C. Godfrey Jacobs, Program Manager Health Determinants & Disparities Practice SRA International, discusses Legislative Updates - CLAS Standards & What They Mean for Hospitals and Interpreters

1. The Importance of Culturally and
Linguistically Appropriate Services
and How to Achieve Them
C. Godfrey Jacobs
Program Manager, Health Determinants & Disparities
Practice at SRA International, Inc.
October 11, 2013
International Language Services Conference
Advancing Health Equity at Every Point of Contact

2. What are we talking about today?
Culturally & Linguistically
Appropriate Services
Why?
How?

3. What are culturally and linguistically
appropriate services (CLAS)?
Services that are respectful of and responsive
to individual cultural health beliefs and
practices, preferred languages, health literacy
levels, and communication needs and
employed by all members of an organization
(regardless of size) at every point of contact.
OMH, 2013

4. What are culturally and linguistically
appropriate services (CLAS)?
Services that are respectful of and responsive
to individual cultural health beliefs and
practices, preferred languages, health
literacy levels, and communication needs
and employed by all members of an
organization (regardless of size) at every point
of contact.
OMH, 2013

5. Culture

6. World Population, 2012

7. World Population, 2050 Estimate

8. Majority Religion by Country
Pew Research Center,
2012

9. Population Density, 2010

10. English Speakers

11. Demographics in the U.S.
Reporting a
disability:
12.1%
Limited English
Proficient:
22%
Over the age of 65: 13%
Under the age of 18: 25%

12. LGBT
There are
approximately
9 million
LGBT Americans,
a figure roughly
equivalent to the
population of New
Jersey.

13. Health Literacy

14. Patient Safety
Events
Greater Risk for
Medical Errors
Poorer Health
Outcomes
Higher Rate of
Readmissions

15. Communication
A two-way process in which messages are
negotiated until the information is correctly
understood by both parties.
The Joint Commission, 2010

16. Communication
• When providers understand and integrate the
information gleaned from patients.
• When patients comprehend accurate, timely,
complete, and unambiguous messages
The Joint Commission, 2010

17. Why Are These Issues Important?
Quality
Litigation
Patient Need
Legislation
Informed
Consent
Changing
Demographics
Disparities
Social
Justice
Medical
Error
Regulation
Accreditation

18. The Case for Culturally and
Linguistically Appropriate Services
Business
OMH, 2013
Social

19. Litigation
Misinterpretation of one word:
Intoxicado
$71million dollar
settlement
19

20. Disparities
Eliminating health disparities
for minorities would have
reduced direct medical care
expenditures by
$229.4 billion in 2003-2006.

21. Patient Need-Satisfaction
When a non-English speaking
patient comes to the hospital
everything is strange…
The only familiar thing in this
alien environment is the voice
of the interpreter.

22. Quality
Rita Quintero

23. Medical Error
9 out of 10

24. Social Justice & Other Implications
"Please don't cry, Mama;
they tell me I have
cancer".

25. Legislation

26. Regulation

27. Accreditation

28. Every Point of Contact
Initial point of
contact &
appointment
scheduling
Preparation for
the visit
Entering &
navigating the
health
organization
Registration
Waiting in the
lobby
Procedures,
radiology & lab
work
Assessment &
clinical encounter
including physical
exam
Diagnosis and
explanation of
treatment &
discharge plans
Discussion &
referrals
Billing
Pharmacy
Reminders &
follow-up
communication
Patient Feedback

29. How can we address
these issues?

30. The National Standards for Culturally and
Linguistically Appropriate Services
in Health and Health Care
• Published by the HHS Office of Minority Health in 2000
• Re-published in 2013

31. The National CLAS Standards
Physical
Mental
Social
Spiritual
Health

32. The National CLAS Standards
Advance
health
equity
Help
eliminate
disparities
Improve
quality of
services
32

33. What are the
National CLAS Standards?

34. Principal Standard
1. Provide effective, equitable, understandable,
and respectful quality care and services that
are responsive to diverse cultural health
beliefs and practices, preferred languages,
health literacy, and other communication
needs.
34

35. Theme 1: Governance, Leadership
and Workforce
governance
leadership
workforce

36. Standards on Governance,
Leadership, and Workforce
2. Advance and sustain organizational governance
and leadership that promotes CLAS and health
equity through policy, practices, and allocated
resources.
3. Recruit, promote, and support a culturally and
linguistically diverse governance, leadership, and
workforce that are responsive to the population in
the service area.
4. Educate and train governance, leadership, and
workforce in culturally and linguistically
appropriate policies and practices on an ongoing
basis.
36

37. Theme 2: Communication and
Language Assistance

38. Standards on Communication
and Language Assistance
5. Offer language assistance to individuals who have limited
English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health
care and services.
6. Inform all individuals of the availability of language
assistance services clearly and in their preferred
language, verbally and in writing.
7. Ensure the competence of individuals providing language
assistance, recognizing that the use of untrained
individuals and/or minors as interpreters should be
avoided.
8. Provide easy-to-understand print and multimedia
materials and signage in the languages commonly used
by the populations in the service area.
38

39. Theme 3: Engagement, Continuous
Improvement and Accountability

40. Standards on Engagement, Continuous
Improvement, and Accountability
9. Establish culturally and linguistically appropriate goals,
policies, and management accountability, and infuse
them throughout the organization’s planning and
operations.
10. Conduct ongoing assessments of the organization’s
CLAS-related activities and integrate CLAS-related
measures into measurement and continuous quality
improvement activities.
11. Collect and maintain accurate and reliable
demographic data to monitor and evaluate the impact
of CLAS on health equity and outcomes and to inform
service delivery.
40

41. Standards on Engagement, Continuous
Improvement, and Accountability
12. Conduct regular assessments of community health
assets and needs and use the results to plan and
implement services that respond to the cultural and
linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and
evaluate policies, practices, and services to ensure
cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes
that are culturally and linguistically appropriate to
identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization’s progress in
implementing and sustaining CLAS to all stakeholders,
constituents, and the general public.
41

42. Where can you find more information
about the National CLAS Standards?
National CLAS
Standards:
A Blueprint for
Advancing and
Sustaining CLAS
Policy and Practice

43. Where do we go from here?

44. Think Cultural Health

45. Godfrey_Jacobs@sra.com