provider training - liberty dental plan · frieden’s pyramid model for promoting the health of...

Cultural Competency

2015 Cultural Competency

Provider Training


• Breakdown of Current Laws and Regulations

• DMHC requirements

• DHCS requirements

• The Importance of Cultural Competency in Health

Care

• Staff to Staff

• Staff to Member

• Provider to Member

• Strategies for Working with our Members and their

Communities

• Breakdown of our membership (sub-

populations)

• Addressing specific sub populations

• LIBERTY’s Resources for Members

• Interpreter Services

• Provider Directory

• Translated Materials

training

objectives


CLAS monitoring

LIBERTY shall monitor, evaluate, and take effective

action to address any needed improvement in the

delivery of culturally and linguistically appropriate

services. The Cultural and Linguistic Services Program

(CLAS) incorporates the requirements of Title 22 CCR

Section 53876


advancing health equity through

culturally responsive care Health Disparities are the differences in the quality of

health or differences in health status experienced

between population groups. Culturally responsive care

is the ability to interact effectively with people from

different cultures, languages, and backgrounds. It is

built on a set of attitudes, skills, behaviors, and policies

that enables health-care providers to deliver services

that are respectful of and responsive to the health

beliefs, practices, and cultural and linguistic needs of

diverse patients (American College of Physicians,

2010).

contributing factors for health disparities

• Language Difference

• Low Health Literacy

• Low Income .


Frieden’s Health Impact Pyramid Frieden’s pyramid model for promoting the health of populations experiencing

health disparities shows the interventions that can be employed to address

the social determinants of health (2010).


implementing culturally and

linguistically appropriate services

The National Standards for Culturally and Linguistically Appropriate Services

(CLAS) in Health and Health Care are not one-size-fits-all guidelines. As in

other quality improvement initiatives, think big and start small to make

change practical and doable. The following are varied strategies on where to

infuse CLAS standards in your practice:

• Diversify your workforce

• Hiring and raining Policies based on the CLAS blueprint

• Leadership and Governing Policies and Procedures


embracing culture

& differences


culture

Refers to the integrated patterns of human behavior that

include the languages, thoughts, actions, customs, beliefs,

values, and institutions that unite a group of people.

Culture includes:

• Ethnicity

• Language

• Education

• Religion/beliefs

• Family and community

• Race, age, and gender

• Immigration status

• Socioeconomic status


cultural competency

The capability of effectively dealing with people from

different cultures

Elements of Cultural Competency:

• Awareness of one’s own culture

• Understanding the dynamics of differences

• Awareness and acceptance of differences

• Development and application of cultural knowledge

• Celebration of diversity


cultural influences

Cultural Influences

Acculturation

Language Skills &

Preferences

Botanical Treatments &

Healers

Decision Making

Privacy


demographics of LIBERTY members

Membership Language

(500 or more)

Membership Ethnicity

(Top 10)

Total Membership: 941,178

English 630,883

Not Provided 149,715

Spanish 11,4066

Vietnamese 1,3304

Russian 1,2500

Korean 6,967

Armenian 2,664

Tagalog 2,640

Arabic 2,525

Mandarin 2,135

Cantonese 1,984

Lao 659

Total Membership: 941,178

Not Provided 437501

Hispanic 197914

Caucasian 126393

Black 81467

Asian or Pacific

Islander 26370

Filipino 13085

Chinese 13047

Amerasian 12708

Vietnamese 10493

Asian Indian 6870


culture impacts every health care

encounter Culture defines health care expectations

• Who provides treatment

• What is considered a health problem

• What type of treatment

• Where is care sought

• How symptoms are expressed

• How rights and protections are understood


embracing culture

& differences


different communication styles

It is your job to support and communicate with

members in a way that is effective for them.

• Interpreter

• California Relay Services

• Sending materials in threshold languages, large

print, braille or audio tape

• American Sign Language or speech reading

• Reading materials to members


benefits of clear communication

Improve Safety &

Adherence

Provider & Patient

Satisfaction

Improving Office

Process saves Time and Money

Reduce Malpractice

Risk


clear communication

What the Member is Thinking… How we can respond…

My English is pretty good but sometimes I

need an interpreter

Office staff should confirm interpreter

needs during scheduling

When I don’t seem to understand,

talking louder in English intimidates me

Match the volume and speed of the

patient’s English

If I look surprised, confused or upset, I may

have misinterpreted your nonverbal cues

Mirror body language, position, and eye

contact; ask the patient if you are unsure if

they understand


communicating with our

Lesbian, Gay, Bisexual,

and Transgender (LGBT)

community


some LGBT terminology

Sexual Orientation:

• A person’s emotional, sexual, and/or relational

attraction to others. Usually classified as heterosexual,

bisexual, and homosexual (i.e. lesbian or gay)

• Describes how people view themselves on the

spectrum of attraction and identity

• It is distinct from gender identity or gender

expression

• Transgender people exhibit the full range of

sexual orientations, from homosexual to bisexual

and heterosexual


health disparities of LGBT populations

17%

5% 2%

33%

16%

29%

19%

5%

44%

27%

48% FtM

18%

50%

25%

15%

0%

10%

20%

30%

40%

50%

60%

Delaying Care Violent Injury Suicidal Ideation Alcohol Abuse Smoke Cigarettes

Heterosexual Lesbian, Gay or Bisexual Transgender


communicating with our

refugee & immigrant

members


health care for refugees & immigrants

Refugees and Immigrants may:

• Not be familiar with the U.S. health care system

• Experience illness related to life changes

• Practice spiritual and botanic healing or treatments

before seeking U.S. medical advice


benefits of open communication for

recent arrivals

• Builds trust

• Results in fuller disclosure of patient knowledge

and behavior


addressing the health care system

What the Member is thinking… How we can respond…

My expectations do not align with California

managed care

Keep members informed and provide a brief

explanation of managed care (Primary Care

Physician (PCP) as a gatekeeper)

I wonder why I have diagnostic testing

before a prescription is written

Office staff should confirm preferences during

scheduling; ask about the use of home

remedies and healers

I am more comfortable with a female doctor Office staff should confirm preferences during

scheduling

Its important for me to have a relationship

with my doctor Spend a few minutes building rapport


addressing the health care system


I‘ve had different experiences in refugee

camps Explain confidentiality

My experiences have caused me to be

suspicious Ensure that staff adhere to your policies

I fear my health information will be released

to the community

Make HIPAA forms easy to understand and

available in preferred languages

I am not able to make important decisions

by myself Confirm decision making preferences


communicating with

seniors & persons with

disabilities (SPDs)


working with seniors & persons

with disabilities

SPDs

Cognitive Impairment / Mental Health

Disease / Multiple

Medications

Visual Impairment

Physical Impairment

Hearing Impairment

Physical Impairment


disease & multiple medications


I have a medical condition that affects my

thinking/understanding (e.g. pain, stroke,

hypertension, Diabetes, UTI, pneumonia)

Pay attention and be aware

• Slow down

• Speak clearly

• Use plain language

• Recommend assistive listening devices

My medication can affect my cognition (e.g.

pain medication, anti-depressants, drug

interactions)

Obtain information through health history


how to assist members who are

hearing impaired

• Always speak to and look at the person who is

deaf, not the interpreter

• Familiarize yourself with available technology


how to assist members who have

speech disabilities

• Many Types:

• Learning disability

• Deafness

• Cerebral Palsy

• People with speech disabilities may use:

• Their own voice

• Letter board


members with speech disabilities

If you do not understand…

Do:

• Speak slowly and clearly

• Offer to repeat or spell it

• Offer a paper and pen

• Be patient

Do not:

• Shout

• Finish a person’s sentence or thoughts


members with limited mobility

• Physical disabilities are most obvious, but invisible

mobility issues are most common

• Leg swelling below jeans

• Internal aches and pains

• Distance is an issue

• Hip, knee, or foot problems

• Respiratory

• Weakness


assisting persons with limited disabilities

Do:

• Sit, don’t stand

• Speak directly

• Relax

Do not:

• Touch a person’s wheelchair without permission

• Push someone's wheelchair unless they ask you to


members with learning disabilities

There are many forms of learning disabilities:

• Dyslexia

• Auditory processing

• Information processing

Do:

• Read things out loud

• Speak slowly

• Allow time – be patient

Do not:

• Ask to “hurry up”

LIBERTY provides all written member material at a 6th grade reading level, or at

a lower reading level as determined appropriate by the client. Alternate formats

will be made available upon request including large print (14 point font or larger),

audio and Braille.


visual impairments

• Problems

• Reading, depth perception, contrast, glare, loss

of independence

• Common Diagnosis

• Macular Degeneration, Diabetic Retinopathy,

Cataract and Glaucoma

• Solutions

• Decrease glare

• Bright, indirect lighting

• Bright, contrasting colors

• LARGE, non-serif fonts


visual impairments

Do:

• Verbalize where things are (e.g. “It’s on your left)

• Identify yourself when someone visually impaired

enters a room or when you are approaching the

person

• Direct questions or comments directly to the person

who is blind or visually impaired

Do not:

• Point to objects

• Speak in an exaggeratedly loud voice

• Be afraid to ask a person if he or she needs help;

if the answer is no, respect his or her wishes


service

animals

Allowed:

• Dogs

• Always under the person’s control

• Cannot impose a threat

Typically not allowed:

• Large animals, rodents & reptiles ‘Therapy’ or ‘comfort’

animals

Do:

• Ask if the animal is a service animal, and if it provides

assistance for a disability

Do not:

• Deny a member with a service animal entrance inside

the clinics or Alliance offices

• Pet any service animal or give it a treat without

asking first


disability etiquette

Person-First Language

• Show respect by putting the person before the

disability

• The disability or the equipment they use is a

descriptor

• People with a disability are more like people without

disabilities than different


people-first examples

Best Avoid

People with disabilities The handicapped or disabled

He has a cognitive disability He is mentally retarded

She has autism She is autistic

He has a physical disability He is a quadriplegic

He uses a wheelchair He is wheelchair bound

Children without disabilities Normal or healthy kids

Accessible parking Handicapped parking


LIBERTY staff & provider

• Know the basics of disability rights, etiquette

• Know how to apply the basics to your job

• Direct members to the appropriate services or

facility

• Find the appropriate resource when you don’t know

the answer to a question

• Provide excellent customer service to all members


resources for

members


language assistance program

LIBERTY has a Language Assistance Program that:

• Asks the Member Advisory Committee for input on

ways to better serve its members both culturally

and linguistically

• Monitors provider language capacity

• Ensures our bilingual staff is trained

• Tracks our member language preferences and

ethnicities

• Monitors our cultural and linguistic services through

grievance and appeals review

If you have questions related to the Language

Assistance Program please contact LIBERTY’s

Member Services Department at 888-703-6999


interpreter services

• All members are entitled to an interpreter at all points

of contact

• LIBERTY uses Language Valet Services for

interpreter services

• Call 1-888-703-4149 for telephonic interpreter

• Requests for in-person interpreters go through

LIBERTY’s Member Services Department at: 888-

703-6999 Request 72 hours prior to appointment

• Many of our contracted clinics and hospitals also have

interpreters onsite


tips for working with interpreters

• Hold a brief introductory discussion

• Your name, organization and nature of the

call/visit

• Reassure the patient about confidentiality

• Allow enough time

• Avoid interrupting

• Speak in a normal voice; not too fast or too loudly

• Speak in short sentences

• Avoid acronyms, medical jargon

• If in person, face and talk to the member directly


member facing material translations

• LIBERTY members have the right to have member

material translated into their preferred reading

language or a preferred alternative format.

• Requests will be filled within 21 days.

• Members may call Member Services at 800-268-9012

to make a request; for TTY please contact 877-855-

8039


provider directory & EOC

• The Provider Directory helps members find

providers that fit their preferences (e.g. gender,

location, accessibility, etc.)

• LIBERTY’s Evidence of Coverage (EOC) describes

how to access language assistance and how to file

grievances.

• The EOC and Provider Directory are available in print

form, on our website and in our threshold languages.

thank you


Making members shine, one smile at a time™

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