Staff Training

1. Staff Training • Rights of Person Served • Person and Family Centered Services • Confidentiality • Cultural Competency/Diversity

2. consumer rights • Each consumer shall retain all rights, benefits, and privileges guaranteed by law except those lost through due process of law. • Each consumer has the right to receive services in an environment which provides privacy, promotes personal dignity, and provides opportunity for the consumer to improve his/her functioning. • Each consumer has full benefit of HIPAA and state privacy rights.

3. The release of a consumer’s confidential information shall be guided by confidentiality standards. • Each consumer has the right to receive services suited to his or her condition in a safe, sanitary and humane treatment environment regardless of race, religion, gender, ethnicity, and age, degree of disability, handicapping condition, legal status or sexual orientation. • No consumer shall be humiliated, neglected or sexually, physically, verbally, financially or otherwise abused.

4. No consumer shall be retaliated against or subjected to any adverse change of conditions or treatment because the consumer asserted his or her rights. • Each consumer shall be provided with prompt, competent, and appropriate treatment, and an individualized treatment plan. A consumer shall participate in his or her treatment programs and may consent or refuse to consent to the proposed treatment or concurrent services. The right to consent or refuse to consent may be abridged for those consumers judged incompetent by a court of competent jurisdiction and in emergency situations as defined by law. If the consumer permits, family shall be involved.

5. Every consumer’s record shall be treated in a confidential manner. • Each consumer shall have access to information pertinent to their treatment needs in sufficient time to facilitate their decision making. The information will be offered in a participate in team meetings and treatment planning. • Each consumer shall have a voice in the selection of their service provider. Consumer preferences will be taken into consideration and should it be necessary every effort will be made to find an alternate provider as determined by available resources. If resources are unavailable a referral will be made if the consumer so wishes.

6. No consumer shall be subject to unnecessary, inappropriate or unsafe termination from treatment. • No consumer shall be required to participate in any research project or medical experiment without his or her informed consent as defined by law. Refusal to participate shall not affect the services available to the consumer. Should a consumer choose to participate, QUEST will adhere to research guidelines and ethics. • Each consumer has the right to request the opinion of an outside medical, psychiatric, or legal consultant at his or her own expense or a right to an internal consultation upon request at no expense.

7. A consumer has the right to know why services were refused. In that event, Quest will provide a written explanation of the reasons why services were not provided. Appropriate referrals will me made. • A consumer shall have the right to assert grievances with respect to an alleged infringement on his or her rights. Consumers should expect an investigation and resolution of any infringement of rights. This process is outlined in the Consumer Grievances section of Quest policy.

9. Person and Family centered services • The person-centered approach views the client as their own best authority on their own experience, and it views the client as being fully capable of fulfilling their own potential for growth. • There are core conditions that provide a climate conducive to growth and therapeutic change, these core conditions are: • Unconditional positive regard • Empathic understanding • Congruence Here’s what Carl Rogers says:

10. Here’s what CARF says: • Person and family centered services are based on the strengths, needs, abilities, preferences, desired outcomes, and cultural background of the person or family served.  The individual plan is developed with the input of the persons and/or families served.  Person and family centered services are a way of identifying what people want to achieve and what kind of support they need to reach those goals, hopes, or dreams.  The process considers the needs and goals of the person or family served and develops or directs those services to be provided in a manner that reflects and responds to those needs and goals.

11. The Key Principle Foundations of Person-Centered Services are: • 1. Person-centered services build on the individual’s/family’s strengths, gifts, skills, and contributions. • 2. Person-centered services support personal empowerment, and provides meaningful options for individuals/families to express preferences and make informed choices in order to identify and achieve their hopes, goals, and aspirations. • 3. Person-centered services are a framework for providing services, treatment, supports and interventions that meet the individual’s/family’s needs, and that honors goals and aspirations for a lifestyle that promotes dignity, respect, interdependence, mastery and competence. • 4. Person-centered services support a fair and equitable distribution of system resources.

12. The Key Principle Foundations of Person-Centered Services Continued: • 5. Person-centered services processes create community connections. They encourage the use of natural and community supports to assist in ending isolation, disconnection and disenfranchisement by engaging the individual/family in the community. • 6. Person-centered services see individuals/families in the context of their culture, ethnicity, religion and gender. All the elements that compose a person’s individuality and a family’s uniqueness are acknowledged and valued in the planning process. • 7. Person-centered services support mutually respectful partnerships between individuals/families and providers/professionals, and recognizes the legitimate contributions of all parties.

13. So, what does this mean for all Quest staff? • All consumers are greeted pleasantly and warmly. • All consumers are treated with respect and dignity. • All consumers are informed and included in every aspect of service. • Be sensitive to cultural differences, disabilities, personal preferences, etc.

14. What does it mean for intake and assessment staff? • Ask consumers directly what they want/need. • Discuss assessment and recommendations and utilize their needs/wants. • Get their specific input into the services recommended. • Utilize their strengths, hopes, and goals in determining the best services for them.

15. What does it mean for counseling staff? • Openly discuss service options and fit to consumer want/s needs, capitalize on strengths. • Individualized treatment plans, based on assessment and individual preferences/needs, with goals and objectives that are behavioral, measurable, and ATTAINABLE. • Understanding consumer’s goals, consider stage of change, and their individual recovery process.

16. What does it mean for administration and stakeholders? • Sensitivity to differences in communities and people. • Policies, procedures, and services accounting for differences, needs, requests. • Services provided based on identified needs/wants of groups served. • Willingness and ability to provide a variety of information to a variety of people. • Responsiveness to community partners and supporters.

17. To summarize, what does Person and Family Centered Services mean at Quest? It means that, as representatives of Quest, anyone we come into contact with, deserves our utmost respect and should be treated with kindness, consideration and dignity. Our consumers will receive professional, knowledgeable and compassionate services that utilize consumer input and make use of their strengths, needs, desires, and goals. It means, doing what we do best: Providing quality individualized services.

19. Confidentiality • QUEST adheres to the highest standards of HIPAA and 42 CFR regarding client confidentiality and the privacy of consumer health information. Employees with privileges may have access to “PROTECTED HEALTH INFORMATION.” The purpose of this notice is to help employees understand their duty regarding protected health information and recourse that may be taken by QUEST for violations regarding disclosure of protected health information.

20. Protected Health Information PHI • Protected Health Information includes consumer information, employee information, financial information, other information relating to QUEST, and information proprietary to other companies or persons. Employees may learn of or have access to some or all of this protected health information through a computer system or through service delivery activities.

21. Protected Health Information PHI • Protected health information is valuable and sensitive and is protected by law and QUEST policy. The intent of these laws and policies is to ensure that protected health information will remain confidential and will be used only as necessary to accomplish the mission of the organization. Employees are required to conduct themselves in strict conformance to applicable laws and QUEST policies governing protected health information. Principal obligations in this area are explained below. Employees are required to read and to abide by these duties. The violation of any of these duties will subject employees to discipline, which includes, but is not limited to termination of privileges.

22. As a condition of and in consideration of access to protected health information, employees must: Access protected health information only as needed to perform legitimate duties as an employee affiliated with QUEST. This means among other things that employees: 1. Will only access protected health information for which they have a need to know. 2. Will not in any way divulge, copy, release, sell, loan, review, alter or destroy any protected health information except as properly authorized within the scope of their professional activities affiliated with QUEST. 3. Will not misuse protected health information or carelessly care for protected health information.

23. Confidentiality • 42 CFR part 2 • Health Insurance Portability and Accountability Act (HIPAA) Generally, no personnel of this agency may disclose information in regard to a consumer’s history and treatment, unless the following conditions are present:1. The consumer and/or parent or legal guardian consents in writing.2. The disclosure is allowed by a court order.3. The disclosure is made to medical personnel for research, audit, or program evaluation.

24. Limits of Considentiality Program personnel shall be informed that Federal laws and regulations do not protect any information concerning suspected child abuse, domestic violence, elder abuse or neglect. Disclosure of such information shall be reported to appropriate State and/or local authorities. See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 of the Federal Register for federal laws, and 42CFR Part 2 for federal regulations. Program personnel and agents will also be informed of their “duty to warn” in the event there is a dangerous situation, in the opinion of the clinician, and the consumer and/or others are considered to be in danger. Non-identifying information may occasionally be shared with specific government agencies for statistical and research purposes.

25. Written Consent Upon intake, each consumer and/or family member or legally authorized representative is notified of their rights to confidentiality as a consumer. A consumer’s written consent for the release of information shall be considered valid only if the following conditions have been met:1. The consumer has been informed of the reason and need for the release, the specific information to be released, and the period of time covered by the information to be released.2. The consumer has been informed that treatment services are not contingent upon, or influenced by his or her decision to permit the release of information.3. The consumer’s consent has been given freely and voluntarily.

26. The consent form for the disclosure of consumer information shall be in writing, renewed annually, and must contain the following: ~Consumer’s name and date of birth.~Name and address of facility which is to make the disclosure.~Name of person or agency to which the disclosure is to be made.~Description of information requested to be disclosed.~Purpose or need for the disclosure.~A statement that the consent is subject to revocation at any time, except that action has been taken in the reliance thereon, and a specification of the date, event, or condition upon which it will expire without revocation.~Signature of consumer, or when required, signature of person authorized to sign under that section in lieu of the consumer.~Signature of parent/legal guardian, if consumer is defined by the law as a minor.~Date on which consent is signed by consumer.~Witness Signature

28. Cultural Comepetency/ diversity • QUEST is committed to developing and utilizing the diverse talents and energies of all our employees and contractors. We respect our employees, contractors and all people who are touched by QUEST without regard to their differences or similarities. Our actions and behaviors must demonstrate and confirm our respect for each other and each other's contributions. QUEST leadership, management, direct service personnel and support service positions shall be filled by persons who represent the Oklahoma culture. QUEST will make every attempt to recruit and employ persons who reflect the cultural diversity in the areas that we serve.

29. Our differences and similarities include but are not limited to: • Age and experience • Culture (individual, group and global) • Socio-economic status • Education and training • Job Level • Job tasks and responsibilities • Lifestyle, including marital status, family status and sexual orientation

30. Our differences and similaritiescontinued... • Personal style • Physical and mental abilities • Race, nationality, ethnicity and language • Religion and spiritual beliefs • Thoughts and perspectives • Veteran and active armed service status • Gender

31. QUEST is committed to reflecting the characteristics of our population served by utilizing and assessing intake materials, consumer surveys and other sources. QUEST conducts and participates in public education/activities that promote the elimination of discrimination and stigma as well as advocating for the needs of persons served. In order to reinforce the commitment to our daily work, all QUEST activities, policies, practices and procedures are to be carried out in accordance with this policy. Each employee and contractor is personally responsible and accountable for ensuring that his/her actions and behaviors reflect this policy.

32. What is Cultural Competency? • A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations. Cultural competency is the acceptance and respect for difference, a continuous self-assessment regarding culture, an attention to the dynamics of difference, the ongoing development of cultural knowledge, and the resources and flexibility within service models to meet the needs of minority populations.

33. Cultural Competency • Davis (1997) operationally defines cultural competency as the integration and transformation of knowledge, information, and data about individuals and groups of people into specific clinical standards, skills, service approaches, techniques, and marketing programs that match the individual's culture and increase the quality and appropriateness of health care and outcomes.

34. Cultural Competency • Cultural competency does not refer to the establishment or maintenance of diversity per se. The concept of competency is not related to numbers of representation, either in clients or in service providers. • Competency refers more explicitly to folkways, mores, traditions, customs, formal and informal helping networks, rituals, dialects, and so forth. In these areas, knowledge about various cultures and the development of specific skills and attitudes in providing services in a manner consistent with the client's needs are essential. • The cultural appropriateness of mental health services may be the most important factor in the accessibility of services by people of color. Developing culturally sensitive practices can help reduce barriers to effective treatment utilization. • Rapport building is a critical component of competency development. Knowing whom the client perceives as a "natural helper" and whom he/she views as traditional helpers (such as elders, the church) can facilitate the development of trust and enhance the individual's investment and continued participation in treatment. • Shifts in ethnic diversity are not just about numbers, but also the impact of cultural differences. New approaches are needed in service delivery to address cultural differences among consumers. • As managed care processes extend into the public sector through Medicaid and Medicare, the need to identify a relevant conceptual framework to guide service design and delivery becomes even more evident.

35. Essential Knowledge, Skills, and Attributes to Developing Cultural Competence • Ensuring the provision of culturally competent services to clients places a great deal of responsibility upon the mental health professional. In particular, there are a number of generally expected levels of knowledge, skills and attributes that are essential to providing culturally competent mental health services.

36. Knowledge • Knowledge of clients' culture (history, traditions, values, family systems, artistic expressions). • Knowledge of the impact of racism and poverty on behavior, attitudes, values, and disabilities. • Knowledge of the help-seeking behaviors of ethnic minority clients. • Knowledge of the roles of language, speech patterns, and communication styles in different Recognition of how professional values may either conflict with or accommodate the needs of clients from different cultures.

37. Knowledge Continued... • Knowledge of the impact of the social service policies on clients of color. • Knowledge of the resources (i.e. agencies, persons, informal helping networks, research) available for ethnic minority clients and communities. • Recognition of how professional values may either conflict with or accommodate the needs of clients from different cultures. • Knowledge of how power relationships within communities or institutions impact different cultures.

38. Professional Skills • Techniques for learning the cultures of ethnic minority client groups. • Ability to communicate accurate information on behalf of culturally different clients and their communities. • Ability to openly discuss racial and ethnic differences/issues and to respond to culturally based cues. • Ability to assess the meaning that ethnicity has for individual clients. • Ability to discern between the symptoms of intra-psychic stress and stress arising from the social structure.

39. Professional Skills Continued... • Interviewing techniques that help the interviewer understand and accommodate the role of language in the client's culture. • Ability to utilize the concepts of empowerment on behalf of culturally different clients and communities. • Ability to use resources on behalf of ethnic minority clients and their communities. • Ability to recognize and combat racism, racial stereotypes, and myths among individuals and institutions. • . Ability to evaluate new techniques, research, and knowledge as to their validity and applicability in working with people of color.

40. Personal Attributes • Personal qualities that reflect “genuineness, empathy, non-possessiveness, warmth,” and a capacity to respond flexibly to a range of possible solutions. • Acceptance of ethnic differences between people. • A willingness to work with clients of different ethnic backgrounds. • Articulation and clarification of the worker's personal values, stereotypes, and biases about his/her own and others' ethnicity and social class. Also, recognizing ways that these views may accommodate or conflict with the needs of clients from different cultures.

41. Communication is the key! • Obviously, the most fundamental function of any therapeutic session is communication. We all use verbal and non-verbal ways of expressing ourselves that have been influenced by the culture in which we were raised. These styles can vary dramatically for people from other backgrounds.

42. Communication • Personal Space: In the United States, it is common for people to stand about 3 feet apart when having a personal conversation. In other cultures, people may typically stand close, which may feel awkward to someone unfamiliar with this style. • Eye Contact and Feedback Behaviors: In the United States, individuals are encouraged to look each other directly in the eye and participate actively in feedback behaviors (leaning forward, smiling, nodding, etc.). In contrast, people from other backgrounds may show respect or deference by not engaging in eye contact or participating more passively in their body language. • Interruption and Turn-taking Behaviors: Most Americans have come to expect a conversation to progress linearly, while in other cultures it may be more natural for several people to be talking at once. Listening skills to deal with different turn-taking rules must be developed. • Gesturing: Hand and arm gesturing can vary quite a bit in different cultural backgrounds. In general, extra gesturing should not necessarily be interpreted as excitement since it can just be an ordinary manner of communication, depending on the speaker.

43. Communication continued... • Facial Expression: Variance in this form of communication is also common, and again it is important to not assume that someone is cold or distressed based solely on one's own cultural experience. • Silence: Americans often find it harder to tolerate periods of prolonged silence than do others from different cultures, and may try to fill it in. • Dominance Behaviors: In the United States, prolonged eye contact, an erect posture, looking down at someone with lowered lids, hands on hips, holding the head high are all examples of behavior that may be interpreted as assertive or even aggressive but can vary in different cultures. • Volume: Irritation often results when culturally different speakers consider differing levels of volume acceptable. It is important to remember that each individual may be reacting based on the rules learned in his/her own background and considered normal by his/her peers. • Touching: Persons from cultures outside the U.S. mainstream may perceive someone as cold and aloof if there is not much touching and standing close, while the American may find someone from a different culture a bit rowdy, intrusive, or rude.

44. Do’s and Don’ts • Don’t assume or pretend you know how they experience their culture or yours. • Do ask about their culture, let the consumer educate you! • Don’t make assumptions about their beliefs, spirituality, roles, etc. • Do ask! Be open to learning what is important to the consumer! • Do be respectful, open minded, accepting, warm!

45. The End