Implementing the CLAS Standards to Reduce HIV Disparity

1
Implementing the CLAS Standards to Reduce HIV
Disparity Part 2

• An Overview Strategies for HIV/AIDS Providers

Co-Presented by Tawara D. Goode, MA, Director,
National Center for Cultural Competence (NCCC)
Wendy Jones, M.Ed.,. MSW, Director, NCCC,
Children and Youth with Special Health Care Needs
Project Georgetown University Center for Child
and Human Development
National Center for Cultural Competence,
Georgetown University Medical Center
2
Learning Objectives

• At the completion of this webinar each
  participant will
• state the importance of the 14 CLAS Standards and
  their relevance to HIV/AIDS care and treatment.
• identify at least one implementation strategy
  relative to HIV/AIDS care and treatment for each
  of the 14 Standards.

3
CLAS Webinar Series

• Part 2 of this Webinar series discusses Standards
  6-14 and strategies organizations and their
  personnel might pursue to implement CLAS.
• We will use a case study to illustrate various
  points.
• This Webinar series is designed to increase your
  awareness and knowledge of how you deliver care
  that is responsive to the cultural and linguistic
  characteristics of populations impacted by
  HIV/AIDS.

4
CLAS Standard 6

• Ensure the competence of language assistance
  provided to limited English proficient
  clients/consumers by interpreters and bilingual
  staff.
• Family and friends should not be used to provide
  interpretation services (except on request by the
  client/consumer).

5
CLAS Standard 6 Implementation Strategies

• Use professional medical interpreters or trained
  and qualified bilingual/multilingual staff or
  volunteers.
• Use telephone or video interpreting technology as
  an alternative to on-site interpretation,
  especially for low incidence languages.

6
CLAS Standard 6 Implementation Strategies

• The organization should critically review and
  keep abreast of the evidence against using
  family, friends, minors, and untrained
  interpreters in the provision of health and
  mental health care and related services and
  supports.
• Use this evidence to inform policy and procedures
  as to whom can provide interpretation services
  for the health/mental health care organization.

7
CLAS Standard 6 Implementation Strategies

• The organization must have established policy and
  specific procedures to assess the competency of
  staff, contractors, and volunteers providing
  language access services. This may include
  assessment of
• English and foreign language proficiency.
• Knowledge of health and mental health terminology
  and key terms specific to HIV/AIDS (e.g. terms
  for sexual practices and behaviors, substance
  abuse, medical procedures, medications).
• Awareness of colloquialisms used by cultural
  groups (e.g.
• slang, street terms).

8
CLAS Standard 6 Implementation Strategies

• The organization must have established policy and
  specific procedures to assess the quality of
  language access services.
• Assess patient/client and provider satisfaction
  with the accuracy and quality of interpretation
  services received.
• Analyze patient/client and provider satisfaction
  data to inform quality improvement efforts.
• Inform patients/clients and staff how data will
  be used to improve services and supports.
• Ensure that the organizations contracts for
  interpreters and translators have quality
  provisions.

9
CLAS Standard 7

• Make available easily understood, client-related
  materials, and post signage in the languages of
  the commonly encountered groups and/or groups
  represented within the service area.

10
CLAS Standard 7 Implementation Strategies

• Develop and/or adapt patient/client materials and
  resources that address the literacy and health
  literacy of the patient populations served.
• Design alternative approaches to provide
  information to those patients/clients who may
  neither be literate in English nor their language
  of origin.

• Provide training to staff in the use of literacy
  and health literacy tools and strategies (e.g.
  REALM-SF, SAHLSA-50, Teach Back, Ask Me 3,
  Plain Language) to assess and respond to
  patient needs.

11
CLAS Standard 8

• Develop, implement, and promote a written
  strategic plan that outlines clear goals,
  policies, operational plans, and management
  accountability/oversight mechanisms to provide
  culturally and linguistically appropriate
  services.

12
CLAS Standard 8 Implementation Strategies

• Integrate the delivery of culturally and
  linguistically competent HIV/AIDS care,
  treatment, and related services into the
  organizations strategic plan. The strategic plan
  should include implementation of all CLAS
  standards.
• Involve people living with HIV/AIDS across
  demographic groups, their families, and advocates
  in the development of the strategic plan (e.g.
  race, ethnicity, culture, age, gender, gender
  identity, sexual orientation, socio-economic
  status, education).
• Ensure that the plan includes establishment of a
  work group or team responsible for the provision
  of culturally and linguistically competent, care,
  treatment, and related services to all
  patients/clients, including those with HIV/AIDS
  and their families.

13
CLAS Standard 8 Implementation Strategies

• Set SMART goals and objectives for the delivery
  of HIV/AIDS care, treatment and related services.
• Report to the organizations board, staff and
  patients/clients on progress towards meeting
  these goals and objectives.

14
CLAS Standard 9

• Conduct initial and ongoing organizational
  self-assessments of CLAS-related activities.
  (Organizations) are encouraged to integrate
  cultural and linguistic competence-related
  measures into their internal audits, performance
  improvement programs, patient satisfaction
  assessments, and outcomes-based evaluations.

15
CLAS Standard 9 Implementation Strategies

• Establish a structure and dedicate resources
  (personnel and fiscal) to plan and conduct
  CLAS-related self-assessment activities.
• Identify and select instruments, tools, data
  sources, and processes for self-assessment of
  CLAS-related activities. Embed measures for
  cultural and linguistic competence in the
  organizations internal auditing, evaluation, and
  quality improvement processes.

16
CLAS Standard 9 Implementation Strategies

• Collect and analyze data from multiple sources.
  Develop reports and data summaries. Share
  findings with staff, patients/clients, board
  members, and contractors. Discuss their
  implications for policy, practice, and community
  engagement.
• Monitor data that demonstrate the degree to
  which the organization as a whole, and individual
  departments/programs, are progressing toward the
  goals and objectives of the strategic plan for
  cultural and linguistic competence.

Ensure that data sharing processes and reports
are accessible to patients/clients (in plain
language) and are provided in multiple formats
(translation, oral presentations, large
print/Braille).
17
CLAS Standard 10

• Ensure that data on the individual
  client's/consumer's race, ethnicity, and spoken
  and written language are collected in health
  records, integrated into the organization's
  management information systems, and periodically
  updated.

18
CLAS Standard 10 Implementation Strategies

• The organizations information systems should
  have the capacity to collect data on race,
  ethnicity, and language. Capacity should include,
  but is not limited to
• Patients or clients primary language (written,
  spoken, sign) , and preferred language for
  service delivery.
• Need for an interpreter.
• English language ability (i.e. ability to speak,
  read, and understand English).
• Literacy and health literacy levels.

19
CLAS Standard 10 Implementation Strategies
Communicate (in writing and verbally) the
organizations policy and practices for
confidentiality to all patients.

• Advise patients/clients that data collected will
  be used to improves services and reduce
  disparities in health and health care based on
  race, ethnicity, and language.

Inform patients/clients that they have the option
to share or not share racial, ethnic, and
language data, and that their choice will not in
any way affect their ability to receive services.
Determine the extent to which the collection of
granular data will enhance service delivery to
patient populations. Granular data based on
cultural factors may include sexual orientation,
gender, gender identity or expression, country of
origin, cultural identity.
20
CLAS Standard 11

• Maintain a current demographic, cultural, and
  epidemiologic profile of the community as well as
  a needs assessment to accurately plan for and
  implement services that respond to the cultural
  and linguistic characteristics of the service
  area.

21
CLAS Standard 11 Implementation Strategies

• Ensure that policy, procedures, and practices are
  in place to monitor
• current and emerging demographic trends in the
  geographic area served (e.g. race, ethnicity,
  languages spoken, age, immigrant and refugee
  data).
• incidence, prevalence, and future projections for
  HIV/AIDS in the service area. (e.g. age, gender,
  gender identify, sexual orientation, race,
  ethnicity, country of origin).

Analyze these data to determine their
implications for planning, delivering, and
evaluating culturally and linguistically
competent services and supports. Update
periodically.
22
CLAS Standard 11 Implementation Strategies

• Conduct asset and need assessments of the
  geographic area to determine the range of
  community resources that provide services and
  supports to people living with HIV/AIDS. Attend
  to the capacity of the community based resources
  to address culture, language, sexual orientation,
  gender identity or expression, and other
  characteristics of the population of people
  living with HIV/AIDS.
• Consult the National Minority Quality Forum
  (www.nmqf.org) website for current
  epidemiological data based on zip code.

23
CLAS Standard 12

• Develop participatory, collaborative
  partnerships with communities, and utilize a
  variety of formal and informal mechanisms to
  facilitate community and client/consumer
  involvement in designing and implementing
  CLAS-related activities.

24
CLAS Standard 12 Implementation Strategies

• Ensure that the organizations
• mission values communities as essential allies
  in achieving its overall goals.
• policy, procedures, and practices delineate
  community and consumer and participation in
  planning, implementing, and evaluating services
  and supports for people living with HIV/AIDS.
• policy and procedures allow the provision of
  fiscal resources and in-kind contributions to
  community partners, agencies or organizations.
• policy, procedures, and practices support
  community engagement in languages other than
  English.

Data Source Goode, T. (2001). Policy Brief 4
Engaging Diverse Communities Culturally
Competent Approaches. National Center for
Cultural Competence. Retrieved from
http//nccc.georgetown.edu/documents/ncccpolicy4.p
df
25
CLAS Standard 12 Implementation Strategies
continued

• Suggested community and patient/client engagement
  strategies include but are not limited to
• Determine areas of mutual interest, benefit, and
  collaboration for partner organizations and
  agencies.
• Legitimize formal partnerships with memoranda or
  agreements.
• Collaborate with partners, where appropriate, to
  achieve goals, objectives, and desired outcomes
  in the provision of culturally and linguistically
  competent care to people living with HIV/AIDs and
  the communities in which they live.
• Establish a structure for collaborative
  activities and resource sharing specifically for
  the provision of services and supports to people
  living with HIV/AIDS (e.g. referral network,
  exchange of best practices and lessons learned,
  joint grant proposals, shared patient education
  and related materials, joint training/professional
  development).
• Issue joint reports on the outcomes of
  collaboration to partnering organizations, their
  boards, staff and patients/clients, and to the
  community at large.
• Assess satisfaction with partnerships and
  revise partnering agreements as appropriate.
• Identify and collaborate with informal, natural
  networks of support within culturally diverse
  communities to enhance services and supports to
  people living with HIV/AIDS.
• Ensure patient/client voice and choice to plan,
  implement, and evaluate collaborative efforts
  (e.g. community engagement, public education,
  health fairs, representation on boards, media
  campaigns, training/professional development, HIV
  clinical trials and participation in research).

26
CLAS Standard 13

• Ensure that conflict and grievance resolution
  processes are culturally and linguistically
  sensitive and capable of identifying, preventing,
  and resolving cross-cultural conflicts or
  complaints by clients/consumers.

27
CLAS Standard 13 Implementation Strategies

• Suggested approaches for conflict and grievance
  resolution include, but are not limited to
• Obtain patient/client and staff input to craft
  grievance policy and process.
• Create a policy and process that is responsive,
  inclusive, and equitable and that leads to prompt
  resolution of grievances in a culturally and
  linguistically responsive manner. At a minimum,
  the process must address literacy, English
  ability, individuals with disabilities, and
  unfamiliarity or reluctance of some cultural
  groups to make formal complaints.
• Ensure that the organizations data system has
  the capacity to document and track complaints,
  their status, and resolution for both
  patients/clients and staff.
• Provide training to all new staff on the
  grievance policy and process. Ensure all staff,
  volunteers, patients/consumers are informed of
  the policy and process.
• Update the grievance policy and process as
  appropriate.

28
CLAS Standard 13 Implementation Strategies

• Consider using an ombudsperson in the resolution
  of grievances where appropriate. The ombudsperson
  should be knowledgeable of the cultural and
  linguistic contexts in which services are
  delivered and the population served.
  Additionally, the ombudsperson should be
  experienced in working with interpreters (sign
  and foreign language).
• Provide notice to patients/clients in a prominent
  location on how to file a grievance. Include
  assurances that patients/clients have the right
  to file grievances without fear of
  recriminations. Notices should be written in the
  languages of the populations served.
• Monitor adherence to the grievance procedures,
  including tracking resolution rates, as part of
  the overall quality improvement process.
• Assess patients or clients satisfaction with
  grievance processes as part of the overall
  periodic patient satisfaction query efforts.

29
CLAS Standard 14

• Regularly make available to the public
  information about their progress and successful
  innovations in implementing the CLAS standards,
  and provide public notice in (the organization's)
  communities about the availability of this
  information.

30
CLAS Standard 14 Implementation Strategies

• Disseminate progress toward implementing CLAS to
  diverse constituents on at least an annual basis.
  Dissemination may include a variety of formats
  and audiences including
• (1) reports tailored for staff,
  patients/clients, board members, or
  community partners
• (2) presentations for community meetings/forums
  
• (3) multimedia displays in waiting areas
• (4) website postings, and
• (5) use of ethnic media such as radio and
  newspapers.

31
Case Study Appropriateness of Family Members
Serving as Interpreters   Matilde, a 42 year old
Latina, reported for the results of her HIV test
three months after being tested. She has limited
ability to speak and understand English, so she
brought her two teenage sons, Miguel and Javier
along to interpret for her. The clinic neither
has bilingual staff nor contract interpreters.
The counselor feels uncomfortable about sharing
the results of Matildes HIV test with her two
sons but has no other way to communicate the
results. As the counselor begins to inform the
sons that their mother has tested positive for
HIV, Miguel begins to cry. Javier, interprets the
results to his mother, and accuses her of sexual
promiscuity. What are some of the issues that
are reflected in this case study? Which of the
CLAS Standards could provide guidance in
addressing this situation?  
32
As a culturally competent I am capable of
interacting positively with people who do NOT
look like,
talk like,
move like,
think like,
believe like,
act like,
live like...
ME!!!
Data Source Multnomah County Department of Health.
Modification from Mike Magy, Massachusetts
Department of Mental Health, November 2005 .
Slide Source National Center for Cultural
Competence, 2011
33
Internet Resources

• AETC NMC at Howard University
• Office of Minority Health
• National Center for Cultural Competence
• Center for Multicultural Mental Health
• National Minority Quality Forum
• The Cross Cultural Healthcare Program
• DiversityRx
• Ethnomed

• www.aetcnmc.org
• www.omhrc.gov
• http//nccc.georgetown.edu/
• www.cmmh-cmtp.com/index.php
• www.nmqf.org/
• www.xculture.org/
• www.diversityrx.org
• www.ethnomed.org

34
Thank You
National Center for Cultural Competence,
Georgetown University Medical Center