Paving the Way: CLAS & Policy


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Keynote presentation delivered May 6th at the 6th annual conference for Health Care Access and Quality at the University of Massachusetts

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  • Paving the way… because it truly is a journey… sometimes smooth… sometimes bumpy… sometimes fast and sometimes very, very slow. Sometimes we find ourselves asking “Are we there yet?” “Was that my exit?”
  • We are in search of what is equitable. A health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.Health equity is the attainment of the highest level of health for all people. Achieving health equity requires everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. Adopted from the OMHNPA
  • Culture is the integrated pattern of thoughts, communications, actions, customs, beliefs, values and institutions associated wholly or partially on racial, ethnic, religious, spiritual, linguistic, biological, socioeconomic, geographical or sociological characteristics. --Racial and ethnic groups include, but are not limited to, those defined in the US census and other communities. Religious and spiritual characteristics include beliefs, practices and support systems related to how an individual finds and defines meaning in their life.Biological characteristics include age, sex, sexual orientation, gender identity and physical ability or limitations. Geographical characteristics include where one resides, whether it be urban, rural or suburban, one’s country of origin or one’s environment and surroundings. Language characteristics – what language, what dialect, when and where did they learn it? What do they speak at home? Who do they speak Sociological characteristics include length of residency in the US, generation, gender, gender expression, political beliefs, perceptions of family and community, perceptions of health and well-being, perceptions/beliefs around diet and nutrition, occupational groups, military affiliation, education level, and family and household composition.
  • Today’s presentation will focus on the policy portion of this definition…
  • Cultural and linguistic competence – providing language access services – isn’t new…
  • So we have been talking about our journey and paving the way…
  • And why are we on this journey? because Communication is complicated… even when we speak the same language… Jay/Evan Fib & LieHoney, the trash is full.Doctor/Patient  Do you drink alcohol, no, but sometimes I drink beer.Unfortunately we don’t all have capes or magic wands or even super powers to suddenly become “MEDICAL DE-JARGONIZERS” What we do have are policies, guidelines and best and promising practices.
  • This map comes from the National Conference of State Legislatures. I have included their website at the end of this presentation for those who are interested in exploring more. Since 2005, 35 states have created statewide strategic plans to address health disparities. Of the 35 states with plans:18 are legislative initiatives 16 states have plans that are initiatives of the Department of Health State of Pennsylvania has a plan created by a governor’s taskforce.
  • This is a table of contents from a document produced by the National Health Law Program. 50 states plus the District of Columbia all have legislation or policy in place in regards to language access services.
  • We are in search of what is compassionate – respectful - equitable.
  • The State Board of Medical Examiners shall prescribe the following requirements for physician training, by regulation, in consultation with the Commission on Higher Education: The curriculum in each college of medicine in this State shall include instruction in cultural competency designed to Completion of cultural competency instruction [] shall be required as a condition of receiving a diploma from a college of medicine in this State. A college of medicine which includes instruction in cultural competency [] shall offer for continuing education credit, cultural competency training which is provided through classroom instruction, workshops or other educational programs [] A person who received a diploma from a college of medicine in this State prior to the effective date of regulations [], as a condition of initial licensure by the board, to document completion of cultural competency training … A physician licensed to practice medicine in this State shall be required, as a condition of relicensure, to document completion of cultural competency training [] to the satisfaction of the board no later than three years after the effective date of this act.I will share some preliminary results from a New Jersey case study that illustrates some of the impact that this legislation has had.
  • This 2009 legislation adds a fifth mandate for continuing medical education in the area of cultural competency for licensing and renewals after Oct. 1, 2010. As now in effect: A licensee applying for license renewal shall earn a minimum of fifty contact hours of continuing medical education within the preceding twenty-four-month period.
  • Paving the Way: CLAS & Policy

    1. 1. Paving the Way: CLAS & Policy<br />Darci L. Graves, MA, MA<br />Senior Health Education and Policy Specialist, SRA International, Inc.<br />
    2. 2.
    3. 3. Overview<br />Paving the Way… <br />Legislation, Policy and Health Disparities<br />Cultural Competency Legislation<br />Impact of Cultural Competency Legislation <br />
    4. 4. What do we mean by culture?<br />Graves, 2001 (revised 2011)<br />
    5. 5. Cultural and Linguistic Competence in Health<br />A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. <br />
    6. 6. Fiorello H. LaGuardia <br />
    7. 7. Policy & Publication Timeline<br />
    8. 8.
    9. 9. HHS Office of Minority Health: National CLAS Standards <br />The CLAS Standards were developed by OMH in December 2000 as a means to improve access to health care for minorities, reduce disparities, and improve quality of care.<br />There are currently 14 standards which are divided into 3 themes. <br />The National CLAS Standards Enhancement Initiative launched in fall of 2010 and the second iteration of the Standards are due for release in Fall 2011.<br />
    10. 10. Statewide Plans to Reduce Health Disparities <br />National Conference of State Legislatures <br />
    11. 11. Summary of State Law Requirements Addressing Language Needs in Health Care<br />National Health Law Program<br />
    12. 12. Legislation regarding Cultural Competency Training<br />Dark Blue denotes legislation requiring (WA, CA, NJ, NM) or strongly recommending (MD) cultural competence training, which was signed into law. <br />Purple denotes legislation which has been referred to committee and is currently under consideration.<br />Royal Blue denotes legislation which died in committee or was vetoed.<br />
    13. 13.
    14. 14. HHS Plans for AddressingHealth Disparities & Health Equity <br />
    16. 16. First Examples of Mandated Legislation<br />New Jersey, California <br />and Washington<br />
    17. 17. New Jersey – 2005 (#Bill S144)<br />The State Board of Medical Examiners shall prescribe the following requirements for physician training, by regulation, in consultation with the Commission on Higher Education:<br />(e) A physician licensed to practice medicine in this State shall be required, as a condition of relicensure, to document completion of cultural competency training [] to the satisfaction of the board no later than three years after the effective date of this act.<br />
    18. 18. California – 2005 (#AB 1195)<br /><ul><li>This bill would require on and after July 1, 2006, that continuing medical education courses, except as specified, include curriculum in the subjects of cultural and linguistic competency in the practice of medicine, as defined. The bill would require accreditation associations to develop standards for this curriculum before July 1, 2006.</li></li></ul><li>Washington – 2006 (ESB – 6194)<br /><ul><li>By July 1, 2008, each education program with a curriculum to train health professionals for employment in a profession credentialed [] shall integrate into the curriculum instruction in multicultural health as part of its basic education preparation curriculum. </li></li></ul><li>Connecticut – 2009 (#PA 09-232)<br />Continuing medical education shall include at least one contact hour of training or education in each of the following topics: (A) Infectious diseases, including, but not limited to, acquired immune deficiency syndrome and human immunodeficiency virus, (B) risk management, (C) sexual assault, [and] (D) domestic violence, and (E) for registration periods beginning on and after October 1, 2010, cultural competency.<br />
    19. 19. Implications of Cultural Competency Legislation: A Case Study<br />New Jersey<br />
    20. 20. Mandatory cultural competency education garners some criticism; however, many feel that it will improve patient-provider interactions, compliance, and patient satisfaction.<br />New Jersey: A case study on the implications of legislation for cultural competency curricula <br />Legislative Mandates on Cultural Competency Training<br />
    21. 21. Think Cultural Health from the HHS Office of Minority Health<br />Continuing education programs that equip health professionals with awareness, knowledge, and skills to treat diverse patients<br />Up-to-date information on issues related to cultural competency and health disparities<br />Tracking of cultural competency legislation around the country<br />
    22. 22. A Physician’s Practical Guide to Culturally Competent Care<br />Free, online program accredited for physicians, physician assistants, and nurse practitioners<br />Designed to equip physicians with the awareness, knowledge and skills to treat diverse patients and improve quality of care<br />
    23. 23. A Physician’s Practical Guide to Culturally Competent Care<br />Two-year evaluation results: Curriculum participation results in development of knowledge, awareness and skills related to cultural competency.<br />The curriculum shows the potential for improving health outcomes and ultimately mitigating racial and ethnic health disparities.<br />
    24. 24. Assessing the Impact of Cultural Competency Mandates<br />Mandatory training may be an ideal way to promote cultural competency as an effective strategy to eliminate health disparities:<br />Higher exposure to cultural competency due to legislative requirements<br />Higher exposure to cultural competency creates a workforce equipped to provide quality care to diverse patients<br />
    25. 25. Assessing the Impact of Cultural Competency Mandates<br />New Jersey mandated 6 hours of cultural competency continuing education for physician relicensure.<br />Examination of differences in attitudes about cultural competency between individuals who self-select to take the program and those who take it to fulfill a mandate. <br />
    26. 26. Assessing the Impact of Cultural Competency Mandates<br />Self-reflection components of the curriculum were compared among mandated and non-mandated individuals. <br />Physicians’ attitudes related to cultural competency were similar for mandated and non-mandated participants.<br />
    27. 27. Assessing the Impact of Cultural Competency Mandates<br />Large increases in New Jersey physician participation in the cultural competency curriculum<br /> New Jersey physician participants<br />
    28. 28. Cultural Competency Mandates<br />Mandatory cultural competency education garners some criticism, including the idea that forced training will create negative reactions to cultural differences or cross-cultural efficacy. <br />However, these concerns seem to be unfounded based on these results.<br />
    29. 29. Implications – Potential for Cultural Competency Mandates<br />Completion of the physicians’ curriculum, whether mandated or not, increases cultural competency knowledge and may improve practice behavior. <br />
    30. 30. Implications – Potential for Cultural Competency Mandates<br />This negates criticism that mandatory cultural competency training is ineffective because mandated providers will show reluctance in grasping cultural competency concepts. <br />Mandates may be an ideal way to help improve care and ultimately help eliminate health disparities. <br />
    31. 31. Summary<br />Cultural competency education has the potential to improve patient-provider interactions, compliance, and patient satisfaction.<br />Through cultural competency education mandates, policy can play a vital role in eliminating health disparities.<br />
    32. 32. Places to Learn More<br /><ul><li>Think Cultural Health</li></ul><br /><ul><li>National Conference of State Legislatures</li></ul><br /><ul><li>National Health Law Program</li></ul><br /><ul><li>HHS Office of Minority Health</li></ul><br />
    33. 33. For questions or additional information, contact:<br />Darci L. Graves, MA, MA<br /><br /><br />