National Standards on Culturally and Linguistically Appropriate Services (CLAS)
The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.
The 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows:
CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7). CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13). CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
For more information please go to http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15
About the Center of Cultural and Linguistic Competence in Health Care
The OMH was mandated by the United States Congress (P.L. 101-527) in 1994 to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase access to health care for limited English-proficient people. Additionally this mandate directs OMH to support research, demonstrations, and evaluations to test new and innovative models aimed at increasing knowledge and providing a clearer understanding of health risk factors and successful prevention intervention strategies for minority populations.
The United States Congress, House Committee on Appropriations, 103rd Congress 2d Session, Report 103-553, June 21, 1994, also recognized the need to address language barriers faced by limited English-speaking populations in the health care delivery system. The Committee language encouraged OMH to carry out activities to improve the ability of health care providers to deliver health services in the native languages of limited -English proficient populations, as required by the Disadvantaged Minority Health Improvement Act of 1990. Concurrently, the Committee encouraged OMH to establish a center to develop and evaluate models, conduct research, and provide technical assistance to providers on removing language barriers to health care services.
The Center for Linguistic and Cultural Competence in Health Care (CLCCHC) was established in FY 1995 as a vehicle to address the health needs of populations who speak limited English.
The Center for Linguistic and Cultural Competency in Health Care (CLCCHC) is a response to P.L. 101-527, which requires the OMH to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase limited English-speaking individuals' access to health care. The law directs the OMH to support research, demonstrations, and evaluations to test innovative models aimed at increasing knowledge and providing a clearer understanding of health risk factors and successful prevention intervention strategies for minority populations.
Congress encouraged OMH to establish a center to develop and evaluate models, conduct research, and provide technical assistance to providers on removing language barriers to health care services. During FY 1995, OMH established the CLCCHC, a "center without walls," which encompasses all existing and new policy, partnering, communications, service demonstrations, and evaluation activities related to cultural competency.
Cultural Competency Training Tools Available:
Quality Interactions e-learning Program
Quality Interactions is an e-learning program that provides case-based instruction on cross-cultural health care. This interactive program focuses on common clinical and/or cross-cultural scenarios that build a framework of knowledge and skills for delivering quality care to diverse patient populations.
There are several versions of the Quality Interactions e-learning program which include the following:
- Quality Interactions for Physicians: This evidence-based, case-based learning program is accredited by Tufts University School of Medicine for 2.5 hours Continuing Medical Education (CME) Credits. The course features three patient cases and allows the clinician to participate in realistic clinical encounters while learning key concepts and skills for delivering effective cross-cultural care.
- Quality Interactions for Nurses & Case Managers: This evidence-based, case-based learning program is accredited by Tufts University School of Medicine for 2.5 hours Continuing Education Units (CEU). Similar to the physicians' version, this program allows the nurses and other health care professionals to interact with patients in realistic clinical settings to learn about providing effective cross-cultural care.
- Quality Interactions Refresher Courses: Similar in structure to the two-hour course for physicians and nurses, each refresher course presents one new cross-cultural patient case and is accredited by Tufts University School of Medicine for one hour CME. Refresher cases help to reinforce the major concepts learned in the two-hour course while presenting a new clinical scenario.
- Quality Interactions for Health Care Employees: This web-based, interactive program teaches many of the same concepts and skills as the original Quality Interactions program, but is geared toward all employees in health related organizations rather than clinical staff. The program teaches concepts and skills for understanding and interacting effectively with individuals from culturally diverse backgrounds including patients, customers, and coworkers.
- Cultural Competency Resource Center: We recently launched a new Cultural Competency Resource Center Website to help healthcare professionals access vitally important information that will help them better communicate and care for patients of diverse cultural backgrounds. Within the website is the content from all the Quality Interactions® training programs, as well as additional helpful tips on different cultures and health beliefs, use of interpreters, and clinical cross-cultural issues.
- Quality Interactions E-Newsletter: An option is provided to receive a quarterly e-newsletter with cases, updates, and refreshers on important cross-cultural practice and policy issues.
Cultural Competence Health Practitioner Assessment (CCHPA)
The Cultural Competence Health Practitioner Assessment (CCHPA) was developed at the request of the Bureau of Primary Health Care (BPHC), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Service (DHHS). The CCHPA is intended to support the BPHC, and its funded programs, to enhance the delivery of high quality services to culturally and linguistically diverse individuals and underserved communities. It is also intended to promote cultural and linguistic competence as essential approaches for practitioners in the elimination of health disparities among racial and ethnic groups. http://www11.georgetown.edu/research/gucchd/nccc/features/CCHPA.html
Setting the Agenda for Research on Cultural Competence in Health Care - AHRQ
2004 - Health care providers take many approaches to bridge barriers to communication that stem from racial, ethnic, cultural, and linguistic differences. "Cultural competence" encompasses both interpersonal and organizational interventions and strategies for overcoming those differences. This document examines how cultural competence affects health care delivery and health outcomes, and it is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the Office of Minority Health (OMH). Part 1 of the report, which is presented in the pdf document, comprises the introduction and key findings.
THE EVIDENCE BASE FOR CULTURAL AND LINGUISTIC COMPETENCY IN HEALTH CARE - The Commonwealth Fund
2006 - Cultural and linguistic competence are widely recognized as fundamental aspects of quality in health care and mental health care—particularly for diverse patient populations—and as essential strategies for reducing disparities by improving access, utilization, and quality of care. However, it is not clear if evidence exists to support the assertion that cultural and linguistic competence improve health outcomes and well-being. Advocates of culturally and linguistically competent care state that the costs of providing such care are offset by potential benefits, but, again, there is limited evidence to support
this assertion. This report assesses the current evidence base for the impact and benefits of cultural and linguistic competence in health care and mental health care.
American Anthropological Association
The interactive exercises are very beneficial when it comes to personal self awareness.
Resources for Cross-Cultural Health Care
Provider's Guide to Quality and Culture
University of Pennsylvania Health Systems
World Education Culture health, literacy
National Academy Press
Oregon State University
National Center For Cultural Competence, Georgetown University
The State of Literacy in America
Nhelp Racial/ Cultural Issues
Office of Minority Health
The Cross Cultural Health Care Program
Kaiser Family Foundation Minority Health
Federal Registry (enter key word "linguistic”)
Yale University Cultural Competence Resources
Medical Policy Institute
Providing care to diverse populations
Culture and nutrition
AMSA Diversity in Medicine
Center for Cross Cultural Health
Culturally Competent Care: Examples of What Works
Commission on the Public Health System, New York
Cultural Orientation Resource Center
The Cultural Orientation Resource Center provides technical assistance regarding new refugee groups and the orientation they receive either before their resettlement in the United States or after their arrival.
Cultural Competency Training of Trainers Program Video
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