Advancing Health Equity:
The National CLAS Standards
U.S. Public Health Service Scientific and Training Symposium
June 20, 2012
Guadalupe Pacheco
Guadalupe Pacheco, MSW
Senior Health Advisor to the Director
Office of Minority Health, Office of the Secretary
U.S. Department of Health and Human Services
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Presentation Overview
• HHS Office of Minority Health
• Cultural Competency in Emergency Response
• National Standards for Culturally and Linguistically
Appropriate Services in Health Care
• National CLAS Standards Enhancement Initiative
• OMH’s Cultural Competency Curriculum for
Disaster Preparedness and Crisis Response
• Think Cultural Health
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HHS Office of Minority Health
Mission: To improve
the health of racial
and ethnic minority
populations through
the development of
health policies and
programs that will
help eliminate health
disparities.
OMH Functions
Research,
Demonstrations,
and Evaluation
Awareness
Policies,
Programs,
and
Practices
Data
Partnerships
and
Networks
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What Are Culturally and Linguistically
Appropriate Services?
• Culturally and linguistically appropriate health
care and services are broadly defined as care
and services that are respectful of and
responsive to the cultural and linguistic needs
of all individuals (Adapted from Cross, 1989)
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Why Are Culturally and Linguistically
Appropriate Services Important?
“Minorities and low income Americans are more
likely to be sick and less likely to get the care
they need.”
– Secretary Sebelius
“…of all the forms of injustice, inequality in
healthcare is the most shocking and inhumane.”
-- Dr. Martin Luther King Jr.
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Cultural Components of Response
 Minorities are more likely to be under-prepared for disasters, less
likely to be involved in preparedness activities, and are less likely to
receive educational opportunities related to disaster-preparedness
(Pastor et al., 2006; Fothergill et al., 1999; Faupel et al., 1992).
 Minorities are disproportionately impacted by disasters due to a
variety of factors, including level of English proficiency, cultural
insensitivities, acculturation level, immigrant status, lower incomes,
fewer savings, greater unemployment, less insurance, poorer
access to information, and community isolation (Andrulis, Siddiqui, &
Gantner, 2007; Fothergill et al., 1999; Norris & Allegría, 2006; Rodriguez et al., 2006).
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Cultural Components of Response:
Addressing Issues of Equity
 The delivery of culturally and linguistically appropriate
services helps improve quality of care and services:
– Research indicates that understanding culturally-specific
responses to disasters is important for reaching out to disasteraffected minority communities and for the planning and
delivery of disaster mental health services (Perilla et al., 2002).
– Improved language access services can help disaster responders
overcome cultural and language barriers between survivors and
responders, which have been cited as obstacles to appropriate
emergency response.
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The Cultural Competency Journey
Cultural Competency is a
journey, not a destination
Starting Off:
• Self Assessment
• Community Services
Assessment
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The Cultural Competency Journey:
Preparation Phase
Communicating with the Community:
• Ensure that your organization’s early warning system is
culturally and linguistically competent
“
Community engagement and collaboration may be
the only means for achieving appropriate planning.
- Office of Force Readiness and Deployment, HHS
•
•
•
•
”
Know and understand cultural norms and mores
Use appropriate languages and language access services
Recognize strengths and limitations
Take advantage of a community’s strengths
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The Cultural Competency Journey:
Response Phase
Just-in-time training offers:
• just the right information,
• at just the right time, and
• in just the right form.
Linkov F, Ardalan A, Dodani S, Lovalekar M, Sauer
F, Shubnikov E, LaPorte R.
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The Cultural Competency Journey:
Recovery Phase
Disparities in Recovery
Recovery involves both short-term and long-term action.11
Source: DeWolfe 2000
National CLAS Standards, 2000
National Standards for Culturally and Linguistically
Appropriate Services in Health Care
• 14 Standards, published in 2000
• Provide the framework for all health organizations to
best serve the nation’s diverse communities
• Inform practices related to cultural and linguistic
competency in health care
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National CLAS Standards, 2000
The CLAS Themes
Culturally Competent Care
Standards 1-3
Language Access Services
Standards 4-7
Organizational Supports
Standards 8-14
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National CLAS Standards Enhancement Initiative
2010 – 2012
Goals of the Initiative:
• To examine the National CLAS Standards for their
current relevance and applicability.
• To have the enhanced National CLAS Standards serve as
the cornerstone for culturally and linguistically
appropriate services in the United States.
• To coordinate the Standards with the Affordable Care
Act and other cultural and linguistic competency
provisions (e.g. Joint Commission, National Committee
for Quality Assurance).
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National CLAS Standards
Enhancement Initiative: Timeline
Research: 2010
Literature Review
Public Comment
Advisory Committee
Development: 2011
Analysis
Consultations
Drafting
Launch: 2012
Enhanced National CLAS Standards
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Comparison–2000 and 2012 National CLAS Standards
2000 Standards
2012 Standards
Goal: to decrease health care disparities and
make practices more culturally and linguistically
appropriate
Goal: to advance health equity, improve quality
and help eliminate health and health care
disparities.
“Culture”: racial, ethnic and linguistic groups
“Culture”: racial, ethnic and linguistic groups, as
well as geographical, religious and spiritual,
biological and sociological characteristics
Audience: health care organizations
Audience: health and health care organizations
Implicit definition of health
Explicit definition of health to include physical,
mental, social and spiritual well-being
Recipients: patients and consumers
Recipients: individuals and groups
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National CLAS Standards: Next Steps
• Departmental Briefings at the U.S. Department of Health and
Human Services
• Communications Roll Out – the Office of Minority Health plans
to promote the Standards to all health care delivery sectors for
adoption
• Publication of the enhanced National CLAS Standards in the
Federal Register in fall 2012
• Publication of a guidance document, The National CLAS
Standards: A Blueprint for Advancing and Sustaining CLAS Policy
and Practice
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Resource Tools: OMH’s Think Cultural Health
Think Cultural Health (TCH): Cultural Competency Clearinghouse
Advancing health equity at every point of contact
E-learning
programs
National CLAS
Standards
TCH
Communication
Tools
CLAS
Clearinghouse
http://www.ThinkCulturalHealth.hhs.gov
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Cultural Competency Curriculum for Disaster
Preparedness and Crisis Response
 Housed at OMH’s Think Cultural Health
 Free, online continuing education course launched 2009
 Equips disaster personnel with the knowledge, awareness,
and skills needed to provide emergency health care
services to diverse populations
 Accredited for First Responders, Emergency Managers,
Disaster Mental Health Workers, and Dentists
 2,500 individuals have registered for the program; 10,000
credits have been awarded
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Cultural Competency Curriculum for Disaster
Preparedness and Crisis Response
 Accredited for First Responders, Emergency Managers,
Disaster Mental Health Workers, and Dentists
 2,500 individuals have registered for the program; 10,000
credits have been awarded
 “This has been both a great refresher course on previously
acquired knowledge and a source of new information to
consider and apply when planning for and working with
the cultural needs of disaster victims.”
– Program Participant
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Cultural Competency Curriculum for Disaster
Preparedness and Crisis Response
Contains four courses:
 Course I: Introduction to CLAS in Disaster
Preparedness and Crisis Response
 Course 2: Implementing CLAS in the Preparation
Phase of a Disaster
 Course 3: Implementing CLAS in the Response Phase
of a Disaster
 Course 4: Implementing CLAS in the Recovery Phase
of a Disaster
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Video Case Study
But What if I’m Deported?: Providing Culturally
Competent Care and Language Access Services During
Recovery
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Video Case Study
Questions for discussion:
 How do you feel about the story presented?
 Do you think it was handled appropriately?
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For More Information:
Guadalupe Pacheco
HHS Office of Minority Health
Guadalupe_Pacheco@hhs.gov
http://www.ThinkCulturalHealth.hhs.gov
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