1. Fundamentals of the National CLAS Standards
Kenneth D. Johnson, JD
Senior Public Health Advisor, Office of Minority Health
U.S. Department of Health and Human Services
Florida Association of Community Health Centers
2015 Summer Training Institute
July 22, 2015 Webinar

2. Presentation Overview
Overview of Office of Minority Health (OMH), Mission and Strategic Priorities
OMH Center for Linguistic and Cultural Competence in Health Care (CLCCHC)
National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
Think Cultural Health

3. The Office of Minority Health (OMH)
OMH Mission
OMH Functions
Awareness
Data
Partnerships and Networks
Policies, Programs and Practices
Research, Demonstrations and Evaluation
To improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities.
Legislative Authority:
Section 1707 of the Public Health Service Act 42 U.S.C. 300u-6

4. HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Vision:
“A Nation free of disparities in health and health care”
Goals:
Transform Health Care
Strengthen the Nation’s Health and Human Services Infrastructure and Workforce
Advance the Health, Safety, and Well-Being of the American People
Advance Scientific Knowledge and Innovation
Increase Efficiency, Transparency, and Accountability of HHS Programs

5. National Partnership for Action (NPA)
Purpose:
To mobilize a nationwide, comprehensive, and community-driven approach to combating health disparities.
Goals:
Awareness
Leadership
Health System and Life Experience
Cultural and Linguistic Competency
Data, Research, and Evaluation

6. Center for Linguistic and Cultural Competency in Health Care (CLCCHC)
The CLCCHC is a "center without walls," encompassing all existing and new policy, partnership, communications, service demonstrations, and evaluation activities related to cultural and linguistic competency.

7. What are Culturally and Linguistically Appropriate Services?
Services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs and employed by all members of an organization (regardless of size) at every point of contact.

8. The Case for Culturally and Linguistically Appropriate Services
Changing Demographics
By 2060, the U.S. population is projected to be 43% non-Hispanic White; 31% Hispanic; 15% Black; 8.2% Asian American; 0.3% Native Hawaiian and Pacific Islander; and 1.5% American Indian/Alaska Native (U.S. Census, 2008).
Cost of Health and Health Care
Disparities
Combined cost of health inequalities and premature death in the U.S. is $1.24 trillion. Eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion in (LaVeist, Gaskin, Richard, 2009).
Legislation
Federal: Affordable Care Act, Title VI of the Civil Rights Act of 1964, Americans with Disabilities Act
State Examples: CA, CT, NJ, OR, WA
Accreditation
Joint Commission, National Committee on Quality Assurance

9. The Case for Culturally and Linguistically Appropriate Services
Limited English proficient (LEP) patients who may not be able to communicate effectively with their health care providers may be at greater risk for medical errors (HHS Agency for Healthcare Research and Quality [AHRQ], 2012).
Medical Errors
Racial and ethnic minorities are more likely to be readmitted for certain chronic conditions than their non-Hispanic White counterparts (HHS AHRQ, 2012).
Readmissions
Length of a hospital stay for Limited English Proficient patients was significantly longer when professional interpreters were not used at admission or both admission/discharge (Lindholm, Hargraves, Ferguson, Reed, 2012).
Length of Stay

10. The Case for Culturally and Linguistically Appropriate Services
Education on cultural and linguistic competency and the introduction of interpreter services improves the quality of care delivered (Pearlman, 2012).
Quality of Care
Effective provider-patient communication impacts patient outcomes, including measures such as increased patient satisfaction, increased trust, and greater patient adherence (Education in Palliative End-of-Life Care for Oncology, 2013).
Patient Adherence
Preventive Services
The quality of care received by racial and ethnic minorities continues to be suboptimal in preventive care. Health education and healthy behavior promotion can help postpone or prevent illness and disease; detecting health problems at an early stage increases the chances of effectively treating those problems, often reducing suffering and costs (HHS AHRQ, 2014).

11. The Case for Culturally and Linguistically Appropriate Services
Patient perceptions of discrimination play an important role in ratings of health care quality across racial/ethnic minority groups.
Discrimination
Establishing policies that are mindful of the relationship between the availability, access, and quality of resources in supporting healthy change in individual behavior is key in closing the health equity gap.
Overcoming Barriers
A hospital increased its market share among individuals with LEP by creating individual maternity suites with a substantial cultural competency component in their design (Alliance of Community Health Plans, 2007).
Increase
Market Share

12. What is the purpose of the National CLAS Standards?
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to implement and provide culturally and linguistically appropriate services.

13. National CLAS Standards: Principal Standard
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

14. Standards on Governance, Leadership & Workforce
Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

15. Implementation of the Standards on Governance, Leadership & Workforce
Organization: Suffolk County Dept. of Health Serv., Long Island, NY
Leadership: Adopted the National CLAS Standards and created a CLAS Leadership and Implementation Team, with the Health Commissioner, two Deputy Health Commissioners and representatives from 11 health centers.
Workforce: Distributed CLAS Standards to 1500 employees; provided training on cultural competency/health disparities to all employees.
Language Assistance: Partnered with Southside Hospital, who translated vital documents and provided 68 hours of medical interpretation training to bilingual staff members from Suffolk County.
Continuous Improvement: Enrolled 258 health care providers in cultural competency e-learning courses provided by HHS OMH.
Holistic Approach: Committed – in its strategic plan -- to implementing all CLAS Standards over a period of years.

16. Standards on Communication & Language Assistance
Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

17. Implementation of the Standards on Communication & Language Assistance
Organization: U. of New Mexico Hospital, Albuquerque, NM
Leadership: To settle a complaint filed with the HHS Office for Civil Rights under Title VI of the Civil Rights Act of 1964, which prohibits race, color and national origin discrimination in programs receiving federal funding, the Hospital created a language assistance program.
Language Assistance: The Hospital:
Provides on-site and telephonic interpreters to LEP patients.
Flags the patient’s primary language on his or her electronic health record so that an interpreter can be present for each patient encounter.
Employs on-site interpreters for 13 languages and contracts with an agency who provides telephonic interpreters for over 200 languages.
Posts documents -- such as a patients’ bill of rights and the availability of interpreters at no cost -- in English, Spanish and Vietnamese.

18. Implementation of the Standards on Communication & Language Assistance (continued)
Organization: U. of New Mexico Hospital
Workforce: The Hospital’s interpreters/translators have met the requirements of the American Council of Teaching of Foreign Languages.
Patient Rights: The Hospital states that each patient has the right to:
Receive the healthcare you need regardless of your race, creed, age, color, beliefs, national origin, gender, gender identity, sexual orientation, religion, disability, marital status, or source of payment.
Have qualified interpreter services available if you do not understand or speak English.
Express your religious and cultural beliefs as long as the exercise of those beliefs does not harm others or interfere with the medical treatment or the rights of others.

19. Standards on Engagement, Continuous Improvement, and Accountability
Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.
Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.

20. Standards on Engagement, Continuous Improvement, and Accountability
Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

21. Implementation of the Standards on Engagement, Continuous Improvement & Accountability
Organization: Inova Alexandria Hospital, Alexandria, VA
Engagement: The Hospital:
Used publicly available data to determine that 12.7% of the population of the City of Alexandria speaks a language other than English at home and the top language is Spanish.
Conducted key informant interviews of public health experts and City, County and State officials; and received survey responses from 308 Alexandria residents.
After completing a Community Health Needs Assessment, found that language and cultural barriers, concerns about immigration status and higher poverty rates prevented some populations from seeking out and obtaining care.

22. Implementation of the Standards on Engagement, Continuous Improvement & Accountability (continued)
Organization: Inova Alexandria Hospital, Alexandria, VA
Continuous Improvement: The Hospital:
Expanded its Community Health Outreach Worker Program, including its Promotores de Salud program to provide information about diabetes prevention in faith based communities.
Created a Patient/Family Advisory Council to provide input on the quality of care at the Hospital and its outpatient clinics.
Accountability: The Hospital:
Prepared a Community Health Needs Assessment Implementation Strategy, which was implemented by the Board of Directors.
Committed to participation in the Partnership for a Healthier Alexandria to identify opportunities to leverage resources and collaborate with the City of Alexandria and the Alexandria Health Department.

23. Where can you find more information?

25. Resources
HHS Office of Minority Health:
For additional information on Suffolk County Department of Health Services’ implementation of the National CLAS Standards, please visit:
For additional information on the University of New Mexico Hospital’s language services program, please visit:
For additional information on Inova Alexandria Hospital’s community health assessment, please visit:
Disclaimer: This PowerPoint presentation has links to websites of private organizations. You are subject to those sites’ privacy policies when you visit those sites. We are not responsible for Section 508 compliance (accessibility) on private organizations’ websites.  Reference in this PowerPoint presentation to specific commercial products, processes, services, or companies does not constitute endorsement or recommendation by OMH or the U.S. Department of Health and Human Services.

26. Acknowledgements
HHS Office of Minority Health: J. Nadine Gracia, MD, MSCE – Deputy Assistant Secretary for Minority Health and the Director of the Office of Minority Health (OMH) Christine Montgomery, Project Officer, Center for Linguistic and Cultural Competence in Health Care Health Determinants & Disparities Practice at SRA: C. Godfrey Jacobs, Program Manager, Center for Linguistic and Cultural Competence in Health Care Juan Carlos Arroyo, MPH Crystal L. Barksdale, PhD Anna DiColli, MPH Darci L. Graves, MA, MA, MPP Jennifer Kenyon

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