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Implementing the CLAS Standards to Reduce HIV Disparity

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Implementing the CLAS Standards to Reduce HIV Disparity Part 2. An Overview: Strategies for HIV/AIDS Providers. National Center for Cultural Competence, – PowerPoint PPT presentation

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Title: Implementing the CLAS Standards to Reduce HIV Disparity


1
Implementing the CLAS Standards to Reduce HIV
Disparity Part 2
  • An Overview Strategies for HIV/AIDS Providers

Co-Presented by Tawara D. Goode, MA, Director,
National Center for Cultural Competence (NCCC)
Wendy Jones, M.Ed.,. MSW, Director, NCCC,
Children and Youth with Special Health Care Needs
Project Georgetown University Center for Child
and Human Development
National Center for Cultural Competence,
Georgetown University Medical Center
2
Learning Objectives
  • At the completion of this webinar each
    participant will
  • state the importance of the 14 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 14 Standards.

3
CLAS Webinar Series
  • Part 2 of this Webinar series discusses Standards
    6-14 and strategies organizations and their
    personnel might pursue to implement CLAS.
  • We will use a case study to illustrate various
    points.
  • This Webinar series is designed to increase your
    awareness and knowledge of how you deliver care
    that is responsive to the cultural and linguistic
    characteristics of populations impacted by
    HIV/AIDS.

4
CLAS Standard 6
  • Ensure the competence of language assistance
    provided to limited English proficient
    clients/consumers by interpreters and bilingual
    staff.
  • Family and friends should not be used to provide
    interpretation services (except on request by the
    client/consumer).

5
CLAS Standard 6 Implementation Strategies
  • Use professional medical interpreters or trained
    and qualified bilingual/multilingual staff or
    volunteers.
  • Use telephone or video interpreting technology as
    an alternative to on-site interpretation,
    especially for low incidence languages.

6
CLAS Standard 6 Implementation Strategies
  • The organization should critically review and
    keep abreast of the evidence against using
    family, friends, minors, and untrained
    interpreters in the provision of health and
    mental health care and related services and
    supports.
  • Use this evidence to inform policy and procedures
    as to whom can provide interpretation services
    for the health/mental health care organization.

7
CLAS Standard 6 Implementation Strategies
  • The organization must have established policy and
    specific procedures to assess the competency of
    staff, contractors, and volunteers providing
    language access services. This may include
    assessment of
  • English and foreign language proficiency.
  • Knowledge of health and mental health terminology
    and key terms specific to HIV/AIDS (e.g. terms
    for sexual practices and behaviors, substance
    abuse, medical procedures, medications).
  • Awareness of colloquialisms used by cultural
    groups (e.g.
  • slang, street terms).

8
CLAS Standard 6 Implementation Strategies
  • The organization must have established policy and
    specific procedures to assess the quality of
    language access services.
  • Assess patient/client and provider satisfaction
    with the accuracy and quality of interpretation
    services received.
  • Analyze patient/client and provider satisfaction
    data to inform quality improvement efforts.
  • Inform patients/clients and staff how data will
    be used to improve services and supports.
  • Ensure that the organizations contracts for
    interpreters and translators have quality
    provisions.

9
CLAS Standard 7
  • Make available easily understood, client-related
    materials, and post signage in the languages of
    the commonly encountered groups and/or groups
    represented within the service area.

10
CLAS Standard 7 Implementation Strategies
  • Develop and/or adapt patient/client materials and
    resources that address the literacy and health
    literacy of the patient populations served.
  • Design alternative approaches to provide
    information to those patients/clients who may
    neither be literate in English nor their language
    of origin.
  • Provide training to staff in the use of literacy
    and health literacy tools and strategies (e.g.
    REALM-SF, SAHLSA-50, Teach Back, Ask Me 3,
    Plain Language) to assess and respond to
    patient needs.

11
CLAS Standard 8
  • 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.

12
CLAS Standard 8 Implementation Strategies
  • Integrate the delivery of culturally and
    linguistically competent HIV/AIDS care,
    treatment, and related services into the
    organizations strategic plan. The strategic plan
    should include implementation of all CLAS
    standards.
  • Involve people living with HIV/AIDS across
    demographic groups, their families, and advocates
    in the development of the strategic plan (e.g.
    race, ethnicity, culture, age, gender, gender
    identity, sexual orientation, socio-economic
    status, education).
  • Ensure that the plan includes establishment of a
    work group or team responsible for the provision
    of culturally and linguistically competent, care,
    treatment, and related services to all
    patients/clients, including those with HIV/AIDS
    and their families.

13
CLAS Standard 8 Implementation Strategies
  • Set SMART goals and objectives for the delivery
    of HIV/AIDS care, treatment and related services.
  • Report to the organizations board, staff and
    patients/clients on progress towards meeting
    these goals and objectives.

14
CLAS Standard 9
  • Conduct initial and ongoing organizational
    self-assessments of CLAS-related activities.
    (Organizations) are encouraged to integrate
    cultural and linguistic competence-related
    measures into their internal audits, performance
    improvement programs, patient satisfaction
    assessments, and outcomes-based evaluations.

15
CLAS Standard 9 Implementation Strategies
  • Establish a structure and dedicate resources
    (personnel and fiscal) to plan and conduct
    CLAS-related self-assessment activities.
  • Identify and select instruments, tools, data
    sources, and processes for self-assessment of
    CLAS-related activities. Embed measures for
    cultural and linguistic competence in the
    organizations internal auditing, evaluation, and
    quality improvement processes.

16
CLAS Standard 9 Implementation Strategies
  • Collect and analyze data from multiple sources.
    Develop reports and data summaries. Share
    findings with staff, patients/clients, board
    members, and contractors. Discuss their
    implications for policy, practice, and community
    engagement.
  • Monitor data that demonstrate the degree to
    which the organization as a whole, and individual
    departments/programs, are progressing toward the
    goals and objectives of the strategic plan for
    cultural and linguistic competence.

Ensure that data sharing processes and reports
are accessible to patients/clients (in plain
language) and are provided in multiple formats
(translation, oral presentations, large
print/Braille).
17
CLAS Standard 10
  • Ensure that data on the individual
    client'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.

18
CLAS Standard 10 Implementation Strategies
  • The organizations information systems should
    have the capacity to collect data on race,
    ethnicity, and language. Capacity should include,
    but is not limited to
  • Patients or clients primary language (written,
    spoken, sign) , and preferred language for
    service delivery.
  • Need for an interpreter.
  • English language ability (i.e. ability to speak,
    read, and understand English).
  • Literacy and health literacy levels.

19
CLAS Standard 10 Implementation Strategies
Communicate (in writing and verbally) the
organizations policy and practices for
confidentiality to all patients.
  • Advise patients/clients that data collected will
    be used to improves services and reduce
    disparities in health and health care based on
    race, ethnicity, and language.

Inform patients/clients that they have the option
to share or not share racial, ethnic, and
language data, and that their choice will not in
any way affect their ability to receive services.
Determine the extent to which the collection of
granular data will enhance service delivery to
patient populations. Granular data based on
cultural factors may include sexual orientation,
gender, gender identity or expression, country of
origin, cultural identity.
20
CLAS Standard 11
  • Maintain a current demographic, cultural, and
    epidemiologic 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.

21
CLAS Standard 11 Implementation Strategies
  • Ensure that policy, procedures, and practices are
    in place to monitor
  • current and emerging demographic trends in the
    geographic area served (e.g. race, ethnicity,
    languages spoken, age, immigrant and refugee
    data).
  • incidence, prevalence, and future projections for
    HIV/AIDS in the service area. (e.g. age, gender,
    gender identify, sexual orientation, race,
    ethnicity, country of origin).

Analyze these data to determine their
implications for planning, delivering, and
evaluating culturally and linguistically
competent services and supports. Update
periodically.
22
CLAS Standard 11 Implementation Strategies
  • Conduct asset and need assessments of the
    geographic area to determine the range of
    community resources that provide services and
    supports to people living with HIV/AIDS. Attend
    to the capacity of the community based resources
    to address culture, language, sexual orientation,
    gender identity or expression, and other
    characteristics of the population of people
    living with HIV/AIDS.
  • Consult the National Minority Quality Forum
    (www.nmqf.org) website for current
    epidemiological data based on zip code.

23
CLAS Standard 12
  • Develop participatory, collaborative
    partnerships with communities, and utilize a
    variety of formal and informal mechanisms to
    facilitate community and client/consumer
    involvement in designing and implementing
    CLAS-related activities.

24
CLAS Standard 12 Implementation Strategies
  • Ensure that the organizations
  • mission values communities as essential allies
    in achieving its overall goals.
  • policy, procedures, and practices delineate
    community and consumer and participation in
    planning, implementing, and evaluating services
    and supports for people living with HIV/AIDS.
  • policy and procedures allow the provision of
    fiscal resources and in-kind contributions to
    community partners, agencies or organizations.
  • policy, procedures, and practices support
    community engagement in languages other than
    English.

Data Source Goode, T. (2001). Policy Brief 4
Engaging Diverse Communities Culturally
Competent Approaches. National Center for
Cultural Competence. Retrieved from
http//nccc.georgetown.edu/documents/ncccpolicy4.p
df
25
CLAS Standard 12 Implementation Strategies
continued
  • Suggested community and patient/client engagement
    strategies include but are not limited to
  • Determine areas of mutual interest, benefit, and
    collaboration for partner organizations and
    agencies.
  • Legitimize formal partnerships with memoranda or
    agreements.
  • Collaborate with partners, where appropriate, to
    achieve goals, objectives, and desired outcomes
    in the provision of culturally and linguistically
    competent care to people living with HIV/AIDs and
    the communities in which they live.
  • Establish a structure for collaborative
    activities and resource sharing specifically for
    the provision of services and supports to people
    living with HIV/AIDS (e.g. referral network,
    exchange of best practices and lessons learned,
    joint grant proposals, shared patient education
    and related materials, joint training/professional
    development).
  • Issue joint reports on the outcomes of
    collaboration to partnering organizations, their
    boards, staff and patients/clients, and to the
    community at large.
  • Assess satisfaction with partnerships and
    revise partnering agreements as appropriate.
  • Identify and collaborate with informal, natural
    networks of support within culturally diverse
    communities to enhance services and supports to
    people living with HIV/AIDS.
  • Ensure patient/client voice and choice to plan,
    implement, and evaluate collaborative efforts
    (e.g. community engagement, public education,
    health fairs, representation on boards, media
    campaigns, training/professional development, HIV
    clinical trials and participation in research).

26
CLAS Standard 13
  • 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 clients/consumers.

27
CLAS Standard 13 Implementation Strategies
  • Suggested approaches for conflict and grievance
    resolution include, but are not limited to
  • Obtain patient/client and staff input to craft
    grievance policy and process.
  • Create a policy and process that is responsive,
    inclusive, and equitable and that leads to prompt
    resolution of grievances in a culturally and
    linguistically responsive manner. At a minimum,
    the process must address literacy, English
    ability, individuals with disabilities, and
    unfamiliarity or reluctance of some cultural
    groups to make formal complaints.
  • Ensure that the organizations data system has
    the capacity to document and track complaints,
    their status, and resolution for both
    patients/clients and staff.
  • Provide training to all new staff on the
    grievance policy and process. Ensure all staff,
    volunteers, patients/consumers are informed of
    the policy and process.
  • Update the grievance policy and process as
    appropriate.

28
CLAS Standard 13 Implementation Strategies
  • Consider using an ombudsperson in the resolution
    of grievances where appropriate. The ombudsperson
    should be knowledgeable of the cultural and
    linguistic contexts in which services are
    delivered and the population served.
    Additionally, the ombudsperson should be
    experienced in working with interpreters (sign
    and foreign language).
  • Provide notice to patients/clients in a prominent
    location on how to file a grievance. Include
    assurances that patients/clients have the right
    to file grievances without fear of
    recriminations. Notices should be written in the
    languages of the populations served.
  • Monitor adherence to the grievance procedures,
    including tracking resolution rates, as part of
    the overall quality improvement process.
  • Assess patients or clients satisfaction with
    grievance processes as part of the overall
    periodic patient satisfaction query efforts.

29
CLAS Standard 14
  • Regularly make available to the public
    information about their progress and successful
    innovations in implementing the CLAS standards,
    and provide public notice in (the organization's)
    communities about the availability of this
    information.

30
CLAS Standard 14 Implementation Strategies
  • Disseminate progress toward implementing CLAS to
    diverse constituents on at least an annual basis.
    Dissemination may include a variety of formats
    and audiences including
  • (1) reports tailored for staff,
    patients/clients, board members, or
    community partners
  • (2) presentations for community meetings/forums
  • (3) multimedia displays in waiting areas
  • (4) website postings, and
  • (5) use of ethnic media such as radio and
    newspapers.

31
Case Study Appropriateness of Family Members
Serving as Interpreters   Matilde, a 42 year old
Latina, reported for the results of her HIV test
three months after being tested. She has limited
ability to speak and understand English, so she
brought her two teenage sons, Miguel and Javier
along to interpret for her. The clinic neither
has bilingual staff nor contract interpreters.
The counselor feels uncomfortable about sharing
the results of Matildes HIV test with her two
sons but has no other way to communicate the
results. As the counselor begins to inform the
sons that their mother has tested positive for
HIV, Miguel begins to cry. Javier, interprets the
results to his mother, and accuses her of sexual
promiscuity. What are some of the issues that
are reflected in this case study? Which of the
CLAS Standards could provide guidance in
addressing this situation?  
32
As a culturally competent I am capable of
interacting positively with people who do NOT
look like,
talk like,
move like,
think like,
believe like,
act like,
live like...
ME!!!
Data Source Multnomah County Department of Health.
Modification from Mike Magy, Massachusetts
Department of Mental Health, November 2005 .
Slide Source National Center for Cultural
Competence, 2011
33
Internet Resources
  • AETC NMC at Howard University
  • Office of Minority Health
  • National Center for Cultural Competence
  • Center for Multicultural Mental Health
  • National Minority Quality Forum
  • The Cross Cultural Healthcare Program
  • DiversityRx
  • Ethnomed
  • www.aetcnmc.org
  • www.omhrc.gov
  • http//nccc.georgetown.edu/
  • www.cmmh-cmtp.com/index.php
  • www.nmqf.org/
  • www.xculture.org/
  • www.diversityrx.org
  • www.ethnomed.org

34
Thank You
National Center for Cultural Competence,
Georgetown University Medical Center
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