Advancing Health Equity: The National CLAS Standards U.S. Public Health Service Scientific and Training Symposium June 20, 2012 Guadalupe Pacheco Guadalupe Pacheco, MSW Senior Health Advisor to the Director Office of Minority Health, Office of the Secretary U.S. Department of Health and Human Services 1

HHS Office of Minority Health Cultural Competency in Emergency Response National Standards for Culturally and Linguistically Appropriate Services in Health Care National CLAS Standards Enhancement Initiative OMH’s Cultural Competency Curriculum for Disaster Preparedness and Crisis Response Think Cultural Health Presentation Overview 2

Mission: To improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities. Awareness Data Partnerships and Networks Policies, Programs, and Practices Research, Demonstrations, and Evaluation OMH Functions HHS Office of Minority Health 3

Culturally and linguistically appropriate health care and services are broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals (Adapted from Cross, 1989) What Are Culturally and Linguistically Appropriate Services? 4

“Minorities and low income Americans are more likely to be sick and less likely to get the care they need.” – Secretary Sebelius “…of all the forms of injustice, inequality in healthcare is the most shocking and inhumane.” -- Dr. Martin Luther King Jr. Why Are Culturally and Linguistically Appropriate Services Important? 5

 Minorities are more likely to be under-prepared for disasters, less likely to be involved in preparedness activities, and are less likely to receive educational opportunities related to disaster-preparedness (Pastor et al., 2006; Fothergill et al., 1999; Faupel et al., 1992).  Minorities are disproportionately impacted by disasters due to a variety of factors, including level of English proficiency, cultural insensitivities, acculturation level, immigrant status, lower incomes, fewer savings, greater unemployment, less insurance, poorer access to information, and community isolation (Andrulis, Siddiqui, & Gantner, 2007; Fothergill et al., 1999; Norris & Allegría, 2006; Rodriguez et al., 2006). Cultural Components of Response 6

 The delivery of culturally and linguistically appropriate services helps improve quality of care and services: – Research indicates that understanding culturally-specific responses to disasters is important for reaching out to disaster- affected minority communities and for the planning and delivery of disaster mental health services (Perilla et al., 2002). – Improved language access services can help disaster responders overcome cultural and language barriers between survivors and responders, which have been cited as obstacles to appropriate emergency response. Cultural Components of Response: Addressing Issues of Equity 7

Cultural Competency is a journey, not a destination Starting Off: Self Assessment Community Services Assessment The Cultural Competency Journey 8

Communicating with the Community: Ensure that your organization’s early warning system is culturally and linguistically competent The Cultural Competency Journey: Preparation Phase Community engagement and collaboration may be the only means for achieving appropriate planning. - Office of Force Readiness and Deployment, HHS “ ” Know and understand cultural norms and mores Use appropriate languages and language access services Recognize strengths and limitations Take advantage of a community’s strengths 9

Just-in-time training offers: just the right information, at just the right time, and in just the right form. Linkov F, Ardalan A, Dodani S, Lovalekar M, Sauer F, Shubnikov E, LaPorte R. The Cultural Competency Journey: Response Phase 10

Disparities in Recovery The Cultural Competency Journey: Recovery Phase Recovery involves both short-term and long-term action. Source: DeWolfe

National Standards for Culturally and Linguistically Appropriate Services in Health Care 14 Standards, published in 2000 Provide the framework for all health organizations to best serve the nation’s diverse communities Inform practices related to cultural and linguistic competency in health care National CLAS Standards,

The CLAS Themes National CLAS Standards, 2000 Culturally Competent Care Standards 1-3 Language Access Services Standards 4-7 Organizational Supports Standards

National CLAS Standards Enhancement Initiative 2010 – 2012 Goals of the Initiative: To examine the National CLAS Standards for their current relevance and applicability. To have the enhanced National CLAS Standards serve as the cornerstone for culturally and linguistically appropriate services in the United States. To coordinate the Standards with the Affordable Care Act and other cultural and linguistic competency provisions (e.g. Joint Commission, National Committee for Quality Assurance). 14

Launch: 2012 Enhanced National CLAS Standards Development: 2011 AnalysisConsultationsDrafting Research: 2010 Literature ReviewPublic CommentAdvisory Committee 15 National CLAS Standards Enhancement Initiative: Timeline

Comparison–2000 and 2012 National CLAS Standards Standards2012 Standards Goal: to decrease health care disparities and make practices more culturally and linguistically appropriate Goal: to advance health equity, improve quality and help eliminate health and health care disparities. “Culture”: racial, ethnic and linguistic groups“Culture”: racial, ethnic and linguistic groups, as well as geographical, religious and spiritual, biological and sociological characteristics Audience: health care organizationsAudience: health and health care organizations Implicit definition of healthExplicit definition of health to include physical, mental, social and spiritual well-being Recipients: patients and consumersRecipients: individuals and groups

National CLAS Standards: Next Steps 17 Departmental Briefings at the U.S. Department of Health and Human Services Communications Roll Out – the Office of Minority Health plans to promote the Standards to all health care delivery sectors for adoption Publication of the enhanced National CLAS Standards in the Federal Register in fall 2012 Publication of a guidance document, The National CLAS Standards: A Blueprint for Advancing and Sustaining CLAS Policy and Practice

Think Cultural Health (TCH): Cultural Competency Clearinghouse Advancing health equity at every point of contact National CLAS Standards E-learning programs Communication Tools CLAS Clearinghouse TCH Resource Tools: OMH’s Think Cultural Health 18

 Housed at OMH’s Think Cultural Health  Free, online continuing education course launched 2009  Equips disaster personnel with the knowledge, awareness, and skills needed to provide emergency health care services to diverse populations  Accredited for First Responders, Emergency Managers, Disaster Mental Health Workers, and Dentists  2,500 individuals have registered for the program; 10,000 credits have been awarded Cultural Competency Curriculum for Disaster Preparedness and Crisis Response 19

 Accredited for First Responders, Emergency Managers, Disaster Mental Health Workers, and Dentists  2,500 individuals have registered for the program; 10,000 credits have been awarded  “This has been both a great refresher course on previously acquired knowledge and a source of new information to consider and apply when planning for and working with the cultural needs of disaster victims.” – Program Participant Cultural Competency Curriculum for Disaster Preparedness and Crisis Response 20

Contains four courses:  Course I: Introduction to CLAS in Disaster Preparedness and Crisis Response  Course 2: Implementing CLAS in the Preparation Phase of a Disaster  Course 3: Implementing CLAS in the Response Phase of a Disaster  Course 4: Implementing CLAS in the Recovery Phase of a Disaster 21 Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

Video Case Study But What if I’m Deported?: Providing Culturally Competent Care and Language Access Services During Recovery 22

Video Case Study Questions for discussion:  How do you feel about the story presented?  Do you think it was handled appropriately? 23

Guadalupe Pacheco HHS Office of Minority Health For More Information: 24