National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care : A Blueprint for Advancing and Sustaining CLAS Policy and Practice

2013·7 MB·English

tfEALTf, Office of Minority Health
U.S. Department of Health and Human Services
A Blueprint for Advancing and Sustaining CLAS Policy and Practice
Office of Minority Health Resource Center
Knowledge Center
1101 Wootton Parkway, Suite 650
MD
Rockville, 20852
1-800-444-6472
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
National Standards for Culturally and Linguistically
Appropriate Services in Health and Health Care:
A Blueprint for Advancing and Sustaining CLAS
Policy and Practice
Office of Minority Health
U.S. Department of Health and Human Services
April 2013
OfficeofMinority Health ResourceCenter
KnowledgeCenter
1101 Wootton Parkway
Rockville. MD 20852
1-800-444-6472
l
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Table of Contents
ACKNOWLEDGMENTS
7
EXECUTIVE SUMMARY 8
National Standards for Culturally and Linguistically Appropriate Services in Health and Health
Care 14
THE CASE FOR THE ENHANCED NATIONAL CLAS STANDARDS 15
Respond to Demographic Changes 16
Eliminate Health Disparities 17
Improve Quality of Services and Care 18
Meet Legislative, Regulatory, and Accreditation Mandates 19
Gain a Competitive Edge in the Market Place 20
Decrease the Risk of Liability 21
THE ENHANCED NATIONAL CLAS STANDARDS 22
The Standards 22
Purpose 22
Audience 22
Components of the Standards 24
Strategies for Implementation 24
ENHANCEMENTS TO THE NATIONAL CLAS STANDARDS 26
Culture 26
Health 29
Health and Health Care Organizations 29
Individuals and Groups 29
Statement of Intent 30
Clarity and Action 31
Standards of Equal Importance 31
Principal Standard and Three Enhanced Themes 33
New Standard: Organizational Governance and Leadership 35
LOOKING AHEAD: THE FUTURE AND THE NATIONAL CLAS STANDARDS 36
Continued Enhancements 36
State and Federal Legislation 36
Support and Guidance 37
BIBLIOGRAPHY 38
THE BLUEPRINT 45
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
STANDARD 1: PROVIDE EFFECTIVE, EQUITABLE, UNDERSTANDABLE, AND RESPECTFUL
QUALITY CARE AND SERVICES 46
Standard 1 46
Purpose 46
Components of the Standard 46
Strategies for Achievement of the Principal Standard 50
Resources 51
Bibliography 52
STANDARD ADVANCE AND SUSTAIN GOVERNANCE AND LEADERSHIP THAT
2:
PROMOTES CLAS AND HEALTH EQUITY 55
Standard 2 55
Purpose 55
Components of the Standard 55
Strategies for Implementation 59
Resources 60
Bibliography 60
STANDARD 3: RECRUIT, PROMOTE, AND SUPPORT A DIVERSE GOVERNANCE,
LEADERSHIP, AND WORKFORCE 63
Standard 3 63
Purpose 63
Components of the Standard 63
Strategies for Implementation 65
Resources 66
Bibliography 67
STANDARD 4: EDUCATE AND TRAIN GOVERNANCE, LEADERSHIP, AND WORKFORCE IN
CLAS 69
Standard 4 69
Purpose 69
Components of the Standard 69
Strategies for Implementation 72
Resources 73
Bibliography 74
STANDARD 5: OFFER COMMUNICATION AND LANGUAGE ASSISTANCE 76
Standard 5 76
Purpose 76
Components of the Standard 76
Strategies for Implementation 80
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Resources 80
Bibliography 81
STANDARD 6: INFORM INDIVIDUALS OF THE AVAILABILITY OF LANGUAGE ASSISTANCE
83
Standard 6 83
Purpose 83
Components of the Standard 83
Strategies for Implementation 85
Resources 87
Bibliography 88
STANDARD 7: ENSURE THE COMPETENCE OF INDIVIDUALS PROVIDING LANGUAGE
ASSISTANCE 89
Standard 7 89
Purpose 89
Components of the Standard 89
Strategies for Implementation 92
Resources 94
Bibliography 95
STANDARD 8: PROVIDE EASY-TO-UNDERSTAND MATERIALS AND SIGNAGE 97
Standard 8 97
Purpose 97
Components of the Standard 97
Strategies for Implementation 100
Resources 100
Bibliography 101
STANDARD 9: INFUSE CLAS GOALS, POLICIES, AND MANAGEMENT ACCOUNTABILITY
THROUGHOUT THE ORGANIZATION'S PLANNING AND OPERATIONS 103
Standard 9 103
Purpose 103
Components of the Standard 103
Strategies for Implementation 104
Resources 105
Bibliography 106
STANDARD 10: CONDUCT ORGANIZATIONAL ASSESSMENTS 107
Standard 10 107
Purpose 107
Components of the Standard 107
iv
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Strategies for Implementation 109
Resources 110
Bibliography Ill
STANDARD 11: COLLECT AND MAINTAIN DEMOGRAPHIC DATA 113
Standard 11 113
Purpose 113
Components of the Standard 113
Strategies for Implementation 119
Resources 120
Bibliography 121
STANDARD 12: CONDUCT ASSESSMENTS OF COMMUNITY HEALTH ASSETS AND NEEDS
124
Standard 12 124
Purpose 124
Components of the Standard 124
Strategies for Implementation 126
Resources 128
Bibliography 129
STANDARD 13: PARTNER WITH THE COMMUNITY 130
Standard 13 130
Purpose 130
Components of the Standard 130
Strategies for Implementation 131
Resources 132
Bibliography 133
STANDARD 14: CREATE CONFLICT AND GRIEVANCE RESOLUTION PROCESSES 135
Standard 14 135
Purpose 135
Components of the Standard 135
Strategies for Implementation 137
Resources 137
Bibliography 138
STANDARD 15: COMMUNICATE THE ORGANIZATION'S PROGRESS IN IMPLEMENTING
AND SUSTAINING CLAS 139
Standard 15 139
Purpose 139
Components of the Standard 139
v
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Strategies for Implementation 140
Resources 142
Bibliography 142
APPENDIX A: GLOSSARY 144
Bibliography 157
APPENDIX B: NATIONAL CLAS STANDARDS ENHANCEMENT INITIATIVE 164
Background 164
Goals 164
Development Process 165
Public Comment 166
National Project Advisory Committee 167
APPENDIX C: NATIONAL PROJECT ADVISORY COMMITTEE 170
—
APPENDIX D: CROSSWALK NATIONAL CLAS STANDARDS 2000 AND 2012 173
APPENDIX E: RESOURCES 177
List of Figures and Tables
Figure 1: State Legislation 19
Figure 2: Interrelationship of Aspects of Culture 28
Figure 3: Enhanced National CLAS Standards' Themes 33
Figure 4: Phases of the National CLAS Standards Enhancement Initiative 165
Figure 5: Advisory Committee Meetings 167
Table 1: Blueprint Chapter Structure 45
Table 2: Examples of Promoting CLAS Through Policy and Practice 57
Table 3: Interpreting and Translating 77
Table 4: A Process for Collecting Data 119
vi
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Acknowledgments
This document is the result of a multiyear process that involved many individuals across
the country. We extend our appreciation to them:
• The National Project Advisory Committee (Advisory Committee) members, for their
generosity in sharing their time and expertise and their tireless dedication in the
review of numerous drafts of terminology, documents, and the enhanced National
CLAS Standards. A complete list of the Advisory Committee members appears in
Appendix C.
• The individuals and organizations who participated in the public comment period,
either by attending a public comment meeting or by providing online or written
submissions. Your input helped to inform the enhancements to the National CLAS
Standards, originally released in 2000.
Executive Summary 7
National Standards for CLAS in Health and Health Care:
A BlueprintforAdvancing andSustaining CLASPolicyandPractice
Summary
Executive
Health equity is the attainment of the highest level of health for all people (U.S.
Department of Health and Human Services [HHS] Office of Minority Health [OMH], 2011).
Currently, individuals across the United States from various cultural backgrounds are
unable to attain their highest level of health for several reasons, including the social
determinants of health, or those conditions in which individuals are born, grow, live, work,
and age (World Health Organization [WHO], 2012), such as socioeconomic status,
education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion [ODPHP], 2010a). Though health inequities are directly related to
the existence of historical and current discrimination and social injustice, one of the most
modifiable factors is the lack of culturally and linguistically appropriate services, broadly
defined as care and services that are respectful of and responsive to the cultural and
linguistic needs of all individuals.
Health inequities result in disparities that directly affect the quality of life for all
individuals. Health disparities adversely affect neighborhoods, communities, and the
broader society, thus making the issue not only an individual concern but also a public
health concern. In the United States, it has been estimated that the combined cost of
health disparities and subsequent deaths due to inadequate and/or inequitable care is
$1.24 trillion (LaVeist, Gaskin, & Richard, 2009). Culturally and linguistically appropriate
services are increasingly recognized as effective in improving the quality of care and
services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). There are numerous
ethical and practical reasons why providing culturally and linguistically appropriate
services in health and health care is necessary, including the following, which have been
identified by the National Center for Cultural Competence (Cohen & Goode, 1999, revised
by Goode & Dunne, 2003):
1. To respond to current and projected demographic changes in the United States.
2. To eliminate long-standing disparities in the health status of people of diverse
racial, ethnic and cultural backgrounds.
3. To improve the quality of services and primary care outcomes.
4. To meet legislative, regulatory and accreditation mandates.
5. To gain a competitive edge in the market place.
6. To decrease the likelihood of liability/malpractice claims.
Executive Summary 8