Title: Implementing the CLAS Standards to Reduce HIV Disparity
1Implementing 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
2Learning 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.
3CLAS 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.
4CLAS 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).
5CLAS 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.
6CLAS 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.
7CLAS 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).
8CLAS 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.
9CLAS 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.
10CLAS 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.
11CLAS 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.
12CLAS 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.
13CLAS 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.
14CLAS 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.
15CLAS 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.
16CLAS 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).
17CLAS 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.
18CLAS 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.
-
19CLAS 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.
20CLAS 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.
21CLAS 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.
22CLAS 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.
23CLAS 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.
24CLAS 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
25CLAS 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).
26CLAS 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.
27CLAS 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.
28CLAS 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.
29CLAS 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.
30CLAS 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.
31Case 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?
32As 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
33Internet 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
34Thank You
National Center for Cultural Competence,
Georgetown University Medical Center