National Standards on Culturally and Linguistically Appropriate Services (CLAS)
The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.
The 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows:
CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7). CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13). CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
CLAS Standards
National Standards on Culturally and Linguistically Appropriate Services (CLAS)
The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.
The 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows:
CLAS
mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7).
CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).
CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
Standard 1
Health care organizations should ensure that patients/consumers receive from all staff member's effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
Standard 2
Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
Standard 3
Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.
Standard 4
Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
Standard 5
Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
Standard 6
Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).
Standard 7
Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
Standard 8
Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.
Standard 9
Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.
Standard 10
Health care organizations should ensure that data on the individual patient's/consumer's race, ethnicity, and spoken and written language are collected in health records, integrated into the organization's management information systems, and periodically updated.
Standard 11
Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.
Standard 12
Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.
Standard 13
Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.
Standard 14
Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.
For more information please go to:
http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15
Talking With Patients
How Hospitals Use Bilingual Clinicians and Staff to Care for Patients with Language Needs
http://www.calendow.org/uploadedFiles/Publications/By_Topic/Culturally_Competent_Health_Systems/Language_Access/Talking%20with%20Patients.pdf
About the Center of Cultural and Linguistic Competence in Health Care
Background
The OMH was mandated by the United States Congress (P.L. 101-527) in 1994 to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase access to health care for limited English-proficient people. Additionally this mandate directs OMH to support research, demonstrations, and evaluations to test new and innovative models aimed at increasing knowledge and providing a clearer understanding of health risk factors and successful prevention intervention strategies for minority populations.
The United States Congress, House Committee on Appropriations, 103rd Congress 2d Session, Report 103-553, June 21, 1994, also recognized the need to address language barriers faced by limited English-speaking populations in the health care delivery system. The Committee language encouraged OMH to carry out activities to improve the ability of health care providers to deliver health services in the native languages of limited -English proficient populations, as required by the Disadvantaged Minority Health Improvement Act of 1990. Concurrently, the Committee encouraged OMH to establish a center to develop and evaluate models, conduct research, and provide technical assistance to providers on removing language barriers to health care services.
The Center for Linguistic and Cultural Competence in Health Care (CLCCHC) was established in FY 1995 as a vehicle to address the health needs of populations who speak limited English.
The Center for Linguistic and Cultural Competency in Health Care (CLCCHC) is a response to P.L. 101-527, which requires the OMH to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase limited English-speaking individuals' access to health care. The law directs the OMH to support research, demonstrations, and evaluations to test innovative models aimed at increasing knowledge and providing a clearer understanding of health risk factors and successful prevention intervention strategies for minority populations.
Congress encouraged OMH to establish a center to develop and evaluate models, conduct research, and provide technical assistance to providers on removing language barriers to health care services. During FY 1995, OMH established the CLCCHC, a "center without walls," which encompasses all existing and new policy, partnering, communications, service demonstrations, and evaluation activities related to cultural competency.
Cultural Competency Training Tools Available:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=12.
Quality Interactions e-learning Program
Quality Interactions is an e-learning program that provides case-based instruction on cross-cultural health care. This interactive program focuses on common clinical and/or cross-cultural scenarios that build a framework of knowledge and skills for delivering quality care to diverse patient populations.
There are several versions of the Quality Interactions e-learning program which include the following:
- Quality Interactions for Physicians: This evidence-based, case-based learning program is accredited by Tufts University School of Medicine for 2.5 hours Continuing Medical Education (CME) Credits. The course features three patient cases and allows the clinician to participate in realistic clinical encounters while learning key concepts and skills for delivering effective cross-cultural care.
- Quality Interactions for Nurses & Case Managers: This evidence-based, case-based learning program is accredited by Tufts University School of Medicine for 2.5 hours Continuing Education Units (CEU). Similar to the physicians' version, this program allows the nurses and other health care professionals to interact with patients in realistic clinical settings to learn about providing effective cross-cultural care.
- Quality Interactions Refresher Courses: Similar in structure to the two-hour course for physicians and nurses, each refresher course presents one new cross-cultural patient case and is accredited by Tufts University School of Medicine for one hour CME. Refresher cases help to reinforce the major concepts learned in the two-hour course while presenting a new clinical scenario.
- Quality Interactions for Health Care Employees: This web-based, interactive program teaches many of the same concepts and skills as the original Quality Interactions program, but is geared toward all employees in health related organizations rather than clinical staff. The program teaches concepts and skills for understanding and interacting effectively with individuals from culturally diverse backgrounds including patients, customers, and coworkers.
- Cultural Competency Resource Center: We recently launched a new Cultural Competency Resource Center Website to help healthcare professionals access vitally important information that will help them better communicate and care for patients of diverse cultural backgrounds. Within the website is the content from all the Quality Interactions® training programs, as well as additional helpful tips on different cultures and health beliefs, use of interpreters, and clinical cross-cultural issues.
- Quality Interactions E-Newsletter: An option is provided to receive a quarterly e-newsletter with cases, updates, and refreshers on important cross-cultural practice and policy issues.
http://www.qualityinteractions.org/
Cultural Competence Health Practitioner Assessment (CCHPA)
The Cultural Competence Health Practitioner Assessment (CCHPA) was developed at the request of the Bureau of Primary Health Care (BPHC), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Service (DHHS). The CCHPA is intended to support the BPHC, and its funded programs, to enhance the delivery of high quality services to culturally and linguistically diverse individuals and underserved communities. It is also intended to promote cultural and linguistic competence as essential approaches for practitioners in the elimination of health disparities among racial and ethnic groups. http://www11.georgetown.edu/research/gucchd/nccc/features/CCHPA.html
Setting the Agenda for Research on Cultural Competence in Health Care - AHRQ
2004 - Health care providers take many approaches to bridge barriers to communication that stem from racial, ethnic, cultural, and linguistic differences. "Cultural competence" encompasses both interpersonal and organizational interventions and strategies for overcoming those differences. This document examines how cultural competence affects health care delivery and health outcomes, and it is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the Office of Minority Health (OMH). Part 1 of the report, which is presented in the pdf document, comprises the introduction and key findings.
http://www.imiaweb.org/uploads/docs/Setting_the_Agenda_for_Cultural_Competence_in_Health_Care_AHRQ.pdf
THE EVIDENCE BASE FOR CULTURAL AND LINGUISTIC COMPETENCY IN HEALTH CARE - The Commonwealth Fund
2006 - Cultural and linguistic competence are widely recognized as fundamental aspects of quality in health care and mental health care—particularly for diverse patient populations—and as essential strategies for reducing disparities by improving access, utilization, and quality of care. However, it is not clear if evidence exists to support the assertion that cultural and linguistic competence improve health outcomes and well-being. Advocates of culturally and linguistically competent care state that the costs of providing such care are offset by potential benefits, but, again, there is limited evidence to support
this assertion. This report assesses the current evidence base for the impact and benefits of cultural and linguistic competence in health care and mental health care.
http://www.imiaweb.org/uploads/docs/Evidence_Base_for_Cultural_and_Linguistic_Competency.pdf
American Anthropological Association
http://www.understandingrace.org
The interactive exercises are very beneficial when it comes to personal self awareness.
Resources for Cross-Cultural Health Care
http://www.diversityrx.org
Provider's Guide to Quality and Culture
http://erc.msh.org/quality&culture
HRSA
http://bphc.hrsa.gov/cc/3.htm
University of Pennsylvania Health Systems
http://www.uphs.upenn.edu/aging/diverse/direct.shtml
World Education Culture health, literacy
http://www.worlded.org/us/health/docs/culture/
National Academy Press
http://books.nap.edu/books/0309071542/html/index.html
Oregon State University
http://osu.orst.edu/dept/ehe/nu_diverse.htm
National Center For Cultural Competence, Georgetown University
http://gucdc.georgetown.edu/nccc/
The State of Literacy in America
http://www.nifl.gov/reders/reder.htm
Nhelp Racial/ Cultural Issues
http://www.nhelp.org/race.shtml#ling
Office of Minority Health
http://www.omhrc.gov/
The Cross Cultural Health Care Program
http://www.xculture.org
Kaiser Family Foundation Minority Health
http://www.kff.org/content/2001/6012/
Federal Registry (enter key word "linguistic”)
http://www.access.gpo.gov/su_docs/aces/aces140.html
Yale University Cultural Competence Resources
http://www.med.yale.edu/library/education/culturalcomp
Medical Policy Institute
http://www.medi-cal.org/publications/
Providing care to diverse populations
http://www.ahcpr.gov/news/ulp/ulpcultr.htm
Culture and nutrition
http://www.nal.usda.gov/fnic
AMSA Diversity in Medicine
http://www.amsa.org/div
Center for Cross Cultural Health
http://www.crosshealth.com
Culturally Competent Care: Examples of What Works
Commission on the Public Health System, New York
http://www.cphsnyc.org/pdf/childhealth.pdf
Cultural Orientation Resource Center
The Cultural Orientation Resource Center provides technical assistance regarding new refugee groups and the orientation they receive either before their resettlement in the United States or after their arrival.
http://www.cal.org/co/
Ethnomed
http://ethnomed.org
Cultural Competency Training of Trainers Program Video
http://xculture.org/cultural-competency-programs/cultural-competency-training/?utm_source=December+2012+Newsletter&utm_campaign=Dec+2012+Newsletter&utm_medium=email
Cultural Competence
Cultural competency tied to hard dollars
>>> http://mighealth.net/eu/index.php/Economic_cost_of_health_discrepancies
Cross Cultural Health Care Program
>> www.xculture.org
Diversity RX
>> www.diversityrx.org
Mass. General Hospital Medical Interpreter Services
>> www.massgeneral.org/interpreters/
The Multilingual Magazine 2013 Resource Directory and Editorial Index 2012 is now available for download from our website at:
>> www.multilingual.com/resourceDirectory
