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Running Head: Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
Implementation of the National Standards on Cultural and Linguistic
Services(CLAS)in two Hospitals in the Bronx, New York; Challenges and
Benefits.
By
Ahmed Otokiti, M.B,.B.S. CCRP.
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
Abstract
In this Essay I have tried to bring to the fore, the various challenges faced by two Bronx
hospitals in implementing the National standards for culturally and linguistic appropriate
services(CLAS). While these challenges are real, I have also tried to highlight the benefits of its
implementation to the hospitals and to the society at large in the process of reducing Health
disparity.
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
Implementation of the CLAS standard and culturally competent Health care
Delivery with its challenges in two Bronx Hospitals.
Introduction
The National standards for culturally and linguistic appropriate services(CLAS) from the
office of minority Health at the U.S department of health and human services are composed of
15 standards that serve as a guide for successfully implementing and maintaining a culturally and
linguistic appropriate service. Culturally and linguistically appropriate services and care should
be respectful of and responsive to the cultural and linguistic needs of all individuals(US
Department of Health and Human Services, 2008).The enhanced National CLAS Standards are
organized into one Principal Standard and three themes: (1) Governance, Leadership, and
Workforce; (2) Communication and Language Assistance; and (3) Engagement, Continuous
Quality Improvement, and Accountability.
Need for CLAS; The purpose of class is to help reduce the health disparity and increase
health equity as health equity is defined as the attainment of the highest level of health for all
people(U.S. Department of Health and Human Services, 2011). Among the various
socioeconomic factors responsible for health inequity and disparity,lack of culturally and
linguistically appropriate service has been identified as one of the most modifiable factors. 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, 2009)
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
CLAS implementation in Bronx Lebanon Hospital and Montefiore Hospital Center
in Bronx New York
Bronx is by far the poorest amongst the five Boroughs of New York city with an
estimated 27.6 percent of families living below the poverty line(Sisk, 2010) .For a family of four
with two children under 18 years to be considered poor their average annual household income
has to be less than $22,113.While the south Bronx is the poorest district in the Nation with up to
38% living below poverty line(Sisk, 2010). The demography of the Bronx is such that groups
that experience disparity the most are dominant here. The first three groups with the highest
population are the Hispanic/latino which constitute53.5%, Blacks/African American are 30.1%
and whites are 10.9%.At the 2009 American Community Survey, 31.9% of Bronx's population
was foreign born and another showing a huge significant amount of immigrants(Cubit website of
demographics, 2012). These demography and socioeconomic status clearly showsthat this is an
area highly prone to health disparity. Also considering the fact that some of the immigrants are
undocumented as there are 535,000 undocumented immigrants in New York City(Kershaw,
2010).
Challenges Faced in the Implementation of CLAS Standards
Language Barrier
There is the problem of lack of English language proficiency in the majority of the Bronx
immigrant population.Up to 55 percent of individuals aged 5 years and older living in Bronx
speak a language other than English(Skinner, Wight, Aratani, Cooper, & Thamp, 2010) . This
can create further miscommunication between the care giver and patients making CLAS
implementation very difficult.
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
Poverty and Illiteracy
This hydra headed determinant of health further complicates the situation and compliance
is difficult for patients due to poverty.
Government and Health care System mistrust
There is mistrust of the health care system by the mostly the minority population in the
Bronx. Due to atrocities that have been committed in the past, various conspiracy theories are
brought up to discredit the health care system.
Problem of Undocumented Immigrants
Even when reassured that the health care delivery system is independent of the U.S
immigration services.Many Undocumented immigrants do not come forth for health screening
for fear of being handed to the immigration service.
Scarce Financial, Human and Material Resources
There is excess strain on resources as health care professionals are overworked and with
hospitals working on slim margins amidst financial crisis. It becomes even more difficult to
implement CLAS standards due to these challenges.
Steps Taken To Implement the CLAS Standards
Despite all the challenges outlined above, these two hospitals have tried to implement the
CLAS standards to the best of their ability. For this reason Montefiore Hospital has received
various awards for its effort(Montefiore.org, 2013a).The following efforts have been made; All
signs and patient education literatures handed out have been translated to Spanish language and
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
the literatures are set out at a basic school reading level,both hospitals have 24hours interpreter
services, both hospitals also offer out of pocket option of payment for the uninsured on a “sliding
Scale” pay as you earn basis, both hospital offer a free Spanish language immersion program to
all employees to encourage them to learn to speak the common language of the community they
serve, Montefiore hospital has a chaplaincy service and an interfaith Chapel to cater to the
spiritual needs of the patients, bot Hospital also employ a diverse work force.
Benefit of CLAS Adoption
Although it is a very challenging task to adopt the CLAS standard in this community with
the issues of scarce of resources. However both Hospitals have benefitted from taking the pain to
adopt culturally competent care and CLAS standards. One benefit that stands out is that both
hospitals have a good reputation among the residents of Bronx and for this they have been able
to weather the storm in this harsh economic crisis. As they continue to be patronized and
ensuring their continuous existence. Recently some hospitals have been forced to close down
because of the economic crisis. Both hospitals performance score with accreditation agencies
have always been high(Montefiore.org, 2013b).Also the screening rate of HIV in the Bronx have
increased through the Bronx knows HIV program which both hospitals are participants.The
Bronx Knows partners have offered and conducted 607,570 HIV tests and have identified over
4,800 confirmed HIV positive tests to date. Of those, at least 1,700 individuals were reported
to be newly diagnosed and more than three-quarters have been linked to care. This result far
surpasses the target for the intervention(NYC.gov, 20011).
Conclusion
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
No doubt, the CLAS standard implementation and provision of culturally competent
services in health care delivery can be very costly in the short term. However we all have more
to gain in the long run as we try to reduce health disparity. It is also advocated that the
Government should increase funding of research related to outcome of provision of culturally
competent care in other to fortify evidence based practice.
References
Cubit website of demographics. (2012). Bronx,New York Demographics Retrieved August 7, 2013, from
http://www.newyork-demographics.com/bronx-county-demographics
Kershaw, S. (2010). Immigration Crackdown Steps Into the Kitchen. Retrieved 2013, from
http://www.nytimes.com/
LaVeist, T. A., Gaskin, D. J., Richard, P. (2009). The economic burden of health inequalities in the United
States. Retrieved from the Joint Center for Political and Economic Studies Retrieved August 7,
2013, from
http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burd
en%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
Montefiore.org. (2013a). Awards and Recognitions Retrieved August 8, 2013, from
http://www.montefiore.org/about-awards-and-recognition
Montefiore.org. (2013b). Montefiore Einstein Center for Cancer Care Receives Highest Level of
Commendation from Commission on Cancer Retrieved August 8, 2013, from
http://www.montefiore.org/body.cfm?id=1738&action=detail&ref=980
NYC.gov. (20011). The Bronx knows HIV testing initiative final Report Retrieved August 8, 2013, from
http://www.nyc.gov/html/doh/downloads/pdf/ah/bronx-knows-summary-report.pdf
Sisk, R. (2010). South Bronx is poorest district in nation, U.S. Census Bureau finds: 38% live below
poverty line Retrieved August 7, 2013, from http://www.nydailynews.com/new-york/south-
bronx-poorest-district-nation-u-s-census-bureau-finds-38-live-poverty-line-article-
1.438344#ixzz2bJnHzbe4
Skinner, C., Wight, V. R., Aratani, Y., Cooper, J., & Thamp, K. (2010). English Language Proficiency,Family
Economic Security, and Child Development Retrieved August 8, 2013, from
http://www.nccp.org/publications/pdf/text_948.pdf
U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic
health disparities: A nation free of disparities in health and health care. Retrieved August 7,
2013, from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
US Department of Health and Human Services, Office of Minority Health. (2008, April 2008). Final
National Standards on Culturally and Linguistically Appropriate
Culturally competent health care delivery; Bronx Hospitals
Ahmed Otokiti(ahmedotoks@yahoo.com)/2013
Services (CLAS) in Health Care Retrieved December 2012, from
www.omhrc.gov/inetpub/wwwroot/cultural/cultural4.htm.

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Challenges and benefits of implementation of the national standard on cultural and linguistic services; a case study of two bronx hospitals

  • 1. 1 Running Head: Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 Implementation of the National Standards on Cultural and Linguistic Services(CLAS)in two Hospitals in the Bronx, New York; Challenges and Benefits. By Ahmed Otokiti, M.B,.B.S. CCRP.
  • 2. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 Abstract In this Essay I have tried to bring to the fore, the various challenges faced by two Bronx hospitals in implementing the National standards for culturally and linguistic appropriate services(CLAS). While these challenges are real, I have also tried to highlight the benefits of its implementation to the hospitals and to the society at large in the process of reducing Health disparity.
  • 3. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 Implementation of the CLAS standard and culturally competent Health care Delivery with its challenges in two Bronx Hospitals. Introduction The National standards for culturally and linguistic appropriate services(CLAS) from the office of minority Health at the U.S department of health and human services are composed of 15 standards that serve as a guide for successfully implementing and maintaining a culturally and linguistic appropriate service. Culturally and linguistically appropriate services and care should be respectful of and responsive to the cultural and linguistic needs of all individuals(US Department of Health and Human Services, 2008).The enhanced National CLAS Standards are organized into one Principal Standard and three themes: (1) Governance, Leadership, and Workforce; (2) Communication and Language Assistance; and (3) Engagement, Continuous Quality Improvement, and Accountability. Need for CLAS; The purpose of class is to help reduce the health disparity and increase health equity as health equity is defined as the attainment of the highest level of health for all people(U.S. Department of Health and Human Services, 2011). Among the various socioeconomic factors responsible for health inequity and disparity,lack of culturally and linguistically appropriate service has been identified as one of the most modifiable factors. 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, 2009)
  • 4. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 CLAS implementation in Bronx Lebanon Hospital and Montefiore Hospital Center in Bronx New York Bronx is by far the poorest amongst the five Boroughs of New York city with an estimated 27.6 percent of families living below the poverty line(Sisk, 2010) .For a family of four with two children under 18 years to be considered poor their average annual household income has to be less than $22,113.While the south Bronx is the poorest district in the Nation with up to 38% living below poverty line(Sisk, 2010). The demography of the Bronx is such that groups that experience disparity the most are dominant here. The first three groups with the highest population are the Hispanic/latino which constitute53.5%, Blacks/African American are 30.1% and whites are 10.9%.At the 2009 American Community Survey, 31.9% of Bronx's population was foreign born and another showing a huge significant amount of immigrants(Cubit website of demographics, 2012). These demography and socioeconomic status clearly showsthat this is an area highly prone to health disparity. Also considering the fact that some of the immigrants are undocumented as there are 535,000 undocumented immigrants in New York City(Kershaw, 2010). Challenges Faced in the Implementation of CLAS Standards Language Barrier There is the problem of lack of English language proficiency in the majority of the Bronx immigrant population.Up to 55 percent of individuals aged 5 years and older living in Bronx speak a language other than English(Skinner, Wight, Aratani, Cooper, & Thamp, 2010) . This can create further miscommunication between the care giver and patients making CLAS implementation very difficult.
  • 5. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 Poverty and Illiteracy This hydra headed determinant of health further complicates the situation and compliance is difficult for patients due to poverty. Government and Health care System mistrust There is mistrust of the health care system by the mostly the minority population in the Bronx. Due to atrocities that have been committed in the past, various conspiracy theories are brought up to discredit the health care system. Problem of Undocumented Immigrants Even when reassured that the health care delivery system is independent of the U.S immigration services.Many Undocumented immigrants do not come forth for health screening for fear of being handed to the immigration service. Scarce Financial, Human and Material Resources There is excess strain on resources as health care professionals are overworked and with hospitals working on slim margins amidst financial crisis. It becomes even more difficult to implement CLAS standards due to these challenges. Steps Taken To Implement the CLAS Standards Despite all the challenges outlined above, these two hospitals have tried to implement the CLAS standards to the best of their ability. For this reason Montefiore Hospital has received various awards for its effort(Montefiore.org, 2013a).The following efforts have been made; All signs and patient education literatures handed out have been translated to Spanish language and
  • 6. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 the literatures are set out at a basic school reading level,both hospitals have 24hours interpreter services, both hospitals also offer out of pocket option of payment for the uninsured on a “sliding Scale” pay as you earn basis, both hospital offer a free Spanish language immersion program to all employees to encourage them to learn to speak the common language of the community they serve, Montefiore hospital has a chaplaincy service and an interfaith Chapel to cater to the spiritual needs of the patients, bot Hospital also employ a diverse work force. Benefit of CLAS Adoption Although it is a very challenging task to adopt the CLAS standard in this community with the issues of scarce of resources. However both Hospitals have benefitted from taking the pain to adopt culturally competent care and CLAS standards. One benefit that stands out is that both hospitals have a good reputation among the residents of Bronx and for this they have been able to weather the storm in this harsh economic crisis. As they continue to be patronized and ensuring their continuous existence. Recently some hospitals have been forced to close down because of the economic crisis. Both hospitals performance score with accreditation agencies have always been high(Montefiore.org, 2013b).Also the screening rate of HIV in the Bronx have increased through the Bronx knows HIV program which both hospitals are participants.The Bronx Knows partners have offered and conducted 607,570 HIV tests and have identified over 4,800 confirmed HIV positive tests to date. Of those, at least 1,700 individuals were reported to be newly diagnosed and more than three-quarters have been linked to care. This result far surpasses the target for the intervention(NYC.gov, 20011). Conclusion
  • 7. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 No doubt, the CLAS standard implementation and provision of culturally competent services in health care delivery can be very costly in the short term. However we all have more to gain in the long run as we try to reduce health disparity. It is also advocated that the Government should increase funding of research related to outcome of provision of culturally competent care in other to fortify evidence based practice. References Cubit website of demographics. (2012). Bronx,New York Demographics Retrieved August 7, 2013, from http://www.newyork-demographics.com/bronx-county-demographics Kershaw, S. (2010). Immigration Crackdown Steps Into the Kitchen. Retrieved 2013, from http://www.nytimes.com/ LaVeist, T. A., Gaskin, D. J., Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic Studies Retrieved August 7, 2013, from http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burd en%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf Montefiore.org. (2013a). Awards and Recognitions Retrieved August 8, 2013, from http://www.montefiore.org/about-awards-and-recognition Montefiore.org. (2013b). Montefiore Einstein Center for Cancer Care Receives Highest Level of Commendation from Commission on Cancer Retrieved August 8, 2013, from http://www.montefiore.org/body.cfm?id=1738&action=detail&ref=980 NYC.gov. (20011). The Bronx knows HIV testing initiative final Report Retrieved August 8, 2013, from http://www.nyc.gov/html/doh/downloads/pdf/ah/bronx-knows-summary-report.pdf Sisk, R. (2010). South Bronx is poorest district in nation, U.S. Census Bureau finds: 38% live below poverty line Retrieved August 7, 2013, from http://www.nydailynews.com/new-york/south- bronx-poorest-district-nation-u-s-census-bureau-finds-38-live-poverty-line-article- 1.438344#ixzz2bJnHzbe4 Skinner, C., Wight, V. R., Aratani, Y., Cooper, J., & Thamp, K. (2010). English Language Proficiency,Family Economic Security, and Child Development Retrieved August 8, 2013, from http://www.nccp.org/publications/pdf/text_948.pdf U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care. Retrieved August 7, 2013, from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf US Department of Health and Human Services, Office of Minority Health. (2008, April 2008). Final National Standards on Culturally and Linguistically Appropriate
  • 8. Culturally competent health care delivery; Bronx Hospitals Ahmed Otokiti(ahmedotoks@yahoo.com)/2013 Services (CLAS) in Health Care Retrieved December 2012, from www.omhrc.gov/inetpub/wwwroot/cultural/cultural4.htm.