U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Standards for Culturally and Linguistically Appropriate Services in Health Care

Overview of OMH Rationale for Cultural Competence OMH’ s Center for Linguistic and Cultural

Competence in Health Care (CLCCHC) Describe the CLAS Standards Challenges

Office of Minority Health Mission

To improve the health of racial and ethnic populations through the development of health policies and programs that help to eliminate health disparities and gaps.

OMH’s “7+4”

(1) Heart Disease & Stroke(2) Cancer; (3) Substance Abuse; (4) Diabetes; (5) Homicide, Suicide and Unintentional Injuries; (6) Infant Mortality; (7) HIV/AIDS.

Crosscutting areas: (1) Access to health care; (2) Improve Data Collection/Analysis; (3) Health Professions Development; and (4) Cultural Competence.

What Does Cultural Competence Mean?

Cultural Competence is the:– ability of health organizations and practitioners

to recognize the cultural beliefs, attitudes and health practices of diverse populations, and

– to apply that knowledge in every intervention; at the systems level or at the individual level.

Rationale for Cultural Competence?

POR QUE (Why)?

Legislative Framework for Cultural Competence

Disadvantaged Minority Health Improvement Act of 1990; and

The Health Professions Education Partnership Act of 1998.

T h e F a c e o f A m e r i c a — 2 0 0 0 - U .S . C e n s u s

H is p a n ic1 2%

B la c k1 2%A /I

1%

Wh i te s7 1%

A P I4%

Demographics

Language Diversity in U.S. Spanish 17.1 million French 1.7 million German 1.5 million Italian 1.3 million Chinese 1.2 million Tagalog 843,000

Source: U.S. Census 1990

Racial and Ethnic Distribution of Selected Health Professions: Source: HRSA, U.S. Census 2000

73

5 4

17

0.1

89

1 27

0.1

76

6 3

14

0.3

73

19

4 30.8

82

93 6

0.40

10

20

30

40

50

60

70

80

90

MDs Dentists PharmDs LPN RNs

WhiteBlackHispanicAsian/PIAI

Health Divide 1985 Task Force Report on Black and

Minority Health revealed:– Minorities continue to have poor health;– Health disparities have worsened;– Minorities chronically underserved by the

health care system. IOM Report - March 2002.

The OMH Center for Linguistic and Cultural Competence in Health Care

Mandated by Congress to develop projects to eliminate language barriers for Limited English Proficient (LEP) individuals to increase their access to health care.

Culturally and Linguistically Appropriate Services (CLAS) Standards Project.

Cultural Competency Curriculum Modules (CCCMs). Hispanic Cultural Competence for Medical Education

Curriculum.

Why CLAS Standards?

Address the patchwork of definitions, guidelines, overlap, etc., on what constitutes cultural competence service delivery.

Provide a road-map for providing culturally competent services.

Serve as guiding principles for the delivery of quality health care to diverse populations.

CLAS As A Vehicle to Improve Health

Improve access to services;

Reduce medical errors;

Improve effectiveness of preventive services;

CLAS As A Vehicle to Improve Health

Improve patient satisfaction;

Improve patient compliance; and

Reduce financial costs and risks.

CLAS Standards

14 National Recommended Standards: inform, guide, and facilitate implementation of CLAS.

Three themes: – Culturally Competent Care (1-3); – Language Access Services(4-7); and– Organizational Supports for Cultural

Competence (8-14).

Culturally Competent Care - 1

Patients and consumers receive effective, understandable, and respectful health care.

Cultural Competent Care - 2

Recruitment, retention, and promotion of diverse staff and leadership.

Cultural Competent Care - 3

All staff receive ongoing education and training.

Language Access - 4

Language assistance services, including bilingual staff and interpreters must be offered at no cost to the patient.

Language Access - 5

Patients and consumers must be informed of their right to language assistance services.

Language Access - 6

Health organizations must assure the competence of language assistance provided by interpreters/bilingual staff.

Language Access - 7

Availability of easily understood patient materials and applicable signage posted.

Organizational Supports - 8

Written strategic plan with clear goals, policies, and accountability mechanisms.

Organizational Supports - 9

Conduct initial and ongoing organizational self-assessments, and

Integrate cultural and linguistic competence measures into overall program activities.

Organizational Supports - 10

Patient data collection to include: race, ethnicity, and spoken and written language.

Organizational Supports - 11

Maintain current demographic, cultural, and epidemiological community profiles, and

Conduct needs assessment on cultural and linguistic characteristics of the service area.

Organizational Supports - 12

Participatory, collaborative partnerships to facilitate community and patient/ consumer involvement.

Organizational Supports - 13

Ensure that conflict and grievance resolution processes are culturally and linguistically sensitive.

Organizational Supports - 14

Keep the public informed about progress and successful innovations in implementing the CLAS standards.

Challenges

Developing the evidence. Marketing strategies. Collaborating with medical societies. Working at the State and Federal levels. Working with advocacy groups.