DFCHS TITLE V MATERNAL AND CHILD HEALTH PROGRAMS...

DFCHS TITLE V MATERNAL AND CHILD HEALTH PROGRAMS

Cultural and Linguistic Competence Planning and Capacity Building

Developed by the MCH Cultural and Linguistic Competency Workgroup May 2014

STRATEGIC PLAN

“The mission of the Division of Family and Community Health Services (DFCHS) is to assure access to health services for Ohioans.”

--DFCHS Mission Statement

Cultural and Linguistic Competence Planning and Capacity Building 2


ACKNOWLEDGEMENTS

This strategic plan is the result of years of dedication and perseverance by the Cultural and Linguistic Competence Workgroup (CLCW), also known as the Maternal and Child Health State Performance Measure 04 (SPM 04) Workgroup. Many thanks to past and present members for their contributions towards this plan, their collaborative efforts have culminated in this comprehensive strategic plan.

In addition, we would like to thank current members of the CLCW subcommittee who dedicated their time and expertise to the content development of this strategic plan:

Ohio Department of Health Staff:

• Vivian Jackson Anderson

• Anureet Benipal

• Barbara Carnahan

• Dyane Gogan-Turner

• Sierra Mullen

• Theresa Seagraves

• Lillian Stuckey

• Robyn Taylor

• Wengora Thompson

• Kim Weimer

Special thanks to our stakeholder participants and partners:

• Thometta Cozart Brooks, DHPE Fellow – Ohio Commission on Minority Health

• Grace Kolliesuah, Columbus Public Health

• Melissa LaManna, Planned Parenthood of Greater Ohio, Youngstown, Ohio

• Esta Powell, Multiethnic Advocates for Cultural Competence

• Reina Sims, Ohio Commission on Minority Health

• Michelle Y. Smith-Wojnowski, Neighborhood Health Association, Toledo, Ohio

Implementation of this strategic plan will provide a better understanding and adherence to the National Culturally and Linguistically Appropriate Services (CLAS) Standards, as well as enhance our capacity to build a cultural and linguistically competent system that provides the most appropriate services for maternal and child health populations.

Prepared by RAMA Consulting Group, Inc.May 2014


Table of Contents

I. Introduction

II. The Plan

Goal Area 1: Leadership & Governance

Goal Area 2: Workforce Development

Goal Area 3: Language Services & Signage

Goal Area 4: Engagement & Communications

III. Appendix A – CLAS Standards

IV. Appendix B – Glossary of Terms

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I. Introduction


Background Individual health is a critical component of strong communities and a prosperous nation. Though life expectancy and overall health has increased over the years thanks to preventative health services and advances in medical technology, not all Americans have experienced equal benefits. Women, racial and ethnic minorities, and low-income individuals often experience extreme health disparities, attributed to inequalities among economic status and access to appropriate care. Cultural and linguistic competence is a key strategy for closing health disparities. According to the National Office of Minority Health, a culturally and linguistically competent staff is better able to discuss healthcare beliefs, needs, and preventative care without being hindered by cultural differences or communication barriers. And the need for targeted, appropriate services in Ohio is growing. According to the Ohio Department of Development, the minority population in Ohio increased by 20% between 2000 and 2010, and population surveys show that 27% of adult Ohioans and 18% of children report having a disability.

One of the largest federal initiatives to address the issue of poor health outcomes among these populations is the Title V Maternal and Child Health Program. Title V Programs were enacted in 1935 under the Social Security Act, and were designed to provide a solid foundation for the health of women and children, with a special emphasis on children with special healthcare needs. In order to raise the health status of our community as a whole, Title V Programs will need to incorporate more culturally and linguistically competent services to effectively engage and assist this growing population. To build this capacity in Ohio’s Title V Programs, the Ohio Department of Health (ODH) enlisted the support of RAMA Consulting Group to develop a comprehensive cultural and linguistic competency approach that includes strategic planning, training and resource development, and sustainability planning to ensure that Title V staff and subgrantees continue to progress through the cultural competence continuum, ensuring effective and appropriate care for women and children in Ohio.

CULTURAL AND LINGUISTIC COMPETENCY PLANNING AND CAPACITY BUILDING OVERVIEWThis Cultural and Linguistic Competency Planning and Capacity Building effort has four primary goals:

1. Implementation of a comprehensive plan to build cultural and linguistic competence throughout the Division of Family and Community Health Services (DFCHS).

2. Documentation of best and promising practices to support cultural and linguistic competence in a user friendly toolkit.

3. Build better understanding, appreciation for, and adherence to the National Culturally and Linguistically Appropriate Services (CLAS) Standards.

4. Strengthen divisional capacity to build culturally and linguistically competent models for administering the Maternal and Child Health Block Grant.

These goals will be supported through the following deliverables:• Strategic Plan – Document outlining goals, objectives, and timelines to support the movement of DFCHS forward on the cultural

competency continuum.

• Cultural and Linguistic Competency (CLC) Toolkit – An interactive set of resources that will address training and capacity building needs and build stronger cultural and linguistic competence throughout the division.

• Cultural and Linguistic Competency (CLC) Training – Baseline training for all levels of the division and subgrantees to ensure consistent understanding of CLC concepts.

• Sustainability Plan – Document outlining process and evaluation strategies to ensure toolkit and training activities are well integrated and are set up for long-term success and impact.

THE STRATEGIC PLANThis Cultural and Linguistic Competency Strategic Plan was developed through several planning sessions with the Maternal and Child Health (MCH) Cultural and Linguistic Competency Workgroup and Subcommittee. This group is comprised of representatives from multiple divisions within ODH, external partners, and subgrantees. Other inputs to this strategic plan include the DFCHS Title V Program Cultural and Linguistic Competence Survey Assessment Data Report, which identified specific capacity building opportunities; recommendations and best practices from the Office of Minority Health’s National CLAS Standards in Health and Health Care; and other best practices in the fields of cultural competency and strategic planning. The result is a comprehensive plan that articulates goals, strategies, and action items to develop the tools and processes for ODH to infuse cultural and linguistic competency practices throughout the division.

Each Goal Area of this plan includes Relevant CLAS Standards for that section. The CLAS Standards, issued by the U.S. Department of Health and Human Services, Office of Minority Health, provide the framework for culturally and linguistically appropriate health delivery services. The full list of CLAS Standards is included in Appendix B. All of the goals, strategies, and activities included in this strategic plan are designed to ensure adherence to these standards. Please note that CLAS Standards 10, 11, and 12 are not included in this strategic plan. These three standards specifically address planning, monitoring and assessment, and therefore will be included in the Cultural and Linguistic Competency Sustainability Plan, the final deliverable for this capacity building effort.


DFCHS Mission StatementThe mission of the Division of Family and Community Health Services (DFCHS) is to assure access to health services for Ohioans.

The division’s goals include assuring access to high quality interdisciplinary, culturally appropriate/competent health services; assuring the availability of health professionals appropriately trained in primary care and other specialties needed to deliver health services to underserved areas and populations including individuals with disabilities; supporting the transformation of the health care delivery system to the Patient-Centered Medical Home model of care; assuring access to and availability of high quality clinical health services for persons with special health care needs; assuring access to a statewide system of early intervention services for infants and toddlers who are delayed, disabled, or at risk and their families; assuring access to and availability of supplemental nutrition services; and developing community-based systems of health care including non-traditional/alternative settings.

CULTURAL AND LINGUISTIC COMPETENCE DEFINITION

Cultural Competence is a continuous learning process that builds knowledge, awareness, skills and capacity to identify, understand, and respect the unique beliefs, values, customs, languages and traditions of all Ohioans in order to provide effective programs and services.

Source: State of Ohio, 2011

Linguistic Competence is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competency requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity.

Source: National Center for Cultural Competence, 2009


II. The Plan


GOAL AREA 1: LEADERSHIP & GOVERNANCEGoal Statement 1: Ensure cultural and linguistic competency strategies are fully and consistently

integrated into policies, practices, procedures and programs throughout the division.

Relevant CLAS Standards:

• Standard 2: Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.

• Standard 9: Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.


1.1.1: Ensure full engagement from Human Resources to fully implement Cultural and Linguistic Competence (CLC) strategies throughout the division.

a) Division leadership, MCH CLC Workgroup Co-Leads, and RAMA Consultants will work with Human Resources Leadership to identify and develop opportunities to adapt existing policies and procedures so that they comply with CLAS Standards.

b) DFCHS leadership will work with Human Resources to ensure all staff, including new hires, receive annual CLC training.

c) Division Leadership and MCH CLC Workgroup Co-Leads will review the strategic plan and the Public Health Accreditation Board’s (PHAB) standards to determine that CLC strategies are in alignment with accreditation requirements.

1.1.2: Communicate the division’s efforts toward achievement of its CLC plan through a cultural and linguistic competence mission/vision statement.

a) Develop a succinct mission statement for DFCHS.

b) Develop a division-wide retreat to communicate the CLC plan.

c) Ensure that cultural and linguistic competency language is woven into all division policies and procedures and communicated to staff via multiple sources (e.g. bulletin board, newsletters, management meetings, etc.).

1.1.3: Ensure leadership has a working knowledge of CLC and CLAS Standards.

a) DFCHS Leaders will receive CLAS and CLC training and will implement this training throughout their departments.

b) Conduct Division staff meetings to ensure messages are clearly and consistently communicated throughout the division.

c) Bureau Chiefs will consistently apply CLC strategies in the leadership and management of their bureaus.

GOAL AREA 1:

LEADERSHIP & GOVERNANCE

Strategy 1.1: Demonstrated Leadership: Leadership that is visible and participatory will support a workplace and direct service programs that strive towards cultural and linguistic competence.

Division ChiefBureau Chiefs Human Resources

MCH CLC Co-Leads RAMA Consultants Q4, 2014

PERSONS RESPONSIBLE TIMEFRAME:


Strategy 1.2: Financial Resources: Division leadership will allocate appropriate resources to ensure plan implementation and continued efforts are adequately supported.

a) Leadership will allocate resources toward annual training and awareness for CLC.

b) Bureau chiefs will identify and submit a request for annual training needs around CLC.

c) Explore partnership opportunities with other agencies for joint grant opportunities to support the CLC Plan.

d) Explore the creation of a position to assure continued policy and procedure development for CLC and CLAS strategies.

Operational Support Chief

Bureau Chiefs

Division ChiefQ1, 2015

PERSONS RESPONSIBLE TIMEFRAME:

GOAL AREA 1:



1.3.1: Establish a plan to monitor and report CLC goals, activities, and successes on an annual basis.

a) Develop template CLC language to include in RFPs for all bureaus that outlines expectations and goals for CLC activities.

b) Require subgrantees to submit a plan which articulates how they are implementing CLC/CLAS standards, along with measureable benchmarks.

c) Ensure that all MCH CLC Workgroup performance measures include and address CLC & CLAS standards.

d) Identify a dedicated resource to support and guide ongoing implementation of CLC strategies.

1.3.2: Ensure data collection strategies support CLC measurements and accountability.

a) Inventory current CLC data collection practices currently used throughout the division.

b) Adapt current data collection tools to better reflect the diversity of MCH customers and staff.

c) Ensure annual review and analysis of divisional CLC data for use in more strategic decision-making.

1.3.3: Incorporate regular self-assessments into division/subgrantee planning and monitoring activities.

a) Administer pre- and post-tests to staff to measure CLC knowledge and understanding.

b) Incorporate CLC as a MCH performance measure.

1.3.4: Establish tools and workplace best practices to support divisional staff’s appreciation and respect for the needs of multicultural employees and clients.

a) Build internal capacity for staff and volunteers to communicate with customers in a language and custom that is understandable, supportive, and welcoming.

b) Advocate for flexible human resource policies that support multicultural staff needs.

c) Ensure divisional staff and subgrantees are sensitive to multicultural customs and practices in scheduling and conducting activities.

GOAL AREA 1:


Strategy 1.3: Policy: Ensure CLC goals and accountability standards are infused throughout division and subgrantee activities.

Bureau ChiefsMCH CLC Co-leadsMCH CLC Workgroup

MCH CDC EpidemiologistODH Health Equity OfficeHuman Resources

Q3, 2015PERSONS RESPONSIBLE TIMEFRAME:

Goal Area 2: WORKFORCE DEVELOPMENTGoal Statement 2: Ensure all division employees and subgrantees have baseline knowledge of CLC and

access to regular capacity-building opportunities to progress through the cultural competency continuum.


• Standard 3: Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.

• Standard 4: Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

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2.1.1: Create a learning environment to establish baseline knowledge and continuous improvement of cultural and linguistic competence.

a) Develop and implement a CLC policy that requires all levels of staff to attend training.

b) Administer pre- and post-tests to evaluate staff on their CLC knowledge and understanding.

c) Develop a schedule of training activities with appropriate learning objectives that includes access to appropriate workshops for all levels of the division and sub-grantee structure.

d) Provide CLC instruction, via OhioTRAIN, and explore the possibility of providing CEU’s.

2.1.2: Train and build capacity of selected individuals to provide continuous internal training and guide implementation of toolkit elements.

a) A representative from all bureaus and Human Resources shall participate on the CLC training subcommittee.

b) Identify a diverse Train-the-Trainer team within the division capable of effectively delivering baseline CLC training.

c) Identify resources to provide ongoing CLC training for internal staff and subgrantees through various channels (e.g. face to face, webinar, self-study, etc.).

d) Utilize Health and Human Services and CLAS established definitions as basis for training elements and describing CLC terms.

2.1.3: Develop and maintain additional CLC training opportunities for career development and continued education.

a) Provide experiential trainings where possible to strengthen understanding of CLC concepts (i.e. “a day in the life”, case study exercises, etc.).

b) Build a library of web-based cultural competency training and development tools and resources for use by staff and subgrantees.

c) Develop an employee mentoring framework and program to continually provide developmental opportunities to MCH staff.

d) Explore “coaching circles” (small group learning sessions) to re-enforce CLC training concepts and best practices.

2.1.4: Regularly assess cultural demographics of clients served to understand and adapt cultural and linguistic competence training needs.

a) Regularly access and submit demographic data of clients serviced (i.e. disability, LGBT, ethnicity/race).

b) Develop a data collection form or utilize the MCHBG demographic form to ensure all providers consistently capture this data.

c) Ensure data collected informs future training and information.

GOAL AREA 2:

Workforce Development

Strategy 2.1: Training & Development: Create a learning environment to establish baseline knowledge and continuous improvement of cultural and linguistic competence.

See persons responsible and timeframe for Strategy 2.1 on next page...


Workforce Development Office

Internal MCH CLC Trainers

Human Resources

RAMA Consultants

MCH CLC Workgroup

Office of Health Equity

Human Resources

Bureau Chiefs

MCH CLC Workgroup

Q2, 2015

Q2, 2015

PERSONS RESPONSIBLE

PERSONS RESPONSIBLE

TIMEFRAME:

TIMEFRAME:

Strategy 2.1: Training & Development continued...

GOAL AREA 2:

Workforce Development

Strategy 2.2: Promotion and Recruitment: Recruit, promote, and support diverse leadership and workforce.

2.2.1: Work collaboratively with ODH Leadership to identify and support policies for diversifying recruitment and employee performance appraisal strategies.

a) The MCH Workgroup will make recommendations for diverse recruitment sources and additional employee performance appraisal strategies.

b) Ensure interview panel for new positions is diverse. Develop a standardized list of CLC interview questions to be utilized by all interviewers.

2.2.2: Support employee retention and satisfaction by regularly assessing perceptions and attitudes of the MCH divisional workforce.

a) Develop employee feedback mechanisms (i.e. focus groups, surveys, etc.) to assess the degree to which staff are satisfied and feel supported in their roles.

b) Add appropriate questions to exit interviews that assess employee’s perception of CLC efforts and their impact.


Strategic Goal Area 3: Language Services & SignageGoal Statement 3: Ensure program materials and environment is welcoming, accessible, and

culturally/linguistically sensitive to the diverse needs of clients served by MCH programs.


• Standard 5: Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

• Standard 6: Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

• Standard 7: Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

• Standard 8: Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.


3.1.1: Ensure materials and signage are adequately translated in all languages and mediums most representative of the consumer base.

a) Adopt and implement the HHS data collection standards to gather race information about clients to inform language and translation needs.

b) Assess current activities and capacity of DFCHS programs and subgrantees regarding signage and translation of materials.

c) Ensure ODH website offers information in various languages and will accommodate persons with various disabilities (e.g. blind, hearing impaired).

d) Ensure literature is provided in multiple languages most representative of consumers served at DFCHS and subgrantee sites.

3.1.2: Ensure necessary phone greetings and scripts are consistently used by staff in communicating with our clients.

a) Develop telephone outgoing messages that are consistent with the needs of populations served.

b) Develop “scripts” for ODH staff to use when answering the phone, providing basic information in multiple languages.

c) Include use of multi-language scripts in general monitoring and Qaulity Improvement control mechanisms.

3.1.3: Ensure that clients are made aware of language services available to them.

a) Incorporate information regarding the availability of language services in general DFCHS program promotion.

b) Ensure clients understand how to access and utilize language and interpreter services.

3.1.4: Embed Health Literacy as a standard throughout DFCHS programs.

a) Follow the Federal Programs Plain Language Guidelines to ensure all written materials are easily understood by varying degrees of literacy.

b) Provide the guidelines as resources within the CLC toolkit for use by subgrantees and staff, as appropriate.

GOAL AREA 3:

LANGUAGE SERVICES & SIGNAGE

Strategy 3.1: Translation of Materials and Services: Materials and services communicate with clients in a language and custom that is intelligible and welcoming, ensuring full access to all MCH services.

MCH CLC WorkgroupRAMA ConsultantsBureau Chiefs Q1, 2016PERSONS RESPONSIBLE TIMEFRAME:


See persons responsible and timeframe for Strategy 3.1 on next page...

3.2.1: Assess current MCH services, policies, and procedures regarding language services and bilingual staff and make recommendations for improvements to ensure consistent and appropriate use of these services.

a) Educate and train staff in available language assistance services, policies, and procedures.

b) Include assessment of language services in subgrantee monitoring activities.

c) Assess the current policy that exists for bilingual staff and ensure understanding of policy among staff.

d) Develop protocol to ensure MCH is sensitive to customs and cultural practices in scheduling and conducting activities based on CLC Toolkit best practices.

GOAL AREA 3:

LANGUAGE SERVICES & SIGNAGE

Strategy 3.2: Policy: Policies, procedures and training are structured to ensure knowledge of and access to necessary language services.

Strategy 3.3: Environment: Encourage subgrantees to make their location of programs/activities both accessible and comfortable for diverse clients and stakeholders needs.

MCH CLC WorkgroupRAMA Consultants

RAMA ConsultantsProgram ManagersMCH CLC Workgroup

Q4, 2014

Q4, 2014

PERSONS RESPONSIBLE

PERSONS RESPONSIBLE

TIMEFRAME:

TIMEFRAME:

3.3.1: Program managers shall assess the internal and external physical environment and signage at direct service locations to ensure they are welcoming and culturally/linguistically sensitive to diverse clientele.

a) Educate and train staff on appropriate environmental and space concerns for cultural and linguistic sensitivity.

b) Program Managers will assess if facilities will accommodate the needs of individuals with seen and unseen physical and mental health challenges.

c) Program managers will assess the degree to which braille and other physical language assistance appears within common areas, at entry points, and elevators.


Goal Area 4: Engagement & CommunicationsGoal Statement 4: Ensure that efforts by MCH to develop and implement a comprehensive

plan for continuous improvement in cultural and linguistic competence are consistently communicated to internal and external stakeholders.


• Standard 13: Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.

• Standard 14: Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.

• Standard 15: Communicate the organization’s progress in implementing and sustaining CLA Standards to all stakeholders, constituents, and the general public.


4.1.1: Develop a MCH Cultural Competency Council to plan, monitor, and evaluate the Division’s CLC efforts.

a) Develop benchmarks and regularly assess if goals and standards are being met.

b) Review the CLC progress of subgrantees through mid-year and/or annual reports.

c) Administer surveys annually to get feedback on client satisfaction.

d) Obtain perspective from subgrantees on what competent care looks like in their organizations (i.e. capture home visitors and client perspective).

e) Identify key messages to communicate the importance of trainings and resources so that all levels of the division and subgrantees participate in activities.

f) Develop a “brand” for the CLC toolkit to promote awareness of it as a resource and ensure its continued use.

4.1.2: Develop a feedback and communication strategy and process to share MCH’s progress in implementing and sustaining CLC to stakeholders.

a) Create a strategy to communicate with stakeholders/staff/etc. the improvement plans for CLC.

b) Provide information on CLC efforts through local health departments, calls, ODH website, division/bureau website/newsletters, Facebook, Twitter.

c) Place information regarding CLC efforts on ODH website, including a dashboard to highlight progress towards goals.

4.1.3: Develop a self-assessment process/tool to effectively gauge and improve CLC strategies.

a) Include adherence to CLAS standards as a requirement for all subgrantees.

b) Outline topics (metrics and targets) on which programs can assess themselves and provide specific examples on how to implement CLC.

c) Determine strategies to promote “healthy competition” between bureaus by using certificate incentives.

GOAL AREA 4:

ENGAGEMENT & COMMUNICATIONS

Strategy 4.1: Inclusion & Feedback: Ensure employees, leadership, and community partners are intimately involved in creating and maintaining CLC services.

MCH CLC Co-LeadsDivision ChiefsMCH CLC WorkgroupRAMA Consultants

Q3, 2015PERSONS RESPONSIBLE TIMEFRAME:


III. Appendix A – Glossary of Terms


Bilingual: A term describing a person who has some degree of proficiency in two languages. A high level of bilingualism is the most basic of the qualifications of a competent interpreter but, by itself, does not ensure the ability to interpret.

Culturally and Linguistically Appropriate Services (CLAS): Services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs and employed by all members of an organization (regardless of size) at every point of contact.

CLAS Standards: The framework for culturally and linguistically appropriate services issued by the U.S. Department of Health and Human Services, Office of Minority Health. The National CLAS Standards are intended to inform, guide, and facilitate practices related to culturally and linguistically appropriate health service delivery.

Cultural and Linguistic Competency: The capacity for individuals and organizations to work and communicate effectively in cross-cultural situations through the adoption and implementation of strategies to ensure appropriate awareness, attitudes, and actions and through the use of policies, structures, practices, procedures, and dedicated resources that support this capacity.

Culture: The integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics. Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes.

Disability: A physical, sensory, emotional, or cognitive impairment that substantially limits a major life activity and fulfilling of social roles.

Diversity: A collective mixture characterized by differences and similarities that are applied in pursuit of organizational objectives. Workforce diversity includes race, sex and gender identity, ethnicity, physical ability, religion, belief systems, sexual orientation, age, parental status, economic status, geographic background, etc.

Health Literacy: The degree to which an individual has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Multicultural: Of, relating to, or including several cultures.

Plain Language: A strategy for making written and oral information easier to understand; communication that users can understand the first time they read or hear it. A plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding.

Appendix AGLOSSARY OF TERMS

Definitions adapted from the National Office of Minority Health and the National Center for Cultural Competence.


IV. Appendix B – CLAS Standards


The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to:

Principal Standard: 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.

Governance, Leadership, and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.

3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.

4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability: 9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.

10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.

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.

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.

13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.

14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.

15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

APPENDIX B – CLAS STANDARDS

Cultural and Linguistic Competence Planning and Capacity Building

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