The CLAS Standards: Starting Your Cultural Competency Journey

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1 The CLAS Standards: Starting Your Cultural Competency Journey Guadalupe Pacheco Senior Health Advisor to the Director Office of Minority Health U.S. Department of Health and Human Services October 7, 2011

2 The Journey of CLAS HHS Office of Minority Health History of CLAS CLAS Concepts Utility of CLAS CLAS Standards Enhancement Initiative

3 HHS Office of Minority Health Mission: To improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities

4 HHS Office of Minority Health National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) Provide the framework for all health organizations to best serve the nation s diverse communities Set of mandates, guidelines and recommendations intended to inform practices related to cultural and linguistic competency in health care

5 CLAS Standards The CLAS Standards Themes: Culturally Competent Care Standards 1 3 Language Access Services Standards 4 7 Organizational Supports Standards 8 14

6 CLAS Standards The CLAS Standards are designed for an interdisciplinary audience, including: Hospitals Public health organizations Community and faith based organizations Institutions of higher education

7 History of CLAS

8 History of CLAS: Highlights include: Office for Civil Rights LEP Guidance State language access services legislation Office of Minority Health e learning programs Health Resources and Services Administration s cultural competency resources Two national entities for the certification of interpreters HHS Action Plan to Reduce Health Disparities National Stakeholder Strategy for Achieving Health Equity

9 History of CLAS: Numbers of Publications and Citations Number of Publications Number of Citations* * Reported citations are approximated based on Web of Science analysis reporting.

10 Nursing Public, Evironmental, & Occupational Health Medicine, General & Internal Health Care Sciences & Services Social Work Health Policy & Services Psychiatry Psychology, Multidisciplinary Education, Scientific Disicplines Psychology Clinical History of CLAS: Number of Publications by Subject Area

11 History of CLAS: Cultural Competency State Level Legislation Dark Blue denotes legislation requiring (WA, CA, NJ, NM, CT) or strongly recommending (MD) cultural competence training, which was signed into law. Purple denotes legislation which has been referred to committee and is currently under consideration. Royal Blue denotes legislation which died in committee or was vetoed. *Think Cultural Health, 2011

12 History of CLAS: Alameda Alliance for Health: a case study The Alliance developed an infrastructure, operational principles, policies and procedures for addressing the CLAS Standards. CLAS related data collection efforts have resulted in the implementation of new interventions that improve the quality of health care for Alliance members. Interpreter and translation services have experienced much success with Spanish speaking members. HHS OMH, 2004

13 CLAS Concepts

14 CLAS Concepts Cultural and linguistic competency is a journey, not a destination an ever expanding capacity to learn and grow.

15 CLAS Concepts Culturally Competent Care refers primarily to the relationship between providers and patients/clients, and the delivery of culturally competent care to patients and their families by individual or collective health professionals.

16 CLAS Concepts Culturally Competent Care Implementation Strategies: Focus on behaviors of all staff Conduct an assessment of staff cultural competency training needs Conduct periodic training, orientation and staff meetings Add cultural competency skill sets into job descriptions (bilingual skills)

17 CLAS Concepts Language Access Services (LAS) focus on facilitating communication during all points of contact during a patient s health encounter/experience. LAS also refers to educating community members about their rights and services.

18 CLAS Concepts Language Access Services (LAS) Implementation Strategies: Use bilingual staff, interpreters, telephone interpretation services Market services available in non English brochures and materials distributed to the public Educate all staff on what services are provided Discourage use of family and friends as interpreters Assess knowledge of medical terminology of interpreter candidates

19 CLAS Concepts Organizational Supports focus on policies and procedures to help health providers and staff provide effective services to the community at every point of patient contact.

20 CLAS Concepts Organizational Supports Implementation Strategies: Develop a cultural competency strategic plan or incorporate cultural competency principles into existing strategic plan Conduct an organizational cultural audit Adapt in take procedures to facilitate collection of racial/ethnic/language patient data Utilize available demographic data (Census data) Involve community representatives on policy making bodies Publish documents focused on cultural and linguistic competence (newsletters, TV, radio, web sites)

21 The Utility of CLAS

22 The Utility of CLAS Think Cultural Health An HHS Office of Minority Health initiative Advancing health equity at every point of contact

23 Think Cultural Health Continuing education programs that equip health professionals with awareness, knowledge, and skills to serve diverse patients Up to date information on issues related to cultural competency and health disparities Tracking of cultural competency legislation around the country Join the CLCCHC : e newsletter and other resources

24 Think Cultural Health Over 100,000 individuals have registered for initiatives hosted by Think Cultural Health, which includes: Continuing Education Programs A Physician s Practical Guide to Culturally Competent Care Culturally Competent Nursing Care: A Cornerstone of Caring Cultural Competency Curriculum for Disaster Preparedness and Crisis Response Cultural Competency in Oral Health (In Development) Other Initiatives Health Care Language Services Implementation Guide Join the CLCCHC (e newsletter and other resources)

25 Think Cultural Health Think Cultural Health: Program Evaluation Highlights Providers enter the programs with a reasonable understanding of cultural competency, but still show increased posttest scores and knowledge gain Participation results in positive impact on practice behavior: Increased sensitivity to cultural differences Take more time with patients Ask more patient centered questions Participation results in enhanced self awareness of cultural competency concepts

26 CLAS Standards Enhancement Initiative

27 CLAS Standards Enhancement Initiative Goals of the Initiative: To examine the CLAS standards, originally promulgated in 2000, for their relevance and applicability to the 21 st century. To have the enhanced CLAS standards serve as the cornerstone for culturally and linguistically appropriate services in the United States. To launch new and innovative promotion and marketing initiatives for the CLAS standards. To coordinate the CLAS Standards with the Affordable Care Act and other cultural and linguistic competency standards (e.g. Joint Commission, National Committee for Quality Assurance).

28 CLAS Standards Enhancement Initiative Development Process: Research Literature Review Public Comment Advisory Committee Development Analysis Consultations Drafting Launch Enhanced National CLAS Standards

29 Research: Points of Convergence Themes from the Environmental Scan, public comment and Advisory Committee discussions: Purpose Audience Inclusivity of cultural groups End Product Health Literacy Linkages to other standards, laws, publications Language Access Services Promotion Resources Benchmarks Crosswalk HHS Integration Plan 29

30 Development: Consulting the Advisory Committee Includes representation of the following organizations and agencies: Institutions and Associations: National Medical Association National Business Group on Health American Nurses Association National Center for Cultural Competence Johns Hopkins University University of California, Davis American Public Health Association National Hispanic Medical Association National Council of Asian Pacific Islander Physicians American Medical Association National Health Law Program (NHeLP) Association of Asian Pacific Community Health Organizations Federal: Centers for Medicare and Medicaid Services Office on Women's Health Administration for Children and Families Indian Health Service Agency for Healthcare Research and Quality National Institutes of Health Health Resources & Services Administration Substance Abuse and Mental Health Services Administration CDC Equity Office for Civil Rights Office of the Assistant Secretary for Legislation Administration on Aging

31 Analysis & Drafting The Enhanced Standards will: Be relevant to health care organizations as well as a broader health audience, including public health, mental health and community health. Embrace a broader definition of culture to include racial and ethnic groups as well as cultural characteristics which can be defined in terms of sociological, biological, geographical, religious/spiritual and linguistic. Be more concise, concrete and provide greater guidance for the end user in terms of implementation.

32 Launch CLAS Standards, 2011 Will be published in the Federal Register in Fall 2011 Will be promoted through collaborations with various NPAC members and representative organizations

33 CLAS Standards version 2.0 : A tool for advancing health equity

34 For More Information: Guadalupe Pacheco, MSW HHS Office of Minority Health

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