or vocational endeavors. Cultural competency implies

we

help

youth and families with these kinds of everyday life challenges, yet Starlight staff must sometimes
“hand-off’ youth to their next situation without confidence in knowing whether adequate supports
are in place and will “stick.” A review of Santa Clara county demographic facts as they pertain to
general life issues of county residents (Appendix B,Table Five) underscores the above points.
The availabnity of accessible, culturally competent, chnically appropriate and community-

based services to support family stabihty and the ongoing treatment needs of youth returning from
high-end services is shaped by state and local pohey (pohtical will), funding, and resource allocation.
Starlight’s clients and their famihes (of origin or destination) are impacted by poverty". They return
to a broad cultural context characterized by low mental health service utilization rates (Appendix B,
Table Seven). In California and many Bay Area counties\ comparatively low service utilization rates
are characteristic of youth compared to adults, non-foster youth compared to foster youth, females

compared to males, female transition age youth (ages 18-20) compared to male transition age youth,
and Asian and Latinos compared to others. 'I'he implications of these facts arc far-ranging for evcty'
group serv'cd and society at large.

Consider the prospect of a female of transition age leaving an intensive treatment setting to

find her way in life. Ideally (over her next decade), she will be able to finish school, obtain a job,
continue her recovery from psychiatric trauma, take medications (if needed), stay free of alcohol and
drugs, experience supportive family relationships, create positive friendships, find love, and avoid
pregnancy (until she is emotionally and financially secure enough to be a parent if she wants to).
Does transition planning go far enough to increase her probability of successr Are adequate
resources available to create a v^alid transition plan? Ihese are the kinds of challenges Starlight staff
stmgglc with for even' discharge.

- KIDS COUNT data (Annie E. Casey Foundation) for 2004 shows California exceeds the national rate of: a)

percent of children whose parents lack full-time work; and, b) percent ofchildren in poverty.
’ Although rates of use are low most everywhere, Santa Clara County is doing better than the state average with
respect to: a) percent of total eligible population served; b) percent of eligible non-foster care youth served; c)
percent of MH expenditures on non-foster care youth; d) average MH expenditure per unduplicated client; and, e)
services to ethnic groups..

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III.

SERVICES AND STAFF
CTF Services

Programming for clients residing in the (iommunity Treatment Facility (C'l'F) includes:
1. Residential board and care with 7 day, 24 hour nursing and psychiatric oversight, youth
counselors, and recreational activities;

2. Five dav, full day, special education Non-Public School(NPS);

3. Seven day, over 4 hours daily of Day 'ireatment Intensive (l^'l'l) programming with
psychotherapy and rehabilitative group scridces; and,

4. Therapeutic Behavioral Sendees (TBS) to support specific behavioral improvements
necessary to stably maintain youth in the residential setting and support step-down to a
lower level of care.

riic program model for milieu treatment is an evidence-based practice that integrates social
learning thcoty^ into an overall bio-psycho-social approach. Visiting and on-call Psychiatrists provide
evaluation, medical oversight, and medication support services. Nurses maintain professional
standards for daily medical management. Both Nurses and Youth Counselors serve as coaches

(encouraging, motivating), teachers (modeling, guiding), counselors (listening, intervening), houseparents (scheduling, monitoring), and limit-setters (enforcing, disciplining) to the youth. The ratio of
direct treatment staff to clients is at least 1:5 daytime and 1:10 nighttime, per California State
Department ofI Inman Semees Community' Care Licensing Standards.
A Points and Ijevels (P<&L) System allows youth to start immediately to earn privileges beyond

basic care. Clients cnteiing residential treatment arc ty'pically seriously impaired in almost aU areas of
hiting. In order to regain normal levels of social, emotional, behavioral, and educational functioning,
they need to Icam a number of skills and change a number of behaviors. I’he P&L System breaks
down tliis process into a scries of “small steps”. I o encourage clients to make these steps, privileges
and rewards arc given to “reinforce” desired behaviors. “Catch a kid doing something right is the
motto. Each skill mastered is called a “merit badge.” ’lire P&I. System is the most effective way for

clients to learn and practice changing maladaptive behaviors — when staff applies creative, positive
incentives with kindness and respect, not as a means of punishment. Our training programs and
handbooks emphasize the correct use of P&l >.

'rhe safety^ of aD clients, staff, and visitors is always a primary concern. Programmatically,
Starlight promotes v'ety^ high standards of staff compliance and ethical conduct, such as with respect

to preventing institutional abuse or neglect. Both chents and staff receive information about their

rights and responsibilities to maintain safe, respectful relationships.
Both the Starlight I ligh School and the Day Treatment Intensive Program nested within the Cl’F
apply a graded and indhddualized approach to programs

and sendees in order to meet the

student/client “where they arc” developmentally, academically, functionally, and in terms of time in
program, The S/arx Behaimral Health Csronp (SBHG) “Program in a Box” provides clinicians and
rehabilitation specialists with a multimdc of specifically focused rehabilitative groups to meet the
treatment needs of youth presenting with different diagnoses, risk factors, or skill development
needs. Ihe groups are organized into one of four types: 1) Adjunctive Iherapy; 2) Process Groups;

3) Psychotherapy; and, 4) Skill-Building. Evidence-based practices such as cogmtive behavior
tlierapy (CBT) or EQUIP (an aggression replacement training program) are intenmntion models.

The overall mix and schcduHiig of groups must be carefully matched to meet tlie needs of the
client population. Additionally, Starlight staff plan and provide recreational activities.

current

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holidays, and special events that recognize and celebrate the ethnic diversity' of chents. For mote
information on StarUght’s program components — including non-public schooling, day treatment,
therapeutic behavioral sendees, ser\dcc planning, care coordination and transition plarming — please
refer to the Professional Semces Plan (program statement).
CTF Staffing

Starlight’s direct care staff is 60% female and 40% male. ITie racial/ethnic composition of all
staff is shown in Appendix B, Table Twelve. Separated out, direct care staff (clinical, nursing, rehab,
social sendees, school, therapeutic behavioral sendees combined) is 21% African American, 21%
Asian/Pacific Islander, 32°/(> Huropcan, and 26% Latino. The language capacity of staff(Appendix
B,Table Twelve) includes Mandarin, Spanish, Pagalog and Vietnamese which are Santa Clara
threshold languages.
Analyses

Culture is a critical elcmcnr of treatment. In order to be effective, interventions and services

need to be tailored and focused within the culmral context of the youth and their family.

Programmatically, both youth and family are invited to engage in open dialogue with treatment staff
about tlic meaning and significance of behavior, communication, role relationships, history, norms
and expectations from their unique culmral perspective. Each youth and family is entitled to services

within their own language; currently, arrangements are made to provide translations and/or
interpreters when staff docs not know the language (for information on staff language capacity, sec
Appendix B,'I'able Thirteen). Not all key consumer documents are translated into all the threshold
languages so this needs to be a culmral competency goal.

A review of trainings provided in 2004 (Appendix B, fable Nine) shows that the majority of
direct care staff, during new hire orientation, is exposed to training on how to acknowledge, respect,
and celebrate the ethnicity, faith, gender, sexual identity, family traditions and cultural norms of

youth and family witliin the framework of the treatment program. Phere were delays in cultural

"diversity training during one quartet (spring) that were later (mostly) made up. How effective the

cultural competency ttainings are at helping staff navigate the challenges of the C^TF treatment
context needs to be assessed carefully. In addition to assuring cultural competency training of 100%
of staff, more training needs to focus on the specific cultural groups found in the Starlight service
population (i.e., African American, specific Asian cultures such as Viemamese,and I.atinos).
One important indicator of Starhght’s cultural competency is the perspective of clients
themselves. Starlight participates in the Califomia State Department oj Mental Wealth (DMH)

performance measurement surveys. The most recent survey data (November, 2004) collected from
100% of Ci'F clients (enrolled at the time) are shown in Appendix B, Table Eight. Starlight’s results
could be better. To be consistent with program design, tlie fundamental item of “Treated with

Respect” must approach lOOTo and other items related to cultural competency need to achieve over
80% client agreement. Currcnriy, little is know about how distinct ethno-culmral groups perceive
and experience the separate, core components of CTF programming: for example, the use of
medications, nursing monitoring, points and levels, and rehab groups. Although in-house
satisfaction surveys inquire about specific program elements, the data have not been tracked so that
subgroup analyses (c.g., by ethnicity and gender) can be performed,

rhere is leadership consensus that a significant dynamic that impacts chent perceptions of
being treated respectfully relates to the use of physical interv’-entions to prevent chents from harming

themselves and others, i he agency has committed significant resources to reduce the use of physical
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restraints and seclusion in the management of dangerous behaedor, including training, coaching, and
debriefing interv'entions with staff. One success is that the use of mechanical restraints was
completely eliminated in 2004 (Appendix B, Table Nine). Policies have been revised and updated to
conform to changes in state law (SB 1.30) regarding risk assessment, client preferences, and staff
training in de-escalation.

There are many proficient and effective employees at Starlight. At the same time, staff turn
over (Appendix B, Table Eleven) is a difficulty related to the broader workforce environment, as
well as the challenges of reermting, training, and retahiing staff to work in an intensive and restrictive
treatment setting where staff arc personally at-risk of physical harm. Reducing and stabilizing staff
mm-over will make it more likely that Youth Counselors’ learning from trainings and incident
debriefings impacts their ability to manage client behaviors with less use of physical interventions.
Reduced mrn-over among social ser\tices, rehab, nursing and school staff will make it more likely
that learning the program model impacts their ability’ to deliver sendees with a high degree of fidelity’
to evidence-based practices.

As with all SBHCt programs, the leadership of Starlight makes every effort to recruit, retain,

and develop diverse staff which represents the diversity' of youtli and families involved with
treatment. The result is that Starlight staff is diverse with the ethnicities of chents well represented,
except for Native American clients (of which there were two in the time period). More diverse staff
should be recruited for the school and rehab departments.

Another aspect of managing dangerous behavior is the racial and ethnic dynamics of
difference that may impact staff and client perceptions of their interactions, especially staff

responses to client risk behaviors. On any given shift, or period of encounter between staff and
clients, it is nor managenally feasible to have staff fuUy reflect chents’ ethnic and gender

composition. There is always a potential for cross-culmral misperception and communication
problems. Staff may be new,inexperienced in parenting or mentoring, and/or not fully prepared for
the level of aggression and other risk behaviors of the chent population. This is compounded by
different cultural norms with respect to the expression of needs, emotions, and the exercise of

personal control (let alone the realities of chents’ mental illness). It is essential that staff training deal
very directly and thoi’oughly with issues of cross cultural perception regarding aggression, behavioral

risk, and behavioral control. Reduemg high risk behaviors tlirough culturally competent preventative
inten'cntions is an important treatment outcome in its own right and makes it possible for clients to
take advantage of all other aspects of service provision.

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IV. S'rARJiGHT CUi;i'URAL COMPRTl^NCY OBJRCrTVR:S
The following are specific objectives for Starlight. Starlight wiU also join the SBHG agencywide cultural competency planning process and therefore be involved with one or more of the areas
of focus identified in Appendix A,SBHG Cultural Competent Steering Cotnmittee. ITie objectives below
arc listed in order of priority within broad topic areas of: management, staff training, clinical
services, and quality assurance. Objectives earmarked for FY 05-06 implementation are identified

and highhghted in bold; others are also identified that may be added as timc/rcsources become
available, or to be taken up in future years.
Management
i-Y 05-06 OBJF.CriVliS;

1. All SBUG/Starhght consumer documents will be translated into Santa Clara county
threshold languages (Mandarin, Spanish, Tagalog and Vietnamese).

2. Significant focus of attention will be paid to retention, including retention of ethnically
diverse staff and those with threshold language capacity. Program managers wih partner
with MR to review staff suivev data, exit intcrctiew data, and other analyses to understand

the factors driving staff mrn-over. A specific plan for decreasing turn-over will be
written that w'ill address training, supentision, performance feedback, general
communication/information flow, and team-building needs by department.
OTHER OBJECiTTVES:

3. Human resources will recruit more diverse staff to school and rehab positions as they
open.

4. Data gathering and analyses related to client demographics and culmral variables will be
developed to enable interpretation of outcomes and cHent satisfaction data by subgroups
of the Starlight service population.
Staff Training
FY 05-06 OBJECTIVES:

5. Staff trainings are to be assessed with respect to effectiveness in increasing

understandmg of threshold cultural groups and then be further developed and dcHvered
for specific culuiral groups found in the service population (i.e., African American,

Latino, and Ahetnamese for starters). 100% of new staff is to be trained.

6. More cultural content and cross-culmral examples will be added to staff training

curriculum on the management of dangerous behavior. Client to staff and cUent to client
aggression will be addressed m training from a cross-cultural perspective.

OTHER OBJECTIVES:

7. In addition to drawing upon from the ethnic diversity of program staff, external
resources will be cultivated and applied to meet staffs’ culmral competency training
needs.

8. All staff will be knowledgeable about procedures for using interpreters when needed
with clients and/or family members. This item will be added to the cultural competency?

training content on the staff in-sentice calendar.
Clinical Sendees

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I-Y 05-06 OBJJiCTIVHS:

9. On a quarterly basis (as the service population shifts), resident managers along witli
treaunent staff \\t11 reflect upon and develop specific guidelines to: a) assist staff in
managing inter-group dynamics on the units; b) provide multi-cultural content
interesting to teenagers for D TI/Rehab/Recreational/School groups as well as special
events/holidays; and, c) foster culturally competent intcr\mntions with clients.
OTHER OBJECTIVES:

10. Clinical and social scnices staff will develop transition and aftercare plans that reflect
culturalh- specific strcngtlis and needs of clients. These will be observable and
measurable on the plans, as reviewed by QA staff.
Quality Assurance

FY 05-06 OBJECTIVES:

11. Client risk behavior and incident management data will be analyzed by ethnic/culture
groups for potential differential staff re.sponscs and rates of use of restrictive
inten^entions.

OTHER OBJECnVES:

12. A quality assurance review will be conducted to assure that client/family culmral
strengths and needs are identified during assessment and service plan development and
that related goals are addressed throughout treatment.

■Starlight Cultural Compuiuncv Plan_FY 05 06

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V. APPENDICES

Starlight Cultural Competency Plan_Appendix A
S<B9{C^ CuCturafCompetency Steering Committee
POTEN'l’IAL ARiCXS OF FOCUS FOR F’Y 05-06

1. Review rhc organizational mission and program statements for possible editing to further

emphasize culture. Ihe committee will review the NIMH monograph on cultural
competency, the Surgeon Creneral’s Report on Mental Flealth, Culture, Race and F^thnicity
(USDHHS, 2001), California MH/MHSA Planning documents, and state and county
cultural competency plans as key resource documents, among others brought forward by
committee members.

2. .Analyze SBHG sendee program (N=10), related county- (N=6), and state demographic
trends, patterns and research findings with respect to ser\-icc need, access, retention, and
treatment outcomes of specific culture groups (i.e., by age, gender, threshold
ethnicity-/language groups, special needs, and poverty). This process will involve application
of SBHG research personnel to compile and present information and analyses to the
committee, hocus groups can be held to flesh out quantitative data with the narrative
experiences and perspectives of persons from different cultural groups.

3. Applv a lens of multi-culmral awareness and relevance to a systematic review and update of
agency poUcies and procedures related to governance/administration, servdee environments,
program practices, quality- assurance, and treatment outcome trackmg. As examples, agenqpolicies ADM 1.30 “Gultural Competency” and NSG 3.10 “Cultural Awareness” have not
been reviewed and updated since 2000. As another example, the SBHG lotal QuahtyManagement QM)“probes” (quality- control checkhsts) include elements related to cultural
competency, consumer voice and choice, personal digmty, and family work, but these could
be improved upon.

4. Review and then enhance avenues for diverse consumer (client and family) voice and choice

at aU levels of the agency including involvement m governance and pohey; program
development, sen-ice and treatment processes and outcome evaluation. SBHG currently
promotes, and applies resources to consm-ner involvement in multiple arenas. This includes
(as examples): a) development and expansion of the TKAMMAd'KS wraparound program in
I.os Angeles with multi-layers of consumer involvement; b) stable funding of ethmcally
diverse Parent Partner positions (N=18)in many programs; c) youth and family involvement
in treatment goal setting as well as with inthvidual, family, group and milieu interventions; d)
collection and application of client, family and agency partner satisfaction sun-ey data to
continuous quality- improvement; and, e) maintenance of mj-riad mechanisms for informal
and formal feedback, including complaint procedures, in all programs. ITiere may be
opportunities to disseminate successful methods more widely as wcU as to develop additional
avenues for consumer input.

5. Brainstorm and then develop opportunities for increasing community partnerships for

multiple purposes including (as examples): sharing of staff trainers; connectivity of
clients/families to aftercare, stable homes and community resources; joint commumty-

advocacy efforts; program/service development projects; and, mutual sharing between
parent partners and consumer groups.

Starlig)it Cultural Competency Plan_Fl' 05-06

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Starlight Cultural Competency Plan_Appenclix A,cont’d.

Stars(BefiavioraCHeaCtfi group
STRATEGIES TO INCREASE CULTURAL COMPETENCE
Across Levels of a System of Organization

POLICY

Engage the participation of relevant minority and community groups in all aspects of
service system development and enhancement;
Set standards for cross-cultural service delivery and professional licensure;

Create training policies that sanction or require development of cultural knowledge and
skills;

Ensure funding for enactment of such training, and require it of policy-making board
members themselves;

Use research and evaluation data to guide decision making, collect data on minority
populations, and monitor research for cultural bias or intrusion; and.
Use funding mechanisms and pathways to create incentive to improve services for
minority children.
ADMINISTRATION

• Assessment and monitoring for cultural bias - the administrator sets the tone and context
for the evolution of cultural competence in an agency;

« Clearly define target populations based upon good demographic data on service areas;
• Increase access to and retention in services through consideration of compatibility of
belief systems, geographic proximity of services, flexible hours, etc.;
* Recruit and maintain minority and non-minority culturally competent persons on staff;
8 Provide training in cultural competence; and,
» Make sure that diverse cultural and community groups are involved in agency activities
and process.
SERVICES

8 Develop services with community and professional minority participation and
consultation;

® Serve the whole person within the context of their community and culture;
8

Individualize case planning;

8 Utilize natural helping systems when relevant;
8

Provide unconditional care;

8 Use least restrictive placement alternatives; and,
8 Seek nonnalization, including home-based and family preservation.

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PRACTITIONERS

®

Develop cultural competence by learning to acknowledge, appreciate, and make use of
cultural variables in the treatment process (e.g., cultural concepts of“family” and
“health”);

®

Seek information and develop understanding adequate to bridging conununication gaps.
Communication gaps may arise from the “dynamics of difference” between practitioner
and client;

e

Avoid projecting one's own cultural assumptions and values onto the child and family;
and,

®

Toward a Culturally Competent System ofCare provides an outline of the personal
attributes, knowledge, and skills of culturally competent providers (see NIMH
Monograph, Cross, Bazron, Dennis & Isaac, 1988, p. 35-37).

FAMILIES
e>

Become effective advocates for their children;

Develop the skills needed to articulate the importance of culture;

Prepare for the ways in which the dynamics of deference and the reality of being bicultural might effect children’s mental health and family member’s interactions with
service providers;

Serve as training resource to agencies and community groups; and,

Alert helping professionals to natural network and resources available within the ethnic
community.

Starlight Cultural Competency Plan_FY 05-06

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Starlight Professional Sciences Plan_Appcndix A,cont’d.

Stars(BeHavioradH'eaCtU Qroup
Program Cultural Competency Objectives
Planning ’i’ool for Selecting Annual Goals
Each program must complete Objective A and Objective B, and select two projects from Objective C.
Objective A: Staff Cultural Competency Training

Every workforce member shall participate in a minimum of 3 hours of cultural competency training
annually. The training may be provided by the agency, or externally. External curricula must meet with
the approval of the supervisor. Employees must sign an attendance log that is to be kept on file with the
Training Department.
Objective B: Multicultural Programming for Clients

Every program shall submit an annual calendar of relevant, diverse multi-culturally-focused events and/or
celebratory activities that will be available to their clients. A report on prior year events, including dates,
foci, and attendance numbers, along with the coming year’s proposal, shall be provided to the Research,
Compliance and Quality Management Department by June 30.
Objective C: Elective Cultural Competency Projects

Please select two projects, which may include other topics you propose:
1.

Identify and obtain funding for development and/or expansion of services to one or more
additional cultural groups.

j.

Engage the participation of relevant minority and community groups in planning and
implementing a consumer driven service development and/or enhancement project.
Articulate in program policies, procedures, and training curricula the ways in which
particular program features and/or practice standards are used to enhance the dignity,
normalization, social inclusion, and independence of cultural groups.

4.

Review program policies, procedures, and/or consumer forms for cultural bias and/or
cultural relevance and make corrections as indicated.

5.

Organize and procure translations of program consumer documents into the multiple

6.

Assess outreach to different population groups, establish an outreach goal for one or more
groups,and implement strategies to positively affect outreach.
Consider the w'ays in which the program addresses the objective of stimulating the natural
resources and helping systems available to clients, and develop strategies to increase

languages of clients.

7.

attainment of this objective.
8.
9.

Assess access to services of different population groups, establish an access goal for one or
more groups, and implement strategies to positively affect access.
Thoroughly assess and revamp program facilities, particularly public/consumer areas, to
make them maximally friendly and comfortable to diverse population groups, or target
client populations.

10.

Assess the retention of different population groups in services, establish a retention goal
for one or more groups, and implement strategies to positively affect retention.
Examine the effects of cultural variables on specific intervention strategies - e.g., potential
differential results as a function of client demographics and then refine or tailor the
interventions to better meet the needs of the demographic.

Starlight Cultural Competency Plan_rY 05-06

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15 of 22

12.

Assess service outcomes (success) of different population groups in services, establish an

outcome goal for one or more groups, and implement strategies to positively affect
outcomes.

13.

More formally integrate review of cultural dynamics into the supervision/coaching of
direct care staff(e.g., projection of cultural assumptions and values onto the child and
family). Articulate the ways such supervision/coaching is provided in program policies and
procedures.

14.

15.

16.

Have each direct care staff assess themselves in light of the personal attributes, knowledge,

and skills of culturally competent providers (see Cross and Bazron manuscript, p. 35-37),
set one or more professional development goals related to the desired attribute(s), and
submit a plan for goal attainment that is monitored during supervision.
Using positive outreach and other non-discriminatory' strategies, increase recruitment and
retention of minority', bi-lingual, and culturally competent persons on staff.
Assist and promote culturally competent staff and clients to serve as training and advocacy
resources to diverse community groups.

17.

Develop and support a multi-cultural consumer support, advocacy, and/or advisory
group(s) related to population needs/issues.

18. Other Idea;

Starlight Cultural Competency Plan_FV O.S 06

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16of22

Starlight Cultural(Competency Plan_Appendix
Table One: Starlight CTF Client Ethnicity
Other

African

1.2%

Native

American

American

21.7%

Latino

All Asian

28.9%

Prior FY percentages were:
European 45%, Latino
34%, African American
18%, Asian American 1%.

European
41.0%

Table Two: Starlight CTF Client Ethnicity by Referral County
Ethnicity of Starlight Clients by County
18
16

Alameda

14

■ African American

y
12

more

Ciounty

African

enrolls

American

m All Aslan

youth while Santa Clara
County (SCC) clients are
more ethnically diverse with
a greater proportion of
Latino youth.

o

□ European
■ Latino

8

I

6

■ Stetive American

n Other

4

2

n

0

Alameda

Santa Clara

All Other
Counties

Table Three: Starlight CTF Client Ethnicity Compared to Other SCC Youth MH Services
American

T

Native

African
All Asian

European

Latino

American 1

Other

U nknown

21.7%

6.0%

41,9%

28-9%

1.2%

1.2%

0.0%

SCC 24 Hour Services

9.9%

14.3%

38.0%

34.1%

0.2%

1.5%

1.9%

SCC Day Services

8.5%

10.2%

46.3%

31.4%

0.4%

1.9%

1.3%

12.7%

28.9%

46.1%

0.9%

1.4%

1.5%

45.3%

1.8%

0.9%

1.1%

Starlight CTF

SCC Outpt Services
SCC Youth MH Pop

8.5%
9 .8%

9 .7%

31.5%

^ Data represent F3' 03-04 unless otherwise indicated and are derived from a Santa Clara county data set, Starbght
information tracking, and aggregate state databases. State information sources include the California Department ofMental
[ \ealth website www.dmh / .cahwnet.gov. County Administrator and Provider Information, Statistics and Data Analyses,
|une 2001 (note: data posted on the state site are pre 2000 figures and may be out-dated); and, California State Department
ofliducation website www.cde.ca.gov. Data and Statistics, 2004.

■Starlight Cultural Competency Plan_rY 05-06

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17 of 22

Starlight (Cultural Competency Plan_Appendix B, Cont’d.
Table Four: Starlight CTF Asian Clients Compared to SCC Youth MH Asian Clients
Other

Pacific

Indian

Cambodian

Chinese

Filipino

Asian

Islander

Vietnamese

Starlight

0.0%

0.0%

0.0%

0.0%

3.0%

0.0%

3.0%

Santa Clara

0.2%

1.0%

1.0%

1.7%

2.1%

0.4%

3.3%

Asian

Table Five: Santa Clara County Demographic Facts
Santa Clara has a Majority-Minorily Population:
Native

African

Santa Clara

American

All Asian

European

Latino

American

Other

2,8%

25.6%

44.0%

24.0%

.7%

5.6''%

Kg Pactsfor Planning Mental I Jealth Semces:
9

9

9

9

9

9

9

Ibc child population of the counw is increasing at a rate double that of adults,
lire rate of legal immigration (per 1,000 population) is die highest in California.
There arc additional high rates of undocumented residents, first generation immigrants, and
persons for whom English is a second language or not acquired.
There is a strong rclationslnp between immigrant status and being uninsuted.
Compared to national statistics, there is a high job loss rate and a poor economic forecast.
One in seven children live in poverty and the percentage of families below self-sufficiency
(income indexed to prices) is higher than in all other Bay Area counties.
Fair market housing rental rates arc higher than any other county in the state.
There are higher levels of environmental contamination compared to most counties in the
countr^^

9

Standards were met or exceeded for many Flealthy People 2010 objectives; however, they
were not met for suicide, drug-induced deaths, incidence of AIDS,and prenatal care among
other health outcomes.

Starlight Cultural CompeteneY Piaii_l'Y 0.5-06

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18of22

Table Six: Ethnicity. Special Prof>rams and Lan^iages of School A^e Youth(SCC.Ala~)

Students by Ethnicity
; Santa Clara County, 2003-04

Students by Ethnicity

I Alameda County, 2003-4
County

County
Percent of
Enrollment
American Indian
Asian

Pacific Islander

1,614
I

0.60%

58,865

23.40%

1,840

0.70%

Filipino

12,817

5.10%

87,397

34.80%

White

Total

[ American Indian
I Asian
i Pacific Islander

1,310
L

0.60%

40,946

18.90%

3,102

1.40%

Filipino

10,900

5.00%

Hispanic

56,870

26.20%

African American

39,352

18.10%

White

60,311

27.80%

4,031
L

1.90%

216,822

100%

8,743

3.50%

75,495

30.10%

4,437

1.80%

Response

100%

Total

Multiple/No

Multiple/No
Response

Percent of
Total

Enrollment

Totals

i Hispanic
i African American

■

251,208 j

r

Special Programs
Alameda County, 2003-04

Special Programs
Santa Clara County, 2003-04

County

County
Participants

i English Learners

Percent of .
Enrollment

English Learners
Free/Reduced

45,067

20.80%

32.20%

Price Meals

75,873

35.70%

5.00%

CalWORKs^

26,440

12.40%

70,231

32.40%

63,389

25.20%

81,640
12,748
L

Free/Reduced

Price Meals
CalWORKs^

Compensatory

Compensatory

I Education

I

Percent of
Enrollment

Participants

25.00%

62,752

Education

I

I Languages of English Learners
; Santa Clara County, 2003-04
Spanish
Vietnamese

Number of

Percent of

Students

Enrollment

41,394

16.50%

7,790

3.10%

Languages of English Learners
Alameda County, 2003-04
Percent of
Enrollment

Number of
Students

Spanish
Cantonese

28,093

13.00%

3,300

1.50%

Tagalog

2,187

0.90%

Vietnamese

2,040

0.90%

Other non-English

1,843

0.70%

Tagalog

1,786

0.80%

1,350

0.60%

8,498

3.90%

45,067

20.80%

Mandarin

Mandarin

(Putonghua)

1,732

0.70%

All Other

8,443

3.40%

63,389

25.20%

Total

.Starlight Cultural Comprtrutv I>lan_FY 1)5-06

(Putonghua)
All Other
Total

KLDv.03/?3/0S

19 of22

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Starlight Cultural (Competency Plan_Appcndix B, Cont’d.
Table Seven: State and Referral Countv Mental Health Service Entollment Rates^
Percent of Eligibles Receiving MH Services
Total Population

Foster Care

Alt Other Youth

Alameda

7.00%

27.13%

2.61%

Santa Clara

7.84%

39.19%

4.32%

Statewide

6.21%

46.68%

2.80%

Percent of Total MH Expenditures by Aid Group
Adult MH Client

Foster Care

All Other Youth

Alameda

77.20%

10.18%

12.62%

Santa Clara

68.00%

10.16%

21.84%

Statewide

70.04%

12.27%

17.69%

Average MH Expenditures per Unduplicated Client
MH Population

Foster Care

All Other Youth

Alameda

$3,734.44

$4,748.26

$2,957.95

Santa Clara

$7,169.11

$8,342.31

$6,161.32

Statewide

$2,531.91

$2,263.45

$2,090.47

Percent of Eligibles Receiving MH Services by Race/Ethnicity
African

Native

Other/

American

All Asian

European

Latino

American

Unknown

Alameda

6.80%

1.78%

10.50%

1.91%

5.36%

14.66%

Santa Clara

9.92%

3.18%

14.16%

3.08%

10.27%

14.85%

Statewide

6.42%

1.95%

9.47%

1.64%

4.34%

16.71%

Percent of Eligibles Receiving MH Services by Age & Gender
Ages 0-17

Age 18-20

Males

Females

Males

Females

Alameda

5.07

2.99

9.36

4.35

Santa Clara

6.66

4.50

8.44

3.96

Statewide

5.27

3.68

7.14

3.79

^ These data are from the state DMH website which provides annual county data from 1991 through 1998. The trend
from 1991 through 1998 is a small, steady increase in MH Mcdi-Cal penetration rates - likely continued through the
present, along with immigrant population influxes in the Bay Area.
Starlight Cultural Compi'lcncy Pian^PY 05-06

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Starlight Cultural Competency Plan_Appendix B, Cont’d.
Table Eight: State Survey Results (Client Items Related to Cultural Competency)
100% -

1 5

90% •
4

80% *
70%

Responses are rated on a

■■

3

60%
50%
40%

30% r
20%
10%
0%

n

M

Treated with

Respect

Respect for

2

••V

V;

-

five point scale, with five
being “Strongly Agree

with a positively worded
statement (desirable).

U

Si
1

0

Spoke with Me in a

Sensitiie to My

Religious/Spiritual Way I Understood

Cultural/Ethnic

Beliefs

Background

Average Score

% Strongly Agree/Agree

Table Nine: 2004 Staff Cultural Competency Training
Diversity Training By Quarter

Trainings arc to be

provided to 100% of
new staff. There arc
Quarter

# New Staff

# Trained

% Trained

Jan-Mar

21

13

62%

Apr-Jun

25

0

0%

Jul-Sep

23

20

87%

Oct-Nov

19

33

171%

Total:

88

66

75%

odrer topics of
training that include
cultural content, dius,
most staff arc

exposed to at least
some relevant

training.

Table Ten: Elimination of Use of Mechanical Restraints

Starlight Use of Mechanical Restraints
Starlight leadership
committed to and then
succeeded m

ehminating us of
mechanical restrahits

vith CTl' youth.

-Starlight Cultural Competency Plan_FY 05-06

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21 of22

Starlight Cultural Competency Plan_Appendix B, Cont’d
Table Eleven: Staff Turn-Over
100-

I

90;:

Turnover has

8oy

been especially
problematic
among social

70 '
60

50 i

work and
40

rehab staff.

30 !
20

10i 0

IstQtr

2nclQtr

3rd Qlr

4th Qtr

1st Qtr

2nd Qtr

3rd Qtr

4th Qtr

2003

2003

2003

2003

2004

2004

2004

2004

■ Clinical (ind.YC's) ■ Nursing oSWs □ Rehab BIBS 0School

Table Twelve: Racial/Ethnic Composition of Starlight CTF Staff
African

Staff Type

American

All Asian

European

Latino

0%

8%

58%

34%

Clinical/Soc. Services

32%

19%

18%

31%

Nursing

26%

36%

19%

19%

8%

8%

76%

8%

7%

7%

72%

14%

0%

19%

27%

54%

Administration/Support

Rehabilitative

School

!

Therapeutic Beh. Srvs.

Table Thirteen: Staff I.angaiages in Addition to English
Language Spoken

% of Staff
28%

Olher (No/ Speajiecl)
French

11%
/o

Manda rin Ch inese

3%

Tagahe,

5%

X'klnamese

3%

Slarlighl Cultural Compotcucy Pian^PY 05-06

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