CLAS Standards Applied to a Community Health Center Setting

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CLAS Standards Applied to a Community Health
Center Setting

• Lowell Community Health Center Our Mission
• To provide caring, quality, and culturally
  appropriate health services to the people of
  Greater Lowell, regardless of their financial
  status.
• To enhance the health of our community and to
  empower each individual to maximize overall well
  being.
• Our Motto
• LCHC
• Linking Community
• to Health Care
• - CLAS Std. 8 -

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Why Focus on Cultural LinguisticCompetence?

• Lowell Population -
• 105,000, 2nd largest
• Cambodian population
• in U.S. at 25,000 17
• Latino 7 African immigrant
• 7 Portuguese speaking
• Lowell Community Health Center serves 24,000
  people annually with medical care, complementary
  medicine, behavioral health care, and public
  health promotion. 60 are persons best served in
  a language other than English.

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How Could We NOT Focus on Cultural Competence??

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3 Major Themes

• Culturally Competent Care
• Standards 1-3 (Recommended)
• Language Access Services
• Standards 4-7 (Required)
• 3. Organizational Supports
• Standards 8-14

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What is Cultural Competence?
a set of congruent behaviors, attitudes, and
policies that come together in a system or agency
or among professionals that enable effective
interactions in a cross-cultural framework.
Georgetown University Child Development Center
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In a nut shell

• Cultural Competence is the ability to function
  effectively in the context of cultural
  differences

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Standards 2 3

• 2 Implement strategies to recruit, retain, and
  promote at all levels of the organization a
  diverse staff leadership representative of the
  demographics of the service area.
• 3 Ensure that staff at all levels and
  disciplines receive ongoing education and
  training in culturally linguistically
  appropriate service delivery

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STD. 2 StaffingLCHC Response

• Decision to hire bilingual, bicultural staff in
  open positions, over 50 of staff complicated
  by the large number of countries, languages, and
  cultures represented in the patient population
• Targeted staff recruitment through associations,
  CBOs, community leaders mailings
• On the job training where needed when there may
  not be many candidates who have a certain type of
  experience
• - CLAS Std. 2 -

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• STD. 3 Cultural Competence TrainingLCHC
  Response
• A staff person received training, along with AAC
  staff and MAPS staff, to be a trainer in cultural
  competence
• Cultural competence training for all staff
  through new staff orientation and annual
  orientation required for all staff PLUS specific
  education about specific cultures and beliefs in
  individual departments and helping staff to
  understand the fears of undocumented immigrants,
  for example
• - CLAS Std. 3 -

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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.

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LASIT

• Language Access Systems Improvement Team
• Offer medical interpreter training and financial
  incentives
• Set up contract arrangement with CBOs - AAC, MAPS
  - to provide interpreting, ATT language line
  availability
• Increased the number of staff trained for medical
  interpreting
• Over 50 of our staff is bilingual and bicultural
• Language classes on site
• - CLAS Std. 4-6 -

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LASIT

• On-going registration staff training on Asking
  the Question regarding race, ethnicity and
  interpreter need
• Secured funding through Blue Cross Blue Shield
  Foundation of Massachusetts to develop
  interpreter training assessment program
• Developing Promotoras de Salud Training on
  cross-cultural communication skills between
  patient, provider and interpreter
• - CLAS Std. 4-6 -

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To improve our patient registration process
LASIT To improve access to interpreter services
within the health center in order to improve
patients health
To improve the scheduling of interpreters
To ensure that sites are complying with the
interpreter policy
To use formally trained interpreters
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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.

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Std. 5 Written materialsLCHC Response

• Developed new signage in many languages for five
  entrances to two buildings
• Developed new materials about accessing health
  care in Portuguese, French and Swahili

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Standard 6

• Health Care organizations must assure that
  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).

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Std. 6 Interpreter Competence LCHC Response

• Language Proficiency Testing is required to be a
  participant in Interpreter Training programs
• Develop LCHC verbal language proficiency testing
  for all health care providers and support staff
  who self-declare as bilingual
• Developed Medical Interpreter Policy
• Formed a Language Access Improvement Team
• Created interpreter lists to be placed at
  clinical areas for easier accessibility for
  providers

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Standard 7

• Patient-related materials and signage in
  languages of commonly encountered groups in the
  service area

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The Environment of Services

• Signage at all sites including English, Spanish,
  Portuguese, Khmer, Laotian, Swahili, and French
• Art work, world maps pictures from various
  cultures in clinical areas,

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Standards 10, 11, 12

• 10 Ensure that data on patients race,
  ethnicity, and spoken and written language are in
  health records, integrated into MIS,
  periodically updated
• 11 Maintain current demographic, cultural,
  epidemiological community profile as well as a
• needs assessment to accurately plan for
  implement services that respond to cultural,
  linguistic characteristics of service area
• 12 Develop participatory, collaborative
  community partnerships facilitate community
  consumer involvement in designing implementing
  CLAS activities

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Community Input

• Patient Advisory
• or focus groups with
• African, SEA, and Spanish/
• Portuguese speaking
• patients to learn about their barriers
• to care, needs, expectations and,
• through CBOs - focus groups with other community
  members
• Input from African, SEA, and Spanish and
  Portuguese speaking staff
• Partnering with ethnic-specific CBOs, sharing
  funding
• - CLAS Std. 11 12 -

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Board and Senior Staff Support

• Governing Board members represent communities
  served, consumer majority
• Senior staff expect cultural competence
  development throughout the center hiring of
  bilingual, bicultural staff
• - CLAS Std. 11 12 -

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Internal External Data Issues

• Asking the Questions
• Practice management system
• Brazilians
• Language vs Race/Ethnicity
• Lumping data issue

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Our First Major Effort Metta Health Center

• LCHC Metta Health Center Integrates mental,
  spiritual, and physical health services through
  Southeast Asian and western treatment
• 1999 2000 Planning

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Reasons for Starting a New Center to Focus on
Southeast Asians

• 30,000 Southeast Asians in Lowell (25,000 Khmer,
  5000 Lao, 1,500 Vietnamese) over 2000 increase
  1980-90
• Only 1,600 used LCHC
• Many barriers to care
• for SEAs in Lowell
• Tremendous health
• mental health needs

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Metta Model and Services

• Integration of mental, physical, and spiritual
  health services
• Integration of SEA and western approaches
• Many gateways to service
• Focus on decreasing stigma of mental health care
• Staffed directed by SEAs (Std. 2)
• Tri-lingual signage, materials, interpreting
  (Stds. 4, 5, 6, 7)
• Cross-cultural cross-disciplinary staff
  training (Std. 3)
• Based on focus groups, interviews, needs
  assessment, data SEA Advisory Board (Stds. 8,
  11, 12)

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Spread to Other Sites Communities

• Attending to changing demographics - Applying
  lessons learned from Metta Health Center to
  Latino, Brazilian, and African immigrant
  communities
• Partnering (sharing funding) with ethnic-specific
  CBOs
• New patient and community advisory groups
• Faith leader partnerships

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Community Outreach

• Health Promotion
• Director
• Outreach includes
• LCHC staff and AAC/MAPS/
• CMAA staff going to temples,
• churches, community events
• - Outreach Works!
• Visiting pastors, informing
• people about how to access health services,
  resources
• available, and issues such as payment for health
  services
• Sponsoring African, Brazilian, Cambodian, Latino
  community events and putting ads in programs
• Connecting with newly arriving African,
  Cambodian, other refugees through provision of
  Refugee Health Assessments

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Funding

• Obviously critical. As we have learned more
  about what the key issues are, we have worked
  with staff, patients, and organizations such as
  AAC to write grants to fund the joint ideas. For
  example, federal CHC grant funds outreach, state
  and federal grants fund HIV work, and federal and
  United Nations grant funds community education
  about results of torture and trauma as well as
  mental health services.

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Thank you.
www.lchealth.orgdorcasgr_at_lchealth.org
sheilaoc_at_lchealth.org