Advancing Health Equity: The National CLAS Standards

1. 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

2. Presentation Overview • 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

3. HHS Office of Minority Health 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. OMH Functions

4. What Are Culturally and Linguistically Appropriate Services? • 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)

5. Why Are Culturally and Linguistically Appropriate Services Important? “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.

6. 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

7. 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

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

9. 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

10. 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

11. Disparities in Recovery The Cultural Competency Journey: Recovery Phase Recovery involves both short-term and long-term action. Source: DeWolfe 2000

12. National CLAS Standards, 2000 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

13. National CLAS Standards, 2000 The CLAS Themes

14. 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).

15. National CLAS Standards Enhancement Initiative: Timeline

16. Comparison–2000 and 2012 National CLAS Standards

17. National CLAS Standards: Next Steps • 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

18. Resource Tools: OMH’s Think Cultural Health Think Cultural Health (TCH): Cultural Competency Clearinghouse Advancing health equity at every point of contact http://www.ThinkCulturalHealth.hhs.gov

19. Cultural Competency Curriculum for Disaster Preparedness and Crisis Response 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

20. Cultural Competency Curriculum for Disaster Preparedness and Crisis Response 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

21. Cultural Competency Curriculum for Disaster Preparedness and Crisis Response 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

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

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

24. For More Information: Guadalupe Pacheco HHS Office of Minority Health Guadalupe_Pacheco@hhs.gov http://www.ThinkCulturalHealth.hhs.gov