Michigan Weaves Cultural Competency into its Substance Misuse Services

Michigan has made cultural competency a major priority of its substance use disorder service delivery system. This goal is being realized in the state’s Office of Recovery Oriented Systems of Care (OROSC)—formerly the Bureau of Substance Abuse and Addiction Services—which oversees all publicly funded substance misuse services. In 2012 the OROSC created a cultural competency toolkit, Transforming Cultural and Linguistic Theory Into Action (PDF | 386 KB), to help substance misuse service providers around the state improve the effectiveness of their prevention, treatment, and recovery efforts and reduce disparities in care.

“To improve client outcomes and service delivery efficiency, it is important to understand the population being assisted,” said Deborah Hollis, director of OROSC. “Our substance abuse and mental health systems are now working together to better serve the people and communities in Michigan. Cultural competency is a crucial component of that effort. It is our goal to build a community of support for our citizenry.”

A Broad View of Health Disparities and Cultural Competency

The risk for experiencing substance misuse, addiction, and other mental health issues, such as depression, is higher among some minority populations and people living in poverty. This results from their relatively limited access to health care, education, and job opportunities, as well as to mental health and substance misuse prevention and treatment services. It stands to reason, then, that achieving health equity—or the attainment of the highest level of health for all people equally and the elimination of health disparities—requires that professionals providing substance misuse services also understand how to recognize and address such health disparities in their work. Cultural competency reduces the potential for inconsistencies among providers and improves the likelihood of positive results.

Cultural competency, a cross-cutting principle of SAMHSA's Strategic Prevention Framework (SPF), refers to the ability of practitioners to interact effectively with people of different cultures and socio-economic backgrounds, including tailoring the delivery services to meet a variety of social, cultural, and linguistic needs. Under Hollis, the OROSC stepped up the state’s efforts around cultural competency—supporting improvements in cultural competency within the OROSC itself as well as its efforts to promote cultural competency among providers across the state.

“Although cultural competency in substance abuse services has been a goal of ours for many years, but our focus used to be narrower, looking to reduce well-documented disparities experienced by underserved racial and ethnic groups,” said Hollis. “This focus is still important, however, today, we’re much more aware that disparities can affect many different disenfranchised population groups, whether those groups are defined by the gender, age, socioeconomic status, sexual orientation, disability, or other characteristics of their members. Successful prevention and treatment of substance abuse requires us to meet people where they are—where they are, not where we hope they are or think they should be.”

“It’s important to understand that cultural competency does not mean stereotyping people,” said Carolyn Foxall, an OROSC prevention specialist. “It is about developing a deep appreciation for diversity and for understanding the need to adapt programs and services in ways that make them more appealing to the population you are trying to reach.”

Toolkit Helps Communities Assess and Improve Their Cultural Competency

The OROSC created the Transforming Cultural and Linguistic Theory Into Action (PDF | 386 KB) toolkit in collaboration with the state’s Cultural Competency Workgroup. It was designed to help the state’s 16 substance misuse coordinating agencies and their service delivery system of providers and community coalitions take meaningful steps toward achieving cultural competence and reducing disparities.

The primary message of the toolkit is this: Delivering effective substance misuse services requires flexibility, respect others’ opinions, and the ability to adapt to different beliefs and lifestyles—all of which comprise the fundamental building blocks for developing cultural and linguistic competence. It also explains that personal biases can lead to assumptions and stereotypes that may hinder the way care is administered. It goes on to explain that when practitioners gain a broader appreciation of people—including understanding how their race, age, gender, socioeconomic status, profession, politics, religion, and other categorical influences impact their lives—the quality of service improves which, ultimately, leads to better outcomes.

Foxall explained that the toolkit contains three different assessment tools to guide agencies and individual providers in measuring their cultural competency and identifying way to improve. “Included in the kit is the assessment tool that the OROSC used to evaluate itself,” said Foxall. “It seemed very important to undergo that process of assessment ourselves as an organization so that we could improve our own cultural competency, and also show agencies around the state that we are following the same process we are asking them to pursue.” The Toolkit suggests that agencies first assess themselves organizationally in terms of their policies and priorities. After that process is well underway, individuals within the agency can begin assessing themselves and the needs of their communities.

In addition to making the Toolkit available across the state, the OROSC also is supporting agencies and organizations as they use the tool. “We’re incorporating discussions of cultural competency into our site visits to our coordinating agencies,” said Foxall. “Those visits provide focused time to talk about the challenges of using the Toolkit and pursuing cultural competency.” The state also has sponsored a number of educational workshops on cultural competency and disparities for substance misuse professionals, and plans to keep up the support going forward.

“It’s a process,” said Foxall. “You can always improve your cultural competency. The coordinating agencies have all had formal policies around cultural competency for several years, and some have really done deep work around implementing those policies. For others, it has been more challenging. The Toolkit and the larger effort that surrounds it is an effort to really bring all of those policies to life and implement them consistently.”

For more information on Michigan’s work in this area, send email to Carolyn Foxall at foxallc@michigan.gov.

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Last Updated: 03/02/2017