Implementing the Enhanced Culturally and Linguistically Appropriate Services

Implementing the Enhanced Culturally and Linguistically Appropriate Services in Health and Healthcare (CLAS )Standards to Reduce HIV Disparity June 29, 2011 Updated August 2013 An Overview: Strategies for HIV/AIDS Providers Co-Presented by: : Ms. Tawara Goode, MA, Director, National Center for Cultural Competence and Ms. Wendy Jones, Director, Children & Youth with Special Health Care Needs project of the National Center for Cultural Competence, Georgetown University Medical Center

Learning Objectives At the completion of this webinar each participant will: state the importance of the 15 CLAS Standards and their relevance to HIV/AIDS care and treatment. identify at least one implementation strategy relative to HIV/AIDS care and treatment for each of the 15 Standards.

The New CLAS Standards In 2013, U. S. Department of Health and Human Services , Office of Minority Health, reissued a new set of CLAS standards. The new 15 CLAS Standards promote the advancement of health equity, improving the deliver of quality care, and the elimination of health care disparities. All of the CLAS Standards are of equal importance 3

The New CLAS Standards The Introductory Statement: 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: Principle 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.

The New CLAS Themes Theme 1) 2 -4: Governance, Leadership, and Workforce Theme 2) 5 -8: Communication and Language Assistance Theme 3) 9 -15: Engagement, Continuous Improvement, and Accountability

Cultural Competence behaviors practices attitudes policies structures requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally (adapted from Cross, Bazron, Dennis and Isaacs, 1989) Slide Source: © 2011 - National Center for Cultural Competence

Five Elements of Cultural Competence Organizational Level value diversity conduct cultural self-assessment manage the dynamics of difference institutionalize cultural knowledge adapt to diversity - policies - structures - values - services (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source: © 2011 - National Center for Cultural Competence

Five Elements of Cultural Competence Individual Level acknowledge cultural differences understand your own culture engage in self-assessment acquire cultural knowledge & skills view behavior within a cultural context (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source: © 2011 - National Center for Cultural Competence

LINGUISTIC COMPETENCE FRAMEWORK POLICY DEDICATED FISCAL RESOURCES PRACTICES LINGUISTIC COMPETENCE DEDICATED PERSONNEL RESOURCES STRUCTURES PROCEDURES Goode & Jones, Revised 2009, National Center for Cultural Competence Slide Source: © 2011 - National Center for Cultural Competence

Key Values for Cultural Competence Values and Guiding Principles for Cultural Competence Cultural competence: embraces the principles of equal access and non- discriminatory practices in service delivery. is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families. involves working in conjunction with natural, informal support and helping networks within culturally diverse communities. Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles http: //nccc. georgetown. edu/foundations/frameworks. html

Key Values for Linguistic Competence Values and Guiding Principles for Linguistic Competence Services and supports are delivered in the preferred language and/or mode of delivery of the population served. Written materials are translated, adapted, and/or provided in alternative formats based on the needs and preferences of the populations served. Interpretation and translation services comply with all relevant Federal, state, and local mandates governing language access. Consumers are engaged in evaluation of language access and other communication services to ensure for quality and satisfaction. Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles http: //nccc. georgetown. edu/foundations/frameworks. html

Culture Shapes Health Beliefs and Practices Culture influences the way people interact with health and mental health care systems including: Participation in health prevention and promotion programs Access to health information and services Choices and decisions related to health and mental health services Understanding of and priorities related to health and illness Help-seeking behavior and adherence to recommended treatment

Barriers to Culturally and Linguistically Competent Care Systems of care poorly designed for diverse populations Poor cross-cultural communication between providers and patients Patient/client fears and distrust Cultural stigma Lack of diversity in health care leadership and workforce

Why should your organization implement the CLAS Standards? EVIDENCE INDICATES IMPROVEMENT Access Effectiveness Acceptability Satisfaction Care Services Supports Outcomes Slide Source: © 2011 - National Center for Cultural Competence

Implementing CLAS will enable your staff to: gain knowledge about cultural values and beliefs of the patient and apply that knowledge in a health care context. interact effectively with people whose cultures and belief systems are different than your own. provide quality care that is respectful and nonjudgmental. deliver health care, services, and supports in the primary languages spoken be patients/clients and their families identify and respond effectively to the preferences and needs of populations served.

CLAS Webinar Series The remainder of this Webinar series will discuss each Standard and strategies organizations might pursue to implement CLAS. We will use the case studies that we asked you to download when you registered to illustrate various points. This Webinar series is designed to increase your awareness and knowledge of how you deliver care. Remember, how patients/clients see you may not be how you see yourself.

How do others see you?

CLAS Principle 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. Creates a safe/welcoming environment appreciation of diversity/focuses on patient-centered care Individuals receive services in a culturally and linguistically appropriate manner to enable them to meet their communication needs/understand their care & participate in their care To eliminate discrimination and disparities 18

CLAS Standard 1: Implementation Strategies Provide processes to ensure staff are trained on the civil rights laws that affect equitable healthcare service delivery Develop policies and procedures to ensure patients are provide information on their rights to receive health care services that address that cultural and linguistic needs Institute cross-cultural training for front-line and clinical staff on the health care needs of cultural/linguistically diverse populations

CLAS Standard 2 Advance and sustain organizational goverance and leadership that promote CLAS and health equity through policy, practices, and allocated resources.

CLAS Standard 2 Implementation Strategies: Develop a mission statement/core values/vision statement-that promotes health equity Seek commitment from top board, management leadership Management/board should set policy/program goals, development of strategic plan of promoting organizational diversity, providing CC care, eliminating health disparities; written policies, practices, procedures, programs, etc. Provide fiscal, human resources, tools, skills, and knowledge to support a culturally competent organization. 21

CLAS Standard 3 Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.

CLAS Standard 3: Implementation Strategies Obtain patient feedback on their preference for patientprovider concordance (e. g. race, ethnicity, language, sexual orientation, gender identity). Assess the degree to which staff demographics match patient preferences.

CLAS Standard 3: Implementation Strategies Establish staff diversity as recruitment, hiring, and retention goals for your organization. Post notices of job announcements and vacancies in forums, venues, and in varied languages to increase the likelihood of attracting diverse applicants. Where possible, recruit and hire qualified individuals (including past and current patients/clients) of the populations and communities impacted by the HIV epidemic. Assist individuals from culturally and linguistically diverse groups to complete required training needed to qualify for varied positions within the health and/or mental health care setting.

CLAS Standard 3: Implementation Strategies Provide ongoing training and mentoring to all staff, including new hires, to enhance their cultural competency and their capacity to communicate effectively cross-culturally (including but not limited to patients/clients and their families who speak languages other than English, those who have disabilities, and individuals who are deaf or hard of hearing). Include criteria for cultural and linguistic competence in staff performance evaluations. Provide staff with an open and safe forum and a process to raise and address issues related to individual and the organizational capacity to deliver culturally and linguistically competent services.

CLAS Standard 4 Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

CLAS Standard 4: Implementation Strategies Periodically query staff about their perceived learning needs in the area of cultural and linguistic competence. Designate interested and knowledgeable staff the responsibility of coordinating in-service training/professional development. Provide cross- and discipline-specific training in cultural and linguistic competency that is responsive to staff’s expressed interests, needs, and learning styles. Keep abreast of current trends and emerging evidence about culturally and linguistically competent care to include in all inservice training and professional development efforts.

CLAS Standard 4: Implementation Strategies Staff performance evaluations should include criteria that addresses active participation in and completion of training/professional development activities. Support professional development by offering varied modalities for learning (e. g. Web-based, self-directed and self-paced curricula, coaching and mentoring, continuing education, journal/book clubs, discussion groups). Address cultural and linguistic competency as a routine component of staff meetings and retreats. Establish meaningful incentives and special recognition awards for cultural and linguistic competency within the organization.

CLAS Standard 5 Offer language assistance to individuals who limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

CLAS Standard 5: Implementation Strategies Conduct an annual assessment of languages (other than English) spoken within the geographic locale served by the organization to ensure language access. Include data on the population of people who are deaf or hard of hearing. Update the organization’s language access plan on an annual basis. Ensure that there adequate resources (fiscal and personnel) for the provision of language access services. Ensure that all staff are knowledgeable of organizational policy, procedures, and practices for language access, including individual responsibility according to job function.

CLAS Standard 5: Implementation Strategies Ensure that language access services include sign language interpretation. Ensure that all legally binding documents are professionally translated into the languages spoken by the patient/client population. Such documents may include, but is not limited to, consent forms, confidentiality and patient rights statements, release of information, eligibility and applications for services. Ensure that medical orders, patient education, and health/mental health promotion resources are translated into the languages spoken by the patient/client population. Such documents should also be offered in Braille.

CLAS Standard 6 Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

CLAS Standard 6: Implementation Strategies Post signage in prominent locations stating patients’/clients’ rights to receive language access services (at no cost) in the health/mental health facility. Ensure that staff provide both verbal and written notification of patients’/clients’ rights to receive language access services at no cost.

Case Presentation: More than Language An elderly African American woman newly diagnosed with HIV presents for the first time at Clinic A. She approaches the receptionist’s desk and hands her the appointment slip. The twenty year old receptionist takes it, and while looking at her computer screen says rather loudly “You’re Mary Smith. Well Mary I need you to complete this intake form and bring it back to me. Here you go Mary, here’s a pen and here’s the form. ” The African American woman does not take the forms instead she turns on her heels and walks out. Anybody want to guess what communication glitch might have occurred here.

Thank You National Center for Cultural Competence, Georgetown University Medical Center

Goulda Downer, Ph. D. , RD, LN, CNS - Principal Investigator/Project Director (AETC-NMC) Josepha Campinha-Bacote, Ph. D, MAR, PMHCNS-BC, CTN-A, FAAN I. Jean Davis, Ph. D, DC, PA Denise Bailey, MEd. National Center for Cultural Competence, Georgetown University Medical Center

1840 7 th Street NW, 2 nd Floor Washington, DC 20001 202 -865 -8146 (Office) 202 -667 -1382 (Fax) Goulda Downer, Ph. D. , RD, LN, CNS Principle Investigator/Project Director (AETC-NMC) www. AETCNMC. org HRSA Grant Number: U 2 THA 19645 National Center for Cultural Competence, Georgetown University Medical Center