1. 2013
VAFCC & VRHA
Joint Conference
Valerie McAllister
CLAS Specialist
Office of Minority Health and Health Equity

2. Workshop Objectives
• Enhance participant’s awareness of the best practices
in providing culturally appropriate services to Virginia’s
increasingly diverse communities
• Increase participant’s knowledge of laws that drive
services to the limited English proficient (LEP)
population
• Provide resources to assist participants in working more
efficiently and effectively across cultures
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3. Did You Know?
Virginia trends...between 1990 – 2006
the Asian population more than doubled
the Hispanic population almost tripled
between 2000 - 2006
Virginia health districts served patients who spoke
nearly 100 different languages in 2008.
During 2008 VDH utilized the language translation
service for 11,338 calls.
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4. Commonwealth of Virginia
2.59
2.78
0.07
Racial / Ethnic Distribution
in Virginia 2009
4.86
0.34
19.67
69.69
White
American Indians
Native Hawaiian
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Black
Some Other Race
Two or More Races
Asian

5. LEP’s Effect on Health Care
Without effective language services, patients
with limited English proficiency:
• May have less access to primary care
• May be less likely to receive follow-up
appointments after Emergency Department visits
• May be less likely to understand their diagnoses,
medications, and follow-up instructions
• May be less satisfied with care received
• May not receive equivalent levels of preventive
care
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6. Effective Health Communication—
Not Just for Clinicians
Understanding and delivering effective health communication is
the charge of all health care professionals from all parts of your
organization
•Dentist
•Physicians
•Nurses
•Direct Service
•Social Workers
•Front-Office
•Patient Relations
•Billing
•Pharmacists
•Medical Interpreter
Each individual involved in a health care encounter is a
key player in ensuring that information is not only
delivered to the patient, but is understood by the patient.
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7. Unified Health Communication:
Like a Three-Legged Stool
• Unified health
communication is the
seat of the stool, and
health literacy,
cultural competency,
and LEP are the legs.
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8. The Importance of Health
Communication
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9. Communication Resources
for LEP Individuals
Individuals Right to Know
Interpreting
Translation
Assistive Technology/Communication Tools
Signage
Way-Finding (Navigation)
Community Involvement
Training
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10. Civil Rights Act of 1964
• Applies to federally funded institutions or programs
through direct or indirect funds
• Prohibits discrimination based on race, color, or
national origin
• Ensures equal access to services and benefits
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11. Regulatory Requirements and Compliance
Standards
• Title VI Civil Rights Act of 1964
• National CLAS Standards for Health and Health
Care, 2012
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12. To Whom Does Title VI Apply?
“Covered entities” include all recipients of federal
financial assistance through:
• Grants
• Loans
• Contracts
• Training
• Use or donation of equipment or property
• Indirectly through state agencies, county agencies,
private agencies
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13. Title VI of the Civil Rights Act of 1964
Recipients of federal financial assistance shall not:
• Deny an individual a service, aid, or benefit
• Provide a benefit, etc. which is different or provided in
a different manner
• Subject an individual to segregation or special
treatment
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14. Executive Order 13166
Title VI
Civil Rights Act of 1964
• Ensures access to interpreting services free of charge
• Discourages use of family, friends, minors as
interpreters
• Stresses the importance of language testing and trained
interpreters
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15. HHS LEP Policy Guide
• Clarifies the principles of Title VI with respect to LEP
persons
• Details reasonable policies and procedures to ensure
meaningful access to services
• Copies are available on OCR’s website:
www.hhs.gov/ocr
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16. National CLAS Standards
Purpose
• Advance Health Equity
• Improve Quality
• Eliminate Health Care Disparities
Themes
• Principal Standard
• Governance, Leadership, and Workforce
• Communication and Language Assistance
• Engagement, Continuous Improvement and
Accountability
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17. What are Culturally and
Linguistically Appropriate
Services?
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18. Who Are Our Consumers?
• Economically
disadvantaged
• Limited language
competence
• Racial and ethnic
minority
• Cultural isolation
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• Geographic isolation
• Disability
• Age vulnerability

19. The Risks of Using Untrained
Interpreters
• Unknown language
competency
• No orientation to
medical interpretation
• No or little knowledge
of medical terminology
• Previous relationship
with patient
• Relationship with
patient could
compromise the quality
of the session
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20. Maintaining Control of the
Encounter
The provider can do a lot to
enhance the quality of the
session:
•Empower the Patient
•Greeting in Native Language
•Body language
•Casual Conversation
•Eye Contact (When
appropriate)
•Remember that everything
said is interpreted
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21. Maintaining Control of the
Encounter
Ask questions directly to your patient
Ask open ended questions
Speak about one problem or symptom at a time
Avoid using slang or idioms
“Up and at ‘em”
“I’m feeling under the weather”
“Barking up the wrong tree”
“Up the creek without a paddle”
“A tough nut to crack”
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22. Children as Interpreters
• Imbalance of power
• Lack of Maturity
• Lack of Language
Proficiency
• Uncomfortable role
• Negates confidentiality
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23. Programs and Services Supported
Through CLAS Funding
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24. CLAS Resources
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25. 25

26. Culturally and Linguistically Appropriate
Services (CLAS)
CLAS Act Website (CLASActVirginia.org)
Culturally and
linguistically
appropriate health
care information
Conferences,
trainings and other
events
Policies,
regulations
and laws
Studies, data,
research
reports and
assessment
tools
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Multicultural
health and
human
service
programs
Translated
patient
education
information
Language
Identification
Poster

27. Culturally and Linguistically Appropriate
Services (CLAS)
Virginia Medical Interpreter Collaborative (VMIC)
VMIC:
A collaboration of
community partners
passionate about
meeting the needs of
the limited English
proficient (LEP)
community
www.vmicn.org
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28. Culturally and Linguistically Appropriate
Services (CLAS)
Virginia Medical Interpreter Database (VMID)
Virginia Medical Interpreter Database
(VMID)
• Database of trained Medical Interpreters in
Virginia
• An avenue for trained Medical Interpreters to offer
their skills
• Links to culturally and linguistically appropriate
resources
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29. VDH CLAS Initiatives
The Language
Identification Poster
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Navigating the U.S.
Heath Care System

30. The Navigating Toolkit is Available in
4 Languages
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31. 2010 Virginia Language
Needs Assessment
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32. Identifying Your Patient’s
Language
You can’t provide language assistance to your patients
with LEP until you know what language they speak
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33. VDH Health Districts
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34. Health Equity & Culturally Appropriate
Health Training Series
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35. OMHHE
As you can see Culturally and Linguistically Appropriate Services
is a link that connects all that we do!
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36. For More Information, Contact:
Valerie McAllister
Office of Minority Health and Health Equity
Division of Multicultural Health & Community
Engagement
CLAS Specialist
http://www.vdh.virginia.gov/healthpolicy/index.
htm
valerie.mcallister@vdh.virginia.gov
(804) 864-7437
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37. Questions
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