Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Pennsylvania Association of Community Health Centers Annual Conference and Clinical Summit Honoring Our History Forging Our Future Pat Rossley CLAS Coordinator Pennsylvania Health Plans - AmeriHealth Caritas Northeast - AmeriHealth Caritas Pennsylvania - Keystone First

Agenda Meeting Overview 1.Importance of CLAS 2.History 3.Standards 4.Resources / Life Lessons / Tips 5.Questions

Thoughts to Ponder How many languages did Keystone and AmeriHealth use to communicate with members in 2014? How many people, in general, are proficient in health literacy? Answers to come at end of presentation

Guiding Principle Title VI of the Civil Rights Act of 1964 "no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance."

Why Is This Important? The Patient Protection and Affordable Care Act of 2010 The Affordable Care Act is making health insurance coverage more affordable and accessible for millions of Americans. For racial and ethnic minorities the law addresses inequities and increases access to quality, affordable health coverage. The Affordable Care Act invests in prevention and wellness, and gives individuals and families more control over their care. The ACA has a specific provision for Data Collection. Collect, report, monitor and trend-data on race, ethnicity, sex, primary language, disability status. 5

How does the Federal Government Define this information? Race Classification of humans based on genetic characteristics American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Ethnicity Classification of humans based on historical connection by a common national origin or language Hispanic/Latino Non-Hispanic/Non-Latino Language Varying degrees of proficiency Spoken language Written language

Some Important Definitions Cultural Competency – the ability to see beyond one’s own cultural background and be sympathetic and responsive to the culture of other societal groups. Health Literacy – The ability to communicate with members/ patients in a way that is easy for them to understand and act upon. Health Disparities – variations or differences in health status among groups of people. This may refer to any difference in health, with no implication that these differences are unjust. Health Care Disparity – individuals who do not have equal access to health care services – this is not the case for your patients or our members. Social determinants of health – the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. Immigrant – a person who chooses to come to the United States – not eligible for Medical Assistance until they have worked here for 3 years. Refugee – a person who is forced from their native land to a another country to await acceptance into the refugee program – eligible for Medical Assistance as soon as they arrive here.

HHS Office of Minority Health: CLAS Standards The CLAS Standards are national standards and guidelines established in 2000 (and enhanced in 2013) by the Department of Health & Human Services, Office of Minority Health to advance health equity, improve quality, and help eliminate health disparities by providing a blueprint for individuals and health care organizations to implement culturally and linguistically appropriate care. CLAS is the road map we use to achieve Health Equity for our members. Key Areas of CLAS Cultural Competence Health Literacy 8 Source: Office of Minority Health

CLAS Standards Principal Standard: 1. 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.

CLAS Standards Governance, Leadership and Workforce 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources. (Executive Buy-in) 3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area. (Human Resources) 4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. ( Training and Policies)

CLAS Standards (This section is based on legal requirements) Communication and Language Assistance 5. 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. (Interpreter and translation services, bi-lingual staff at all levels) 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. (Written documents, Signage and “I Speak” cards) 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. (Testing bi-lingual staff and use of professional interpreters) 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. (Patient materials and directional signage in most common languages)

CLAS Standards Engagement, Continuous Improvement, and Accountability 9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations. ( Program Description and Work Plan) 10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. (Annual Evaluation) 11. 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. (Census Data and Reports from Language Services Vendors)

CLAS Standards Engagement, Continuous Improvement, and Accountability 12. 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. (HEDIS Results) 13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. (Community Advisory Committee or Health Education Advisory Committee)

CLAS Standards Engagement, Continuous Improvement, and Accountability 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints. (Monitor Complaints & Grievances) 15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public. (Report to the Community)

Summary Working towards eliminating health disparities and achieving health equity for all persons: Fulfills our mission, and Is the right thing to do. It is important to remember: All persons are valued equally. Health is highly valued for everyone. All persons have the right to achieve the highest level of health possible. All resources for health care and health education should be distributed equitably.

Resources / Life Lessons / Tips Contact Info:

What Questions do you have?