CULTURAL COMPETENCE INITIATIVES:

PHILOSOPHY & PRACTICES

RAMS has over thirty years of experience and expertise in providing culturally competent services to the community. Founded in San Francisco's Richmond District in 1974, RAMS offers comprehensive services that aim to meet the behavioral health, social, vocational, and educational needs of the diverse community of the San Francisco Area with special focus on the Asian & Pacific Islander American and Russian-speaking populations. The agency was founded in response to the overwhelming need for culturally inclusive, competent, and appropriate mental health services that were accessible to the residents of the Richmond District; today, RAMS has expanded and enhanced its array of programming to offer varying levels of care and services on-site at various community settings, and more. In addition, RAMS actively participates in advocacy efforts and campaigns to enhance access to care and that raises awareness about mental health. The agency and its programs continue to be known by the local, national, and international community for its innovation and cultural competence. 

As such, RAMS has played a key role in defining and implementing culturally competent mental health and integrated behavioral health services in San Francisco. The agency’s philosophy of care are reflective to that recovery & rehabilitation are more likely to occur where the mental health systems, services and providers have and utilize knowledge and skills that are culturally competent and compatible with the backgrounds of consumers and their families and communities.

RAMS is recognized as a leader in providing culturally competent services, and our programs’ breath, depth, and extensiveness have afforded the agency with a highly regarded reputation. As a result, we have received acknowledgements from the community such as: Asian American Psychological Association, Mayor’s Committee for the Employment of People with Disabilities, San Francisco Department of Public Health, California Department of Rehabilitation, San Francisco International Program, National Asian American Pacific Islander Mental Health Association, and various local and regional representatives (e.g. Mayor Gavin Newsom, SF Board of Supervisors, U.S. Senator Dianne Feinstein, Senator Leland Yee, and former Senator Jackie Speier) for contributing to the community.  

RAMS implements its commitment to cultural competent practice through many activities and initiatives such as:

·         Culturally Competent Treatment in Client's Primary and/or Preferred Language
Majority of the RAMS client population have indicated a non-English language/dialect as their primary/preferred language for treatment services, with a significant portion being an Asian & Pacific Islander or Russian language. As such, our agency maintains policies and procedures to recruit, retain, and promote at all levels a diverse staff and leadership that reflect the multicultural, multilingual diversity of the community. When providing services to clients, not only do we take into consideration the primary/preferred language for services but also the immigration status and level of acculturation. RAMS services are available in over 25 languages and dialects, including Asian languages – Cambodian, Chinese (Cantonese, Mandarin, Toishanese, Taiwanese), Hindi, Japanese, Korean, Lao, Malay, Punjabi, Tagalog, Thai, and Vietnamese – and Russian. In addition, RAMS is conscious of and responsive to the linguistic and literary needs of the community and displays and distributes multi-lingual health information material, signage, and treatment-related documents.

·         Strengthen and Empower the Roles of Consumers
Cultural competence involves the empowerment, active participation, employment, and involvement of consumers, such that agency and program development of structure and services are consumer-driven. RAMS engages in strategies and activities such as:

·        Develop, coordinate, and facilitate multi-lingual client councils and advisory groups to inform agency and program structure & services and policies & practices

·       Distribute program-specific client satisfaction surveys that are culturally relevant with translation, as appropriate

·       Facilitate consumer participation and representation at all levels, such as recruiting consumers as staff and being member on the RAMS Board of Directors

·       Tailor services and therapeutic techniques specific to consumers’ needs and reaching out to consumers and provide services in their natural environments

In addition, RAMS has engaged consumers to be involved in the development of several booklets such as How to Be a Smart Consumer in Managed Care and Consumer Satisfaction Report Card. These booklets were published in five Asian languages: Chinese, Tagalog, Cambodian, Vietnamese and Korean. RAMS also played an active role in the development of The Wellness Guide, a bilingual Chinese/English publication of community resources including health care, elder care, prenatal care, mental health, and community advocacy organizations (produced by U.C. Berkeley with funding by the California Endowment). RAMS has provided consultation services to translate documents and materials for the community, such as California Institute of Mental Health, SF Department of Public Health, and Asian Alliance Against Domestic Violence.

·         Integrating the Client’s Practice of Holistic & Complementary Health Beliefs within the  Scope of Care
Working with cultural competence is an integral aspect and fundamental principle for RAMS’ organizational and program development, planning, polices & procedures, service implementation, staff recruitment & employment practices, and outreach & referral. RAMS respects and honors clients’ holistic & complementary health and medicinal beliefs and engages in ongoing training activities to gain knowledge and understanding about various cultural practices. Also, the agency strives to integrate these activities through collaborative efforts to offer complementary services such as: yoga, acupuncture, massage therapy, movement-oriented groups, literary and music groups, and arts therapy.  To further support the consumer’s engagement in the community, RAMS has an established agreement to obtain free tickets to various performing arts, cultural, and sporting events to be utilized by clients and their families.

·         Wellness Recovery Perspective
RAMS has a well established record for providing integrated behavioral health services (components are both mental health and substance abuse treatment) that is inclusive of the wellness recovery perspective, with programming such as the Wellness Centers Program and the PAES Counseling & Pre-Vocational Services, on-site at fifteen high school campuses and the SF Department of Human Services, respectively.

The wellness recovery perspective is also integral in organizational and programmatic policy & procedures that uphold and reflect the vision for a culturally competent, accessible, and integrated system of care in which “any door is the right door” for those seeking services. RAMS maintains a Welcoming and Access Policy, which describes practices that eliminate barriers to access of services for adults, adolescents, children and their family members, in the request for assistance with mental health, substance abuse or co-occurring disorders. Additional policies and procedures at RAMS also reflect the philosophies of harm reduction and equal access as well as treatment for individuals with co-occurring (mental health and substance use/abuse issues).

In addition, RAMS maintains Integration Partnership agreements with San Francisco Veteran’s Administration Medical Center (SFVAMC) Substance Abuse Programs and Horizons Unlimited to further strengthen and support our coordination of wellness recovery services.  The SFVAMC Substance Abuse Programs offers structured care for adults through all stages of recovery, and include specialized programs such as day hospital, anger management classes, and opiate replacement therapy; Horizons is a youth development and empowerment organization rooted in community service and advocacy providing culturally competent and linguistically sensitive programs that are driven by the needs of our youth and reflect the diversity of the population served.  As partners in the community, RAMS coordinates with SFVAMC Substance Abuse Programs and Horizons Unlimited for services to meet the needs of the adults or children, youth and their families who present with mental health and/or substance abuse/dependence issues.

·         Enhancing the Accessibility of Culturally Competent and Community-Based Services
RAMS provides a community-based system of care that includes a full continuum of services. The focus is on treating the consumer in the least restrictive community setting (e.g., outpatient, residential care, vocational training program, schools, community centers), and investing in early intervention and prevention efforts (e.g., consultation programs to 0-5 year olds in pre-school and community building efforts). Services and facilities are made geographically accessible by providing services in more than 40 different sites including schools, childcare centers, youth centers, resource and community centers for refugees and other social service agencies. RAMS also offers evening and Saturday clinic hours. To respect the cultural beliefs of many Asian immigrants and refugees, holistic approaches to assessment and treatment are encouraged and highly valued.

·         Leadership in the Training and Development of Culturally Competent Mental Health Professionals
RAMS offers valuable clinical training for both undergraduate and graduate students in the fields of psychology, social work, counseling, nursing, medicine, psychiatry, and other mental health disciplines. The National Asian American Psychology Training Center (NAAPTC) provides training for APA-approved, full-time pre- and post-doctoral psychology internships. The training incorporates psychodynamic approaches that emphasize contemporary relational approaches to working with chronically disturbed patients, who make up a substantial proportion of the clientele. RAMS maintains a collaboration with the San Francisco Center for Psychoanalysis whose members provide clinical supervision, serve as discussants at clinical case conferences, and conduct didactic trainings on clinical issues. Funded in the past by the National Institute of Mental Health, NAAPTC is the first training program in the United States to focus on the development of psychologists with expertise in working with Asian & Pacific Islander American population. Also, RAMS played an instrumental role in collaborating with the National Asian American Pacific Islander Mental Health Association (NAAPIMHA) to develop the Growing Our Own curriculum, the first national effort in creating a core curriculum for mental health related disciplines to provide culturally competent services to the Asian & Pacific Islander communities.

In addition, RAMS is committed to maintaining and further enhancing the cultural competence of staff, interns, and trainees by coordinating various clinical trainings and conferences on topics that specifically address various cultural issues. On a regular basis at RAMS, there are clinical presentations, case conferences, didactic trainings, and group discussions at which local, nationwide, and internationally renowned experts are invited to present on evidenced-based treatment modalities for specific issues and cultural groups.    

Many RAMS staff have also served on expert panels and lead presenters for local, national, and international association conferences, professional organizations, government agencies, and community-based centers with topics that focus on best practices and cultural competent care. RAMS’ various sites receive visitors from mental health institutions, government agencies, and university faculty & students from other countries such as Japan, Korea, China, and Russia in order to learn about the program structure and client services. 

·         Raise Awareness and Reduce the Stigma of Mental Health in the Community
Cultural competency works at all levels of internal and external community involvements, including macro-level engagement with constituents. Raising awareness about mental health also reduces the stigma about seeking services and promotes detection, early intervention, and prevention of the impact of mental health conditions. RAMS engages in strategies and activities such as:

·         Sponsor and participate in health and neighborhood fairs, serving as a multilingual resource for the community and outreach about mental health conditions and services

·         Actively advocate and impact public policy at various local and state meetings to determine community needs and develop and implement culturally relevant strategies and techniques

·         Facilitate workshops about mental health conditions in the community at health fairs, schools, and/or community centers

·         Facilitate workshops for the professional healthcare community about providing cultural competent services at conferences/conventions

·         Establish formal collaborations with other agencies/programs to provide culturally-focused consultation and case conferences

·         Participate in efforts that further enhance the accessibility of psycho-educational materials, including translation projects

In addition, RAMS actively participate in efforts to bring awareness about mental health through media and/or public campaigns. Various media entities, such as KQED, San Francisco Chronicle, Los Angeles Times, Mental Health Weekly, KTSF-26, KMTP-32 (World Channel), Sing Tao (Radio and Newspaper), Ming Pao, World Journal, Philippine News, and The Richmond Review consult with and utilize RAMS to provide expert commentary on relevant issues and matters.

To raise awareness and address the stigma of mental health, RAMS also actively participates in and are members of various culturally-focused community coalitions and/or committees such as:  San Francisco Asian & Pacific Islander Health Parity Coalition, Asian Youth Advisory Network – Behavioral Health Committee, Asian Alliance Against Domestic Violence, SF Vietnamese Providers Committee, NICOS Chinese Health Coalition, and Westside Health Coalition as well as work in collaboration with organizations (e.g. Chinese Hospital of San Francisco, Asian Mental Health Task Force, etc.) to assess how to better serve the Asian & Pacific Islander community. 

·         Contribute to the Development and Evaluation of Culturally Competent Treatment Strategies and Techniques
RAMS actively engages in and practices innovative treatment approaches of which have been proven and proposed as culturally competent strategies for specific communities. In partnership with various universities and researchers, the agency is involved with research projects, studies, and activities that further evaluate effectiveness of various treatments and/or provide insight of mental health conditions in the Asian & Pacific Islander American community. Such topics include: domestic violence, treatment strategies with Asian & Pacific Islander American groups, vocational rehabilitation, problem gambling, depression & suicide, early childhood & parenting issues, and substance abuse.

·         Organizational Leadership and Management
Historically and currently, the demographic makeup of RAMS Board of Directors is representative of the populations served by the organization. RAMS Board members include professionals, consumer advocates, leaders and members of different Asian and Russian communities as well as have experience working in the SF mental/public health field and/or the ethnic/cultural communities served by RAMS.

As RAMS maintains policies and practices to recruit, retain, and promote at all levels diverse service providers and leadership that reflect the multicultural, multilingual community, the RAMS staff and management appropriately represent various cultures and ethnicities. They are aware of the unique needs of the communities, its levels of complexities, and changing dimensions. The staff members have demonstrated extensive experience and knowledge in cultural competence and working with various groups. In addition, RAMS is committed to promoting within such that many directors, managers, and supervisors have had previous experiences at RAMS as direct service providers and/or former trainees or interns.