The document discusses standards for culturally and linguistically appropriate health services. It outlines that programs receiving federal funding are required to provide language assistance services, including interpreters, to patients with limited English proficiency at no cost. It also mandates that these patients must be informed of their right to language assistance and that the competence of interpreters be ensured. Signage and materials must be made available in commonly encountered languages in the service area. Failure to comply can result in loss of federal funding. More than $1 trillion in excess direct and indirect medical costs over 3 years were estimated to result from health inequities faced by racial and ethnic minorities.

2. The President’s New Freedom Commission
on Mental Health: Achieving the Promise:
Transforming Mental Health Care in America.
Final Report, July 2003.

3. WESTERN PSYCHIATRIC TRADITIONAL ASIAN
• Scientific epistemology • Spiritual orientation
• Biochemical/Genetic etiology • Epistemologically based on
of illness without considering faith and intergenerational
soul or spiritual origins transmission of knowledge
• Defines illness as physical • No discrete lines between
or mental – discrete lines physical and mental illness
between mental and physical – holistic view of health
• Verbalization of problems • Verbalization of problems
viewed as a necessary part is not viewed as productive
of treatment or necessary. Silence is a
virtue.

4. • Widely held stereotypes of Asian Americans
as “problem free” may prompt clinicians
to overlook their mental health problems
(Takeuchi & Uehara, 1996).
• Among all the major ethnic groups, Asian
Americans confronted the most cultural and
linguistic barriers in finding competent
mental health care and received the lowest
quality of care.

5. • Only 12 percent of Asians would mention their
mental health problems to a friend or relative
(versus 25 percent of whites).
• A meager 4 percent of Asians would seek help
from a psychiatrist or specialist (versus 26 percent
of whites).
• Only 3 percent of Asians would seek help from
a physician (versus 13 percent of whites).
• This study of Asian Americans in LA concluded that
stigma was pervasive and pronounced (Zhang et
al., 1998).

7. • Denise McNair – 11 years old
• Carole Robertson – 14 years old
• Cynthia Wesley – 14 years old
• Addie Mae Collins – 14 years old

8. • Sept. 15, 1963 - instantly killed Denise,
Carole, Cynthia, and Addie
• Catalyzed the unified movement among
civil rights leaders
• July 2, 1964 - the passage of the most
comprehensive body of civil rights laws
in American history: U.S. Civil Rights
Act of 1964

9. How Title VI affects health
and human service provisions for those
with limited-English proficiency (LEP)?

10. "No person in the United States shall,
on ground 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."

11. Birthplace, ancestry, culture,
linguistic characteristics common
to a specific national minority group,
or linguistic accent

12. LEP persons are those
individuals with a primary
or home language other
than English who must,
due to limited fluency in
English, communicate in
that primary or home
language if they are to
have an equal opportunity
to participate in or benefit
from any aids or services
provided by an agency that
is receiving federal
funding.

13. Nearly 30% of Asian and
Latino Americans say they do not
speak English “very well.”

14. • Verbal communication is critical to accurate
diagnosis and effective treatment
• Diagnoses are frequently made on the basis
of symptoms verbally reported by the patient.
• No objective medical tests, such as EKGs,
blood tests, or x-rays to verify a psychiatric
diagnosis or the effectiveness of psychotropic
medications, other than the patient’s
presentation and verbal reporting

15. • Minorities face greater disability burden
not necessarily because the illnesses are
more severe but because of the barriers
they face in terms of access to care
• Health disparities result

16. Established that language, by proxy, is national origin
• The United States Supreme Court in Lau vs. Nichols
(1974) stated that one type of national origin
discrimination is discrimination based on a person's
inability to speak, read, write, or understand
English.
• The government has to take affirmative steps, i.e.,
language interpretation, to rectify the lack of equal
and comparable services based on limited-English
language proficiency.

17. "Simple justice requires that public funds,
to which all taxpayers of all races
contribute, not be spent in any fashion
which encourages, entrenches,
subsidizes, or results in racial
discrimination."

18. • There are 14 standards for culturally and
linguistically appropriate services (CLAS), proposed
as a means to correct inequities that currently exist
in the provision of health services and to make these
services more responsive to the individual needs of
all patients/consumers.
• Of these 14, Standards 4-7, which pertain to
language assistance, are mandated by law for all
programs and activities funded by Federal monies

19. Of these 14, Standards 4-7, which pertain to language
assistance, are mandated by law for all programs and
activities funded by Federal monies
4. Language assistance services at no cost to each
patient/consumer with LEP
5. Notices to patients/consumers in their preferred language,
informing them of their right to receive language assistance
services.
6. Competence of language assistance
7. Patient-related materials and signage in the languages of
the commonly encountered groups

20. Culturally and Linguistically Appropriate Services
Standards (CLAS) are the collective set of culturally
and linguistically appropriate services (CLAS)
mandates, guidelines, and recommendations
issued by the U.S. Department of Health and
Human Services Office of Minority Health intended
to inform, guide, and facilitate required and
recommended practices related to culturally and
linguistically appropriate health services
(National Standards for Culturally and
Linguistically Appropriate Services in Health Care
Final Report, OMH, 2001).

21. STANDARD 4
Health care organizations must offer
and provide language assistance services,
including bilingual staff and interpreter
services, at no cost to each patient/
consumer with limited English proficiency
at all points of contact, in a timely manner
during all hours of operation.

22. STANDARD 5
Health care organizations must provide
to patients/consumers in their preferred
language both verbal offers and written
notices informing them of their right to
receive language assistance services.

23. STANDARD 6
Health care organizations must assure
the competence of language assistance
provided to limited English proficient
patients/consumers by interpreters and
bilingual staff. Family and friends should
not be used to provide interpretation
services (except on request by the
patient/consumer).

24. STANDARD 7
Health care organizations must make
available easily understood patient-related
materials and post signage in the
languages of the commonly encountered
groups and/or groups represented in the
service area.

25. • Are supposed to be reported to the
Office of Civil Rights (OCR), Federal
Dept of Health and Human Services
• Reports of violations are investigated by
OCR
• Can result in loss of funding for the
organization in violation

26. More than 30 percent of direct medical costs faced
by African Americans, Hispanics, and Asian
Americans were excess costs due to health
inequities – more than $230 billion over a three
year period (2003-2006). And when you add the
indirect costs of these inequities over the same
period, the tab comes to $1.24 trillion.
— Ralph B. Everett, Esq.
President and CEO
Joint Center for Political and Economic Studies

27. Bruce Adelson, Esq.
Former Senior Attorney of the Dept of Justice
of Federal Compliance Consulting, LLC