Diverse workforce can serve diverse patient populations

As behavioral healthcare organizations know all too well, addiction does not discriminate. People of every race, ethnicity, gender and sexual orientation seek addiction treatment and mental health services. But can a behavioral healthcare organization that does not have a diverse staff and leadership meet the needs of those diverse populations?

That is a growing challenge among for-profit and not-for-profit organizations alike.

“It is very important that a treatment center’s workers, in particular, counselors, nurses and doctors, reflect the face of the community,” says Bill Prasad, vice president of clinical programming for Lifeway International in Houston.

He notes that one way to build trust in the patient/provider relationship often involves patients seeing staff as potential mentors or role models.

“If you are African-American, and there is no one on staff who is African-American, that may send the wrong message that, at times, will fracture the alliance we want to create between a medical provider and a patient.”

And according to a Deloitte international survey, about 70% of business executives rate diversity and inclusion an important issue but less than half (48%) consider their organizations adequate in focusing on global cultural diversity. Of the 140,000 respondents, 81% also rated talent acquisition an important trend.

 In general, diversity affects three areas: staffing, leadership development and patient care.

Diversity and staffing

Increasing diversity has been and continues to be a goal for behavioral healthcare organizations. How well they progress toward meeting that goal is often a function of leadership. If a treatment center uses the same sources and methods to recruit staff year after year, it is likely to limit itself to hiring people from a relatively static pool of candidates. Therefore, expanding strategic recruitment efforts is essential.

Prasad recommends getting involved in community activities and attending various professional and social gatherings to build a local network. Lunch and learn panels, regional conferences and association meetings are also opportunities to scope out potential candidates and make your recruitment needs known.

“It should always be on your radar to be looking for a diverse group of people,” says Prasad.

While race, ethnicity, gender and sexual orientation have long been the cornerstones of diversity, a more refined level of diversity often expands to include religious practice and affiliation, personality and residential neighborhood. Yet, because it is difficult—or illegal in some situations—to hire with these traits in mind, treatment centers instead should nurture broad cultural competency among staff so that they can connect effectively with many different types of people. This cultural competency can be backed with a culture of inclusion.

“Diversity is a measure, but a culture of inclusion is a mechanism. And inclusion is a step beyond diversity and means the provider is open to new perspectives,” says Lindsay Hough, a principal with Deloitte Consulting LLP in Harrisburg, Pa.

Cultural competency includes the ability to work with and understand different types of people with different knowledge, beliefs and behavior. For example, comfort levels with personal space or simple contact, such as a handshake, can be extremely low in certain cultures, while others might revel in an embrace. Given the close nature of the provider/patient relationship, such inclusion and cultural competency is crucial from an operational standpoint.

“Training in cultural competence goes beyond just being sensitive and being careful,” says Prasad. “It addresses questions like, ‘Whose responsibility it is to understand a client’s culture or ethnic background?’”

He adds that not that everyone in an identifiable ethnic group will follow the same characteristics specifically, however, so bias and stereotyping must be addressed as well.

Diversity and leadership

When it comes to diversity, executives have a twofold challenge. First, leaders must make diversity, inclusion and cultural competency priorities throughout the organization. Second, leaders must identify ways to increase diversity within the leadership ranks and the succession pipeline.

“We have a problem when it comes to who advances and who does not,” says Linda Rosenberg, president and CEO of the National Council for Behavioral Health. “I don’t think it is necessarily different in other industries, but we are an industry that prides itself on being mission-driven and dealing with issues of social justice.”

Rosenberg cautions that in behavioral health, leadership positions tend to be occupied by white/Caucasian individuals while the staff tends to be more diverse up to the middle management level. National Council offers a health disparities program as well as a middle-management coaching academy to support development efforts.

Overall, those in the C-suite must demonstrate that they are accountable for diversity and inclusion. Accountability is reflected in strategies to address shortfalls and concrete steps to make inclusion work at all levels of the organization.

For example, a CEO might evaluate how the organization is addressing any real or perceived bias in recruitment efforts. Leaders should consider routine training for inclusion and cultural competency with a program that is created with staff input, says Hough.

“They must also measure how they are doing in these areas,” she says. “They must make sure that they are not just acquiring diversity in staffing but finding ways to advance and promote that staff.”

Diversity and patient care

A provider might need to adjust a long-standing strategy when considering a diverse patient population. And the individuality of patients is seemingly endless. One way to develop the necessary cultural competency to serve a diverse patient population is work with local communities to identify the best channels for engagement.

 “Ethnic minorities or other diverse populations have a history of seeking or utilizing the support of religious resources rather than” seeking treatment in a behavioral healthcare setting, says Ryan Potter, director of clinical development at Ambrosia Treatment Centers with facilities in Florida, California and New Jersey. He urges providers to reach out through established community channels to find a way to bring people into treatment sooner when necessary.

“This is a complex problem that will not be solved by one intervention,” says Rosenberg. “Pay attention, acknowledge the problem and measure it. If you want to develop an environment where everyone feels welcome, you must make it a conscious decision.”

Joanne Sammer is a freelance writer based in New Jersey.

Minority populations are growing in the U.S.

Racial and ethnic minorities currently make up about a third of the U.S. population and are expected to become a majority by 2050, according to SAMHSA. Communities of color tend to experience a greater burden of mental and substance use disorders, often due to poorer access to care; inappropriate care; and higher social, environmental and economic risk factors.

African Americans

• 44.5 million people
• 12.4% reported illegal drug use in the last month in 2014
• 21.6% reported binge drinking
• 16.3% reported any mental illness in the past year for adults

American Indians and Alaska Natives

• 5.2 million people
• 14.9% reported illegal drug use in the last month
• 14.3% reported past-month underage binge drinking
• 21.2% reported a past-year mental illness

Asian Americans, Native Hawaiians and Other Pacific Islanders

• 18.2 million people
• 4.1% of Asian Americans and 15.6% Native Hawaiians or other Pacific Islanders reported illegal drug use
• 13.1% of Asian American adults reported past-year mental illness

Hispanics or Latinos

• 52 million people
• 8.9% reported illicit drug use in the past month
• 24.7% reported binge alcohol use
• 15.6% of adults reported a past-year mental illness
• 3.5% of adults had a serious mental illness
• 3.3% had a co-occurring mental health and substance use disorder

Source: “Racial and Ethnic Minority Populations,” SAMHSA.gov, accessed April 13, 2017.