2017 PA System of Care Cultural & Linguistic Competency Assessment

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* 1. Please List Your County within Pennsylvania

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* 2. Please select your affiliation (check all that apply):

Youth

Family Member/ Guardian/ Caregiver

Staff

SOC County Leadership Team / Governance/ Advisory Board

Cultural Broker

Provider

System Partner

Other (please specify)

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* 3. Does your county have culturally appropriate services to support diverse youth and families from the following communities?

	Not At All	Barely	Fairly Well	Very Well	Unsure
Black or African American	Black or African American Not At All	Black or African American Barely	Black or African American Fairly Well	Black or African American Very Well	Black or African American Unsure
Hispanic	Hispanic Not At All	Hispanic Barely	Hispanic Fairly Well	Hispanic Very Well	Hispanic Unsure
Asian or Pacific Islander	Asian or Pacific Islander Not At All	Asian or Pacific Islander Barely	Asian or Pacific Islander Fairly Well	Asian or Pacific Islander Very Well	Asian or Pacific Islander Unsure
American Indian or Alaska Native	American Indian or Alaska Native Not At All	American Indian or Alaska Native Barely	American Indian or Alaska Native Fairly Well	American Indian or Alaska Native Very Well	American Indian or Alaska Native Unsure
White	White Not At All	White Barely	White Fairly Well	White Very Well	White Unsure
Multi-Racial	Multi-Racial Not At All	Multi-Racial Barely	Multi-Racial Fairly Well	Multi-Racial Very Well	Multi-Racial Unsure
Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ)	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Not At All	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Barely	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Fairly Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Very Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Unsure

Other (please specify)

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* 4. Does your county have culturally appropriate services to support diverse youth and families from the following communities?

	Not At All	Barely	Fairly Well	Very Well	Unsure
Black or African American	Black or African American Not At All	Black or African American Barely	Black or African American Fairly Well	Black or African American Very Well	Black or African American Unsure
Hispanic	Hispanic Not At All	Hispanic Barely	Hispanic Fairly Well	Hispanic Very Well	Hispanic Unsure
Asian or Pacific Islander	Asian or Pacific Islander Not At All	Asian or Pacific Islander Barely	Asian or Pacific Islander Fairly Well	Asian or Pacific Islander Very Well	Asian or Pacific Islander Unsure
American Indian or Alaska Native	American Indian or Alaska Native Not At All	American Indian or Alaska Native Barely	American Indian or Alaska Native Fairly Well	American Indian or Alaska Native Very Well	American Indian or Alaska Native Unsure
White	White Not At All	White Barely	White Fairly Well	White Very Well	White Unsure
Multi-Racial	Multi-Racial Not At All	Multi-Racial Barely	Multi-Racial Fairly Well	Multi-Racial Very Well	Multi-Racial Unsure
Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ)	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Not At All	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Barely	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Fairly Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Very Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Unsure

Other (please specify)

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* 5. How well does your county understand how the causes of mental health/illness are viewed by diverse groups in your area?

	Not At All	Barely	Fairly Well	Very Well	Unsure
Black or African American	Black or African American Not At All	Black or African American Barely	Black or African American Fairly Well	Black or African American Very Well	Black or African American Unsure
Hispanic	Hispanic Not At All	Hispanic Barely	Hispanic Fairly Well	Hispanic Very Well	Hispanic Unsure
Asian or Pacific Islander	Asian or Pacific Islander Not At All	Asian or Pacific Islander Barely	Asian or Pacific Islander Fairly Well	Asian or Pacific Islander Very Well	Asian or Pacific Islander Unsure
American Indian or Alaska Native	American Indian or Alaska Native Not At All	American Indian or Alaska Native Barely	American Indian or Alaska Native Fairly Well	American Indian or Alaska Native Very Well	American Indian or Alaska Native Unsure
White	White Not At All	White Barely	White Fairly Well	White Very Well	White Unsure
Multi-Racial	Multi-Racial Not At All	Multi-Racial Barely	Multi-Racial Fairly Well	Multi-Racial Very Well	Multi-Racial Unsure
Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ)	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Not At All	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Barely	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Fairly Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Very Well	Lesbian, Gay, Bi, Transgender, and Questioning (LGBTQ) Unsure

Other (please specify)

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* 6. Does your county have the following CLC supports? (check all that apply)

County CLC Plan

CLC Coordinator

CLC Mission Statement

Annual CLC Assessment (Quality Improvement Measures)

CLC Trainings

CLC Printed Materials/Resources

Unsure

Other (please specify)

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* 7. As a matter of formal policy, does your county. . .

	No Policy	Considering Policy	Currently Writing Formal Policy	Policy In Place	Unsure
use culture specific treatment approaches?	use culture specific treatment approaches? No Policy	use culture specific treatment approaches? Considering Policy	use culture specific treatment approaches? Currently Writing Formal Policy	use culture specific treatment approaches? Policy In Place	use culture specific treatment approaches? Unsure
envision community empowerment as a treatment goal?	envision community empowerment as a treatment goal? No Policy	envision community empowerment as a treatment goal? Considering Policy	envision community empowerment as a treatment goal? Currently Writing Formal Policy	envision community empowerment as a treatment goal? Policy In Place	envision community empowerment as a treatment goal? Unsure
provide or facilitate childcare for youth and families?	provide or facilitate childcare for youth and families? No Policy	provide or facilitate childcare for youth and families? Considering Policy	provide or facilitate childcare for youth and families? Currently Writing Formal Policy	provide or facilitate childcare for youth and families? Policy In Place	provide or facilitate childcare for youth and families? Unsure
provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)?	provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)? No Policy	provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)? Considering Policy	provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)? Currently Writing Formal Policy	provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)? Policy In Place	provide or facilitate transportation for youth and families (e.g., bus tickets, ride-sharing)? Unsure
allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)?	allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)? No Policy	allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)? Considering Policy	allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)? Currently Writing Formal Policy	allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)? Policy In Place	allow access after regular business hours for youth and families (e.g., agreements with crisis-providers, etc.)? Unsure
specifically consider culture in service plans?	specifically consider culture in service plans? No Policy	specifically consider culture in service plans? Considering Policy	specifically consider culture in service plans? Currently Writing Formal Policy	specifically consider culture in service plans? Policy In Place	specifically consider culture in service plans? Unsure

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* 8. Is your County able to describe the languages and dialects used by diverse groups in your service area?

Not at All

Barely

Fairly Well

Very Well

Unsure

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* 9. Does your County have a mission statement that incorporates cultural and linguistic competence?

Yes

Unsure

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* 10. Does your County identify opportunities within culturally diverse communities for you to:

	Not At All	Sometimes	Fairly Often	Very Often	Unsure	Not Available in my County
Attend cultural or ceremonial functions?	Attend cultural or ceremonial functions? Not At All	Attend cultural or ceremonial functions? Sometimes	Attend cultural or ceremonial functions? Fairly Often	Attend cultural or ceremonial functions? Very Often	Attend cultural or ceremonial functions? Unsure	Attend cultural or ceremonial functions? Not Available in my County
Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)?	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Not At All	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Sometimes	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Fairly Often	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Very Often	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Unsure	Purchase goods or services from a variety of diverse merchants (either for personal use or job-related duties)? Not Available in my County
Support immigrant populations?	Support immigrant populations? Not At All	Support immigrant populations? Sometimes	Support immigrant populations? Fairly Often	Support immigrant populations? Very Often	Support immigrant populations? Unsure	Support immigrant populations? Not Available in my County
Support refugee populations?	Support refugee populations? Not At All	Support refugee populations? Sometimes	Support refugee populations? Fairly Often	Support refugee populations? Very Often	Support refugee populations? Unsure	Support refugee populations? Not Available in my County
Participate in recreational or leisure time activities important to diverse communities?	Participate in recreational or leisure time activities important to diverse communities? Not At All	Participate in recreational or leisure time activities important to diverse communities? Sometimes	Participate in recreational or leisure time activities important to diverse communities? Fairly Often	Participate in recreational or leisure time activities important to diverse communities? Very Often	Participate in recreational or leisure time activities important to diverse communities? Unsure	Participate in recreational or leisure time activities important to diverse communities? Not Available in my County
Participate in career awareness days to support a diverse workforce?	Participate in career awareness days to support a diverse workforce? Not At All	Participate in career awareness days to support a diverse workforce? Sometimes	Participate in career awareness days to support a diverse workforce? Fairly Often	Participate in career awareness days to support a diverse workforce? Very Often	Participate in career awareness days to support a diverse workforce? Unsure	Participate in career awareness days to support a diverse workforce? Not Available in my County
Participate in community education activities?	Participate in community education activities? Not At All	Participate in community education activities? Sometimes	Participate in community education activities? Fairly Often	Participate in community education activities? Very Often	Participate in community education activities? Unsure	Participate in community education activities? Not Available in my County

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* 11. Does your county have linkages with institutions of higher education (e.g., colleges, universities, or
professional schools) that could provide you with accurate information concerning communities of
color and CLC?

None

A Few

Some

Many

Unsure

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* 12. Is there policy for the provision of interpretation services for youth and families with Limited English Proficiency and those who are deaf or have hearing impairments?

No policy

Informal policy

Developing policy

Formal policy

Unsure

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* 13. Does your County:

	Never	Seldom	Sometimes	Regularly	Unsure
Translate and use consent forms, educational materials and other information in other languages?	Translate and use consent forms, educational materials and other information in other languages? Never	Translate and use consent forms, educational materials and other information in other languages? Seldom	Translate and use consent forms, educational materials and other information in other languages? Sometimes	Translate and use consent forms, educational materials and other information in other languages? Regularly	Translate and use consent forms, educational materials and other information in other languages? Unsure
Insure materials address the literacy needs of the person served?	Insure materials address the literacy needs of the person served? Never	Insure materials address the literacy needs of the person served? Seldom	Insure materials address the literacy needs of the person served? Sometimes	Insure materials address the literacy needs of the person served? Regularly	Insure materials address the literacy needs of the person served? Unsure
Assess the health literacy of person served?	Assess the health literacy of person served? Never	Assess the health literacy of person served? Seldom	Assess the health literacy of person served? Sometimes	Assess the health literacy of person served? Regularly	Assess the health literacy of person served? Unsure
Employ specific interventions based on the health literacy levels of persons served?	Employ specific interventions based on the health literacy levels of persons served? Never	Employ specific interventions based on the health literacy levels of persons served? Seldom	Employ specific interventions based on the health literacy levels of persons served? Sometimes	Employ specific interventions based on the health literacy levels of persons served? Regularly	Employ specific interventions based on the health literacy levels of persons served? Unsure

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* 14. Does your County have the following available in languages other than English? (Check all that apply)

Website

Consent Forms

Brochures

Posters

Family Resource Guides

Youth Resource Guides

Unsure

Other (please specify)

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* 15. Does your County reach out to and engage the following individuals, groups, or entities in health and mental health promotion and disease prevention initiatives:

	Never	Seldom	Sometimes	Regularly	Unsure
Places of worship and spiritual leaders?	Places of worship and spiritual leaders? Never	Places of worship and spiritual leaders? Seldom	Places of worship and spiritual leaders? Sometimes	Places of worship and spiritual leaders? Regularly	Places of worship and spiritual leaders? Unsure
Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine?	Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine? Never	Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine? Seldom	Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine? Sometimes	Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine? Regularly	Traditional healers, medicine people, naturopath, herbalists, etc.? Providers of complimentary and alternative medicine? Unsure
Mental health providers, dentists, chiropractors, or licensed midwives?	Mental health providers, dentists, chiropractors, or licensed midwives? Never	Mental health providers, dentists, chiropractors, or licensed midwives? Seldom	Mental health providers, dentists, chiropractors, or licensed midwives? Sometimes	Mental health providers, dentists, chiropractors, or licensed midwives? Regularly	Mental health providers, dentists, chiropractors, or licensed midwives? Unsure
Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources?	Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources? Never	Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources? Seldom	Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources? Sometimes	Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources? Regularly	Ethnic publishers, radio, cable or television stations or personalities, or other ethnic media sources? Unsure
Tribal, cultural, or advocacy organizations?	Tribal, cultural, or advocacy organizations? Never	Tribal, cultural, or advocacy organizations? Seldom	Tribal, cultural, or advocacy organizations? Sometimes	Tribal, cultural, or advocacy organizations? Regularly	Tribal, cultural, or advocacy organizations? Unsure
Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)?	Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)? Never	Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)? Seldom	Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)? Sometimes	Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)? Regularly	Local business owners (e.g., barbers, sports clubs, restaurateurs, casinos, and other ethnic businesses)? Unsure
Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)?	Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)? Never	Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)? Seldom	Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)? Sometimes	Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)? Regularly	Social organizations (e.g., civic/neighborhood associations, sororities, fraternities, ethnic associations)? Unsure

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* 16. Does your county conduct an open house or similar event to which providers, consumers, and others concerned with service delivery to communities of color are invited?

Not At All

Seldom

Sometimes

Often

Unsure

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* 17. Does your county utilize cultural consultants who can help them work more effectively within a cultural context?

Not At All

Seldom

Sometimes

Often

Unsure

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* 1. Please List Your County within Pennsylvania

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* 2. Please select your affiliation (check all that apply):

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* 3. Does your county have culturally appropriate services to support diverse youth and families from the following communities?

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* 4. Does your county have culturally appropriate services to support diverse youth and families from the following communities?

Question Title

* 5. How well does your county understand how the causes of mental health/illness are viewed by diverse groups in your area?

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* 6. Does your county have the following CLC supports? (check all that apply)

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* 7. As a matter of formal policy, does your county. . .

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* 8. Is your County able to describe the languages and dialects used by diverse groups in your service area?

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* 9. Does your County have a mission statement that incorporates cultural and linguistic competence?

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* 10. Does your County identify opportunities within culturally diverse communities for you to:

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* 11. Does your county have linkages with institutions of higher education (e.g., colleges, universities, orprofessional schools) that could provide you with accurate information concerning communities ofcolor and CLC?

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* 12. Is there policy for the provision of interpretation services for youth and families with Limited English Proficiency and those who are deaf or have hearing impairments?

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* 13. Does your County:

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* 14. Does your County have the following available in languages other than English? (Check all that apply)

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* 15. Does your County reach out to and engage the following individuals, groups, or entities in health and mental health promotion and disease prevention initiatives:

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* 16. Does your county conduct an open house or similar event to which providers, consumers, and others concerned with service delivery to communities of color are invited?

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* 17. Does your county utilize cultural consultants who can help them work more effectively within a cultural context?

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* 18. Please list any additional policies supporting cultural and linguistic competence not identified by this instrument.

* 11. Does your county have linkages with institutions of higher education (e.g., colleges, universities, or
professional schools) that could provide you with accurate information concerning communities of
color and CLC?