Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Hector Ortiz - Creating Health Equity by Implementing Culturally and Linguistically Appropriate Services

1,692 views

Published on

Presented by Hector Ortiz, PhD, on March 13, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

Published in: Health & Medicine
  • DOWNLOAD FULL BOOKS INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Hector Ortiz - Creating Health Equity by Implementing Culturally and Linguistically Appropriate Services

  1. 1. Communicating in a Small World: Creating Health Equity by Implementing Culturally and Linguistically Appropriate Services March 12-13, 2015 Hector Richard Ortiz, Ph.D. Communicating in a Small World
  2. 2. Overarching Goal – To develop continued education opportunities for public health officials, clinical staff and patient populations to better understand culture, diversity, inclusion and health equity. Overarching Goal
  3. 3. Culture: Traditions, behaviors, attitudes, languages, thoughts, beliefs, values and ways of communication with any group of people. Culture acts like a template, shaping our behavior and beliefs from generation to generation. What is Culture?
  4. 4. Culture is comprised of: • History/identity • Norms and values • Artifacts and products • Basic assumptions • Language • Customary behaviors • Beliefs • Thought patterns What is Culture?
  5. 5. Three dimensions of culture: “Universal” refers to ways in which all people in all groups are the same. “Group differences” refers to the traits a particular group of people have in common and how they are different from every other group. “Personal” describes the ways in which each of us is unique. We may even be different than others in our group on a personal level. Dimensions of Culture
  6. 6. Intercultural Communication A form of interpersonal communication where cultural influences are sufficiently great and may interfere, distort or result in miscommunication and/or lack of understanding. What is Intercultural Communication?
  7. 7. Diversity • Diversity are the differences that comprise an individual, group or organization. Diversity implies: • Mosaic of people, variety of backgrounds, diverse value systems, different beliefs, several perspectives What is Diversity?
  8. 8. Primary elements of diversity: • Age, gender, color, ethnicity, national origin, physical and mental ability, sexual orientation. Secondary elements of diversity: • Appearance, beliefs, faith, education, family, income, attitude, personal experiences and language structure. Dimensions of Diversity
  9. 9. Diversity and inclusion can allow people to see everyone as part of the larger community, and accept that everyone has skills and knowledge that can contribute to the whole. An inclusive and diverse environment should recognize, affirm and value the worth of every person, and recognize the dignity of all individuals. Diversity and Inclusion
  10. 10. Inclusion implies, but it is not limited to, attract, hire, develop, engage and promote a diverse workforce in the different fields and decision-making processes. Affirmative action, diversity and inclusion are not the same. Diversity and Inclusion
  11. 11. Culture: Integrated patterns of traditions, behaviors, attitudes, languages, thoughts, beliefs, values and ways of communication in any group of people. Competence: Capacity to function efficiently and effectively as individuals and organizations within the context of personal and group differences. What is Cultural Competence?
  12. 12. Cultural competence is a set of behaviors and skills, attitudes and policies, to enable efficient and effective internal and external work in cross-cultural interactions. Cultural and linguistic competence involves individuals and programs that are compatible to a consumer's cultural beliefs, practices and languages needs. What is Cultural Competence?
  13. 13. Health inequities ● Health inequities or health disparities exist when one population or group of people experience worse health outcomes or a lesser quality of health care when compared to other populations. ● These differences are often caused by societal, economic or environmental factors, such as poor housing, poverty or discrimination. What are Health Inequities?
  14. 14. • In the USA, access to quality, affordable and preventive care is not consistent across the country and inadequate for the least healthy populations. • Some health disparities includes, chronic diseases, access to care, child mortality, premature deaths, mental and oral health. Who Suffers From Health Inequities?
  15. 15. What are Enhanced National CLAS Standards • Enhanced national CLAS standards were approved by the Department of Health and Human Services (HHS) in 2013 as a blueprint to help providers improve the quality of care in serving diverse communities.
  16. 16. Enhanced CLAS Standards Promote Health Equity Health equity is the attainment of the highest level of health for all people, independently of their race, ethnicity, origin, color, gender, age, socioeconomic status, sexual identity or expression. (U.S. Department of HHS Office of Minority Health, 2011)
  17. 17. Social Determinants of Health External conditions influencing health outcomes are known as the “social determinants of health.” They are the circumstances in which people are born, grow, live, work and age. Factors such as jobs, the environment, health care, transportation, food security, education and housing, are examples of social determinants.
  18. 18. Civil Rights and Equitable Health Care Dr. Martin Luther King, Jr., identified health inequity as the most harsh form of discrimination saying “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
  19. 19. Health Inequity Awareness • Providers may order fewer diagnostic tests for patients of different cultural backgrounds because they may not understand or believe the patient’s description of symptoms. On the other hand, more diagnostic tests may be ordered to compensate for not understanding a patient.
  20. 20. Health Inequity Awareness • African-Americans may be less likely to be referred for cardiac catheterization than whites, when presenting with identical symptoms. • Hispanics who have a lower overall incidence of breast, oral cavity, colorectal and urinary bladder cancers, will experience death rates from these conditions, similar to that of the majority population.
  21. 21. The Cost of Inequity • The economic cost of health inequities in the United States is significant. • It has been estimated that the combined cost of health complications and subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin and Richard, 2009).
  22. 22. CLAS Standards Reduce Inequities • The standards that define culturally and linguistically appropriate services are known by the acronym “CLAS.” • The provision of CLAS is one of the easiest ways to reduce health equities, improve health outcomes and reduce health care costs.
  23. 23. CLAS Standards Reduce Inequities • The national CLAS standards are intended to advance health equity, improve quality and help eliminate health care disparities. • Health care that meets CLAS standards have been progressively recognized as effective in improving the quality of care and services. (Beach, et al., 2004; Goode, Dunne and Bronheim, 2006)
  24. 24. CLAS Standards Mandates CLAS Mandates: Title VI, Civil Rights Act, 1964 Title VI of the Civil Rights Act of 1964 ‐ § 601 ensures nondiscrimination in federally assisted programs and states that “No person in the United States shall, on the grounds of race, color or national origin, be excluded from participation in, be denied the benefits of or be subjected to discrimination under any program or activity receiving federal financial assistance.” http://www.hhs.gov/ocr/civilrights/resources/laws/index.html
  25. 25. CLAS Standards Mandates • The HHS health resources and services administration found that health professionals who lack cultural and linguistic competency can be found liable under tort principles (2005) for failing to follow the national CLAS blueprint.
  26. 26. Evolution of CLAS Standards • Original national CLAS standards were developed in 2000 by the HHS Office of Minority Health building upon Title VI of the Civil Rights Act of 1964. • To better reflect the objectives of the Affordable Care Act (ACA) of 2010, CLAS standards underwent an enhancement initiative from 2010 to 2012. The enhanced national CLAS standards of 2013 address new developments and trends.
  27. 27. CLAS/Enhanced CLAS Expanded standards National CLAS standards National enhanced CLAS standards 2013 Culture Defined in terms of racial, ethnic and linguistic groups Defined in terms of racial, ethnic and linguistic groups, as well as geographical, religious and spiritual, biological and sociological characteristics Audience Health care organizations Health and health care organizations Health Definition of health was implicit Explicit definition of health to include physical, mental, social and spiritual well-being Recipients Patients and consumers Individuals and groups
  28. 28. Enhanced CLAS Standards Principals The enhanced national standards for CLAS in health and health care can be classified into four categories: 1. Principal standard 2. Governance, leadership and workforce 3. Communication and language assistance 4. Engagement, continuous improvement and accountability
  29. 29. Enhanced CLAS Standards Principal Standard (Standard 1) 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.
  30. 30. Enhanced CLAS Standards Governance, Leadership and Workforce (Standards 2, 3 and 4) 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices and allocated resources.
  31. 31. Enhanced CLAS Standards Governance, Leadership and Workforce (Standards 2, 3 and 4) 3. Recruit, promote and support a culturally and linguistically diverse governance, leadership and workforce that are responsive to the population in the service area.
  32. 32. Enhanced CLAS Standards Governance, Leadership and Workforce (Standards 2, 3 and 4) 4. Educate and train governance, leadership and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
  33. 33. Enhanced CLAS Standards Communication and Language Assistance (Standards 5, 6, 7 and 8) 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to ensure timely access to all health care and services.
  34. 34. Enhanced CLAS Standards Communication and Language Assistance (Standards 5, 6, 7 and 8) 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
  35. 35. Enhanced CLAS Standards Communication and Language Assistance (Standards 5, 6, 7 and 8) 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
  36. 36. Enhanced CLAS Standards Communication and Language Assistance (Standards 5, 6, 7 and 8) 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
  37. 37. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 9. Establish culturally and linguistically appropriate goals, policies and management accountability, and infuse them throughout the organization’s planning and operations.
  38. 38. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
  39. 39. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 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. 40. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 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.
  41. 41. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 13. Partner with the community to design, implement and evaluate policies, practices and services to ensure cultural and linguistic appropriateness.
  42. 42. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent and resolve conflicts or complaints.
  43. 43. Enhanced CLAS Standards Engagement, Continuous Improvement and Accountability (Standards 9, 10, 11, 12, 13, 14 and 15) 15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents and the general public.
  44. 44. The enhanced national CLAS standards align other regulations and guidelines such as: • HHS Action Plan to Reduce Racial and Ethnic Health Disparities (HHS, 2011). • National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to End Health Disparities, 2011). Plans and Strategies Aligned With CLAS
  45. 45. Plans and Strategies Aligned With CLAS The Joint Commission’s Roadmap for Hospitals (2010) Hospital’s ability to advance culturally competent care rests on its “state of organization readiness.” Organizational readiness requires: • use of qualified language interpreters; • addressing patient communication needs; • collection of race and ethnicity information; • strengthening nondiscrimination issues.
  46. 46. Plans and Strategies Aligned With CLAS The Joint Commission on Provision of Care PC.02.01.21: The hospital effectively communicates with patients when providing care, treatment and services.  EP 1: The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care.
  47. 47. Plans and Strategies Aligned With CLAS The Joint Commission on Provision of Care  EP 2: The hospital communicates with the patient during the provision of care, treatment and services in a manner that meets the patient’s oral and written communication needs.
  48. 48. Plans and Strategies Aligned With CLAS The Joint Commission on Record of Care RC.02.01.01: The medical records contain information that reflects the patient's care, treatment and services.  EP 28: The medical record contains the patient's race and ethnicity.
  49. 49. Plans and Strategies Aligned With CLAS The Joint Commission on Human Resources HR.01.02.01: The hospital defines staff qualifications.  EP 1: The hospital defines staff qualifications specific to job responsibilities.  Note 4 in EP 1 requires that individuals who provide interpreting and translation services have defined qualifications and competencies.
  50. 50. Plans and Strategies Aligned With CLAS The Joint Commission on Patient Rights RI.01.01.01: The hospital respects, protects and promotes patient rights.  EP 29: The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression.
  51. 51. Regulations and Laws Aligned with CLAS ACA of 2010 • Expands initiatives to increase racial and ethnic diversity. • Requires health plans to implement activities to reduce health disparities, including the use of language services, community outreach and strengthens cultural competency trainings.
  52. 52. The Significance of ACA • The passage of ACA (2010) increased awareness of health disparities. • The law requires health plans to take measures to reduce health disparities. • ACA expands initiatives to recruit individuals from diverse racial and ethnic backgrounds. • ACA also strengthens cultural competency training in health and health care.
  53. 53. CLAS Legislation Map Denotes legislation requiring (WA, CA, CT, NJ, NM) or strongly recommending (MD) cultural competence training that was signed into law. Denotes legislation that was referred to committee and/or is currently under consideration (NY, OH, IN, KY, GA, MO, OK, AZ). Denotes legislation that died in committee or was vetoed ( IL, IA, FL, TX, CO). This information is located on the website of the Office of Minority Health. https://www.thinkculturalhealth.hhs.gov/content/legislatingclas.asp
  54. 54. Final Thoughts Coming together is a beginning; keeping together is progressing; working together is success! - Anonymous Thank you! ¡Gracias!

×