Cultural Competency Plan Evaluation

Updated April 2020

Carisk Behavioral Health has recently completed the annual evaluation of its Cultural Competency Plan (CCP). The summary below reflects an assessment of the plan’s key elements and its effectiveness in meeting the goals of the CCP.

1. Member Experience Survey

A review of the most recent member experience survey data reflects that over 58% of adult respondents and 76% of child respondents identified with a non-White ethnicity. Below are the statistics regarding the self-identified ethnicity of the adult and child respondents:

ADULT:

Survey Respondent Percentages by Race (Adults) n=2342 Adult Race Percentage Black 37.2% Hispanic 12.0% White 41.9% Multiracial 3.2% Unknown 1.3% Other 4.0% Asian 0.5% Native Hawaiian or Pacific Islander 0.2%

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Adult Member Survey Respondents by Race 4.0% 0.5% 3.2% 1.3% 0.2%

37.2%

41.9%

12.0% Black Hispanic White Multiracial Unknown Other Asian Native Hawaiian or Pacific Islander

Adult Member Survey Respondents by Hispanic Ethnicity 1% 12%

87%

Hispanic Not Hispanic Unknown

CHILD:

Survey Respondent Percentages by Race (Children) n=635 Child Race Percentage Black 45.5% Hispanic 19.9% White 23.3% Multiracial 5.9% Unknown 2.6% Other 2.3% Asian 0.3% Native Hawaiian or 0.2% Pacific Islander

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Child Survey Respondents by Ethnicity 2% 6% 3% 0% 0% 23% 46%

20%

Black Hispanic White Multiracial Unknown Other Asian Native Hawaiian or Pacific Islander

Child Member Survey Respondents by Hispanic Ethnicity

0%

20%

80%

Hispanic Not Hispanic Unknown

Based on the survey questions regarding respect for culture and ethnicity, the results below show that both child and adult members are highly satisfied with their treatment as it relates to these factors, and no corrective action is necessary; however, programs are consistently reviewed for their appropriateness to member’s needs and preferences.

Cultural Competency Questions from Survey: ADULT (n=2342) Item Number Percent Agreed, or Favorable Response 1. I was treated with respect. 92.1%

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18. The staff is sensitive to my 88.2% cultural/ethnic background. 19. The services focus on my 88.3% needs.

CHILDREN (n=635) Item Number Percent Agreed, or Favorable Response 1. I was treated with respect. 94.9% 15. Staff respected my ethnic 93.4% background. 20. I was free to practice my 91.7% religion.

2. Provider Network Regarding Race, Ethnicity, and Cultural Needs

Race, ethnicity, and cultural needs. Carisk assesses its membership to determine if there are needs specific to this population that can be met by the characteristics of the provider network. According to a demographic profile done for Carisk members, the South population, in general, and the Carisk member population, specifically, have a higher-than- average percentage of Hispanics, blacks, and Creole-speaking Haitian- who may require that providers speak Spanish or Creole in addition to English, and be sensitive to the cultural and ethnic needs of Hispanics and Caribbean-Americans. Carisk strives to have appropriate providers available for this large group of Hispanics and Creole-speakers.

The Carisk credentialing and re-credentialing applications do not ask any information regarding race and ethnicity; however, to assist members in seeking treatment from a provider who speaks a specific language or with whom they feel a cultural and/or ethnic connection, there is a question on the application that asks providers their spoken languages:

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There is also a question on the provider application regarding attributes that members may look for in choosing a provider with a specific area of expertise, type of therapy, or who is sensitive to their cultural and ethnic background:

Carisk tracks and trends the languages in which providers can use in treating their patients. According to the Carisk member demographic analysis (derived from the latest United States Census Data [2019]), the ethnic breakdown is 69.1% Hispanic in - Dade county, 30.4% in Broward county, and 22.9% in Palm Beach county. Per the Sun Sentinel in June 2017, the Haitian community in Florida was estimated to be about 300,000, and the population growth for people with Haitian ancestry had increased 18% in Miami-Dade County, 24% in Broward, and 43% in Palm Beach County between 2007 and 2015, compared to an overall population increase in these three counties of only 11%, 4%, and 9%, respectively.

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The majority of Carisk’s membership is in South Florida, so the table below shows a breakdown of the percentages of Spanish-speaking and Creole-speaking providers by county and license level in the South Florida Carisk network:

Providers who speak Spanish or Creole - Language Breakdown by County/License Level – 2019

SPANISH Masters County Doctoral Level Psychiatrist

Broward 21.8% 38.0% 61.4%

Miami-Dade 58.7% 66.4% 62.9%

Palm Beach 22.7% 20.0% 50.0%

CREOLE Masters County Doctoral Level Psychiatrist

Broward 1.3% 5.7% 11.4%

Miami-Dade 3.6% 5.4% 5.0%

Palm Beach 9.1% 1.7% 3.3%

There are a total of 45 Florida counties with Spanish-speaking Carisk providers, and 17 Florida counties with Creole-speaking Carisk providers. The below charts show the counties statewide with providers who speak Spanish and Creole. The percentages in the charts reflect the number of Spanish- or Creole-speaking providers as a percentage of all providers in the state who speak that language (only the top values are called out).

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Providers by County who speak Spanish (counties w/o callouts =< 1%)

Palm Beach St. Lucie 2% 6% Broward Osceola 19% 3%

Orange 3%

Miami-Dade Hillsborough 41% 4% Alachua Bay Brevard Broward Charlotte Citrus Clay Collier Desoto Duval Escambia Flagler Hardee Hendry Hernando Highlands Hillsborough Indian River Jackson Lake Lee Leon Manatee Marion Martin Miami-Dade Monroe Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota St. Johns St. Lucie Sumter Volusia

Providers by County who speak Creole (counties w/o callouts =< 1%) St. Lucie Palm Beach 4% Broward 9% 24%

Hillsborough 2%

Martin Indian River 3% 2% Miami-Dade 42% Brevard Broward Collier Duval Hendry Hernando Hillsborough Indian River Martin Miami-Dade Okaloosa Okeechobee Orange Osceola Palm Beach Polk Seminole St. Lucie Volusia

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Extrapolating the census percentages for Hispanics in South Florida’s three counties and population estimates for people of Haitian ancestry to the Carisk member population, it can be seen in Table 1 and Figures 1 and 2 above that there are sufficient numbers of Spanish-speaking and Creole-speaking providers to adequately serve Carisk’s members of Hispanic or Haitian ancestry.

Carisk has observed over time that those members from the enrollee population who have sought services (those who call the Carisk member services department), about 10% of callers choose the Spanish-speaking option in the automated call distribution system. In 2019, this number decreased to 7.50%. The majority of Hispanic-identified members seem to be comfortable speaking English. Because the statistics above show that Carisk has sufficient provider coverage if the majority of Hispanic members wanted to receive treatment in Spanish, and most of the member population chooses to speak English, Carisk providers more than adequately cover these main linguistic requirements.

In addition to English, Spanish, Creole, and sign language, other languages spoken by Carisk providers include: Afrikaans Gujarati Romanian

Arabic Hebrew Russian

Bangla Hindi Swedish

Bengali Italian Tagalog Bulgarian Kannada Tamil

Czech Malayalam Telugu Dutch Mandarin Ukrainian

Farsi Polish Urdu French Portuguese Yiddish

German Punjabi

For any member who speaks a language other than those above, Carisk contracts with a translation service; however, Carisk has not had any language requests that are not listed above for the provider network.

We have concluded that this data suggests that our Provider network is currently meeting the language and cultural needs of our members.

3. QI Educational Materials for ADHD and MDD

All educational materials for members identified as being diagnosed with ADHD or MDD are available in both English and Spanish. Information on the website is also available in both languages.

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There have been no requests for materials in any other language; however, a translation service is available if this need arises.

4. Member Complaints and Grievances

There have been no complaints registered by members regarding cultural or ethnic issues.

5. Provider Complaints

There have been no complaints registered by providers regarding cultural or ethnic issues.

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