CLAS Standards presentation for UNC SW course

1. Effective and Efficient
services for Everyone
Using the CLAS Standards to support health equity
Cecily Rodriguez, MPA, CDE,
- Manager of Applied Research - School of Public and
International Affairs
- Director of Diversity and Inclusion - College of Architecture and
Urban Studies

2. By the end of this session, participants
will be able to:
• Understand the ethical, legal, and practical case for
providing culturally and linguistically appropriate
services in health and health care
• Define the CLAS Standards by theme
• Describe what culturally and linguistically
appropriate services look like in practice
• Have an emerging capacity to develop plan for
cultural competence in your own organization

3. What
does
CLC
really
look
like?
“The services I need,
from a perspective I
can relate to in a
language I am
comfortable with at a
location I can get to”

4. Principal
Standard
• 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 communications
needs.

5. Theme One
Governance, Leadership, and
Workforce

6. Governance
• Policies
• Planning
• Accountability
• Data Driven
• Community Engagement

7. • Consistent
• Self-Awareness
• Courageous
• Strategic
• Transparent
• Champion
• Connected
• Realistic

8. • Recruitment,
Selection, Retention
• Performance
Management
• Training
• Organizational
Development
• Employee Engagement

9. Recruiting
Think about…
• What do your job
descriptions say?
• Where are you
looking?
• Who recruits for you?
• Who gives you
referrals?
The talent you
want…where are
they?
Is there bias in ads or
job descriptions?
Ask to see the slate
of recruitment
venues
Expand internal
referral system
Communicate
investment in
inclusion and
diversity

10. Cultural Considerations
in the Selection Process
• Is it important to have someone with
cross cultural training on an interview
panel to evaluate responses through a
cultural lens?
• Should an organization have a different
interview guide for people whose mother
tongue is not English?
• How can questions be structured so as
not to screen out candidates who
emphasize team accomplishments over
individual accomplishments?

11. Theme Two
Communication and Language Assistance

13. Organizations are required to
take reasonable steps to ensure
meaningful access to their
programs and activities by LEP
persons.
• The Guidance explains that the obligation
to provide meaningful access is fact-
dependent and starts with an
individualized assessment that balances
four factors:
• Number or Proportion of LEP Individuals
• Frequency of Contact With the Program
• Nature and Importance of the Program
• Resources Available
The Civil Rights Act
of 1964 says that
no person shall be
excluded from
participation in,
be denied the
benefits of, or be
subjected to
discrimination based
on race, gender,
ethnicity or national
origin under any
program or activity
receiving federal
financial assistance.

14. Americans
with
Disabilities
Act- DOJ
Regulations
• Public entities must “take appropriate
steps to ensure that communications with
applicants, participants, and members of
the public with disabilities are as
effective as communications with
others.” 28 C.F.R. § 35.160(a).
• Must “furnish appropriate auxiliary aids
and services where necessary to afford
an individual with a disability an equal
opportunity to participate in, and enjoy
the benefits of, a service, program, or
activity conducted by a public entity.” 28
C.F.R. § 35.160(b).
• Must also give “primary consideration” to
the individual’s preference with respect
to choosing the type of auxiliary aid or
service to provide to ensure effective
communication. 28 C.F.R. § 35.160(c).

15. Offer TTY and
other assistive
technology devices
Require contractors, vendors, and
grantees to plan, budget, and provide for
English language learning stakeholders
Offer materials in Alternative
formats (e.g., audiotape, Braille,
enlarged print documents
Use qualified translation
services especially for
legally binding documents
Print materials in easy to
read, low literacy, picture
and symbol formats
Understand how and when language
selection happens for individuals
who speak more than one language.
Do we have policies in place regarding
the use of interpreters and train staff
on how to access and work with them
What
makes
an
organization
linguistically
competent?

16. Grave consequences
Federal Compliance Consulting LLC and Bruce L. Adelson, 2013
TeamSTEPPS 2006
https://cccdpcr.thinkculturalhea
lth.hhs.gov/AudioPlayer/AudioP
layer.asp?AudioFileName=17_3-
4-2.mp3
https://www.thinkculturalhealth.hhs.gov/FlashPlayer/play508.asp?Video=QHpart2

17. Don’t
forget
literacy
and
cognition!
Health Literacy Partners

18. GNINAELC — Ot erussa hgih
ecnamrofrep, yllacidoirep
naelc eht epat sdaeh dna
natspac revenehw uoy
eciton na noitalumucca fo
tsud dna nworb-der edixo
selcitrap.
Think …

19. Cleaning — To assure high
performance, periodically
clean the tape heads and
capstan whenever you
notice an accumulation of
dust and red-brown oxide
particles.
Think …

20. What are
Language Access
Services?
• Individuals’ Right to Know
• Interpreting
• Translation
• Assistive
Technology/Communication
Tools
• Signage
• Way-finding
• Community Involvement
• Training

21. Individuals’
Right
to
Know

22. Interpreting
Services
Studies suggest that English language evaluations of English language
learners may obscure mental-status findings among patients with
schizophrenia and the effects of language proficiency may vary
according to symptom type (Bauer & Alegria).
Only 48% of Spanish-speaking immigrants who required interpreter
services during their health care visits said they usually had one.
Furthermore, from those receiving interpreter services, only 70%
fully understood what the doctor was saying (Doty).

23. Untrained
Interpreters
• 52% Omission
• 16% False Fluency
• 13% Substitution
• 10% Editorialization
• 8% Addition

24. Trained Interpreters
• Accurately
interpreted most
(74%) of the
conversation
(Range: 47%-98%)
• Had higher accuracy
during nontechnical
portions
of the discussion in
comparison with the
technical portions.
Use of Interpreters by Physicians Treating Limited English Proficient Women with Breast Cancer: Results from the Provider Survey of the Los Angeles Women's
Health Study. Danielle E Rose, Diana M Tisnado, Jennifer L Malin, May L Tao, Melinda A Maggard, John Adams, Patricia A Ganz, Katherine L Kahn. 2010.

25. Children as interpreters

26. Translation
Darci L. Graves, MA, MA - University of Maryland-Baltimore County
What languages?
Who can do this?
Costs?
Who can review this?
Who can coordinate?
What about forms?

28. Graphic
material

29. Sustaining Language Access
Services

30. Theme Three
Engagement, Continuous Improvement, and
Accountability

31. refugees.org
refugees.org
THEME 3:
ENGAGEMENT,
CONTINUOUS
IMPROVEMENT,
AND
ACCOUNTABILITY
To understand how to best
provide high quality services,
you gotta do the hard stuff.

32. THEME 3: ENGAGEMENT, CONTINUOUS
IMPROVEMENT, & ACCOUNTABILITY
32
What do you
want from an
Organizational
Assessment
What kind of
demographic
information do
you need?
Understand the Community
Health Assets & Needs

33. THEME 3: IT’S ALL ABOUT THE PLANNING
33
Establish culturally and linguistically appropriate goals, policies, and management
accountability, and infuse them throughout the organization’s planning and operations.

34. • Understand how inequities may create unique
grievances.
• Create a clear process to take grievances and
complaints in other languages
• Be mindful of technological barriers
• Make sure staff know how to work through cross
cultural conflict and how to tap into language
resources
• Try a secret shopper!

35. refugees.org
refugees.org
SHARE IT!

36. Satisficing versus Social Equity in
Public Administration

37. References
Bauer, Amy M., M.D., M.S.; Alegria, Margarita Ph.D. (2010). Impact of Patient Language
Proficiency and Interpreter Service Use on the Quality of Psychiatric Care: A Systematic
Review. Psychiatric Services
Doty, M. (2003). Hispanic patients’ double burden: lack of health insurance and limited English.
Commonwealth Fund Pub. The Commonwealth Fund. 592.
Hampers LC, Cha S, Gutglass DJ, et al: Language barriers and resource utilization in a pediatric
emergency department. Pediatrics 103:1253–1256, 1999
Karliner, Leah, Jacobs, Elizabeth A, Chen, Alice Hm, and Mutha, Sunita. (2007). Do Professional
Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A
Systematic Review of the Literature. Health Serv Res. Apr 2007; 42(2): 727–754.
Lie, D., Boker, J., & Cleveland, E. (2006). Using the tool for assessing cultural competence
training (TACCT) to measure faculty and medical student perceptions of cultural
competence instruction in the first three years of the curriculum. Academic Medicine,
Miranda J, McGuire TG, Williams DR, et al: Mental health in the context of health disparities.
American Journal of Psychiatry 165:1102–1108, 2008
Wilson-Stronks, A., & Galvez, E. (2007). Hospitals, language, and culture: A snapshot of the
nation. Retrieved from The Joint Commission website:
http://www.jointcommission.org/assets/1/6/hlc_paper.pdf
Youdelman, M., & Perkins, J. (2005). Promising practices for small health care providers. In
Providing language services in small health care provider settings: Examples from the field
(pp. 3–11) (Commonwealth Fund Publication No. 810).