Transcript An Overview: Strategies for HIV/AIDS Providers Co-Presented by: : Ms. Tawara Goode, MA, Director, National Center for Cultural Competence and Ms.

An Overview: Strategies for HIV/AIDS Providers
Co-Presented by: : Ms. Tawara Goode, MA, Director, National Center for Cultural Competence and
Ms. Wendy Jones, Director, Children & Youth with Special Health Care Needs project of the National Center
for Cultural Competence
National Center for Cultural Competence,
Georgetown University Medical Center
At the completion of this webinar each
participant will:
 state the importance of the 15 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 15 Standards.

In 2013, U.S. Department of Health and Human
Services , Office of Minority Health, reissued a new
set of CLAS standards.

The new 15 CLAS Standards promote the
advancement of health equity, improving the
deliver of quality care, and the elimination of health
care disparities.

All of the CLAS Standards are of equal importance
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The Introductory Statement:
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:
Principle 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.
Theme 1) 2-4:
Governance, Leadership, and
Workforce
Theme 2) 5-8:
Communication and Language
Assistance
Theme 3) 9-15: Engagement, Continuous
Improvement, and Accountability
Cultural Competence
behaviors
practices
attitudes
policies
structures
requires that organizations have a clearly defined,
congruent set of values and principles, and demonstrate
behaviors, attitudes, policies, structures, and practices
that enable them to work effectively cross-culturally
(adapted from Cross, Bazron, Dennis and Isaacs, 1989)
Slide Source:© 2011 - National Center for Cultural Competence
Five Elements of Cultural Competence
Organizational Level
value diversity
conduct cultural self-assessment
manage the dynamics of difference
institutionalize cultural knowledge
adapt to diversity
- policies - structures
- values - services
(Cross, Bazron, Dennis and Isaacs, 1989)
Slide Source:© 2011 - National Center for Cultural Competence
Five Elements of Cultural Competence
Individual Level
acknowledge cultural differences
understand your own culture
engage in self-assessment
acquire cultural knowledge & skills
view behavior within a cultural context
(Cross, Bazron, Dennis and Isaacs, 1989)
Slide Source:© 2011 - National Center for Cultural Competence
LINGUISTIC COMPETENCE FRAMEWORK
POLICY
DEDICATED
FISCAL
RESOURCES
PRACTICES
LINGUISTIC
COMPETENCE
DEDICATED
PERSONNEL
RESOURCES
STRUCTURES
PROCEDURES
Goode & Jones, Revised 2009, National Center for Cultural Competence
Slide Source:© 2011 - National Center for Cultural Competence
Values and Guiding Principles for Cultural Competence
Cultural competence:
 embraces the principles of equal access and non- discriminatory practices
in service delivery.
 is achieved by identifying and understanding the needs and help-seeking
behaviors of individuals and families.
 involves working in conjunction with natural, informal support and
helping networks within culturally diverse communities.
Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles
http://nccc.georgetown.edu/foundations/frameworks.html
Values and Guiding Principles for Linguistic Competence




Services and supports are delivered in the preferred language and/or
mode of delivery of the population served.
Written materials are translated, adapted, and/or provided in alternative
formats based on the needs and preferences of the populations served.
Interpretation and translation services comply with all relevant Federal,
state, and local mandates governing language access.
Consumers are engaged in evaluation of language access and other
communication services to ensure for quality and satisfaction.
Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles
http://nccc.georgetown.edu/foundations/frameworks.html
Culture influences the way people interact with health and
mental health care systems including:


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

Participation in health prevention and promotion programs
Access to health information and services
Choices and decisions related to health and mental health services
Understanding of and priorities related to health and illness
Help-seeking behavior and adherence to recommended treatment

Systems of care poorly
designed for diverse
populations

Poor cross-cultural
communication between
providers and patients

Patient/client fears and
distrust

Cultural stigma

Lack of diversity in health
care leadership and
workforce
Why should your organization implement the
CLAS Standards?
EVIDENCE
INDICATES
IMPROVEMENT
Access
Effectiveness
Acceptability
Satisfaction
Care
Services
Supports
Outcomes
Slide Source:© 2011 - National Center for Cultural Competence

gain knowledge about cultural values and beliefs of the
patient and apply that knowledge in a health care context.

interact effectively with people whose cultures and belief
systems are different than your own.

provide quality care that is respectful and nonjudgmental.

deliver health care, services, and supports in the primary
languages spoken be patients/clients and their families

identify and respond effectively to the preferences and
needs of populations served.

The remainder of this Webinar series will discuss each
Standard and strategies organizations might pursue to
implement CLAS.

We will use the case studies that we asked you to
download when you registered to illustrate various points.

This Webinar series is designed to increase your
awareness and knowledge of how you deliver care.
Remember, how patients/clients see you may not be how
you see yourself.
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.

Creates a safe/welcoming environment
appreciation of diversity/focuses on
patient-centered care

Individuals receive services in a culturally and
linguistically appropriate manner to enable them
to meet their communication needs/understand
their care & participate in their care

To eliminate discrimination and disparities
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Provide processes to ensure staff are trained on the
civil rights laws that affect equitable healthcare
service delivery
 Develop policies and procedures to ensure patients
are provide information on their rights to receive
health care services that address that cultural and
linguistic needs
 Institute cross-cultural training for front-line and
clinical staff on the health care needs of
cultural/linguistically diverse populations

Advance and sustain
organizational goverance and
leadership that promote CLAS
and health equity through policy,
practices, and allocated
resources.
Implementation Strategies:

Develop a mission statement/core values/vision statement-that
promotes health equity

Seek commitment from top board, management leadership

Management/board should set policy/program goals, development
of strategic plan of promoting organizational diversity, providing CC
care, eliminating health disparities; written policies, practices,
procedures, programs, etc.

Provide fiscal, human resources, tools, skills, and knowledge to
support a culturally competent organization.
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 Recruit, promote, and support a
culturally and linguistically diverse
governance, leadership, and
workforce that are responsive to the
population in the service area.

Obtain patient feedback on
their preference for patientprovider concordance (e.g.
race, ethnicity, language,
sexual orientation, gender,
gender identity).

Assess the degree to which
staff demographics match
patient preferences.

Establish staff diversity as recruitment, hiring, and retention goals
for your organization.

Post notices of job announcements and vacancies in forums,
venues, and in varied languages to increase the likelihood of
attracting diverse applicants.

Where possible, recruit and hire qualified individuals (including past
and current patients/clients) of the populations and communities
impacted by the HIV epidemic.

Assist individuals from culturally and linguistically diverse groups to
complete required training needed to qualify for varied positions
within the health and/or mental health care setting.

Provide ongoing training and mentoring to all staff, including new hires,
to enhance their cultural competency and their capacity to communicate
effectively cross-culturally (including but not limited to patients/clients
and their families who speak languages other than English, those who
have disabilities, and individuals who are deaf or hard of hearing).

Include criteria for cultural and linguistic competence in staff
performance evaluations.
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Provide staff with an open and safe forum and a process to raise and
address issues related to individual and the organizational capacity to
deliver culturally and linguistically competent services.
Educate and train governance, leadership, and
workforce in culturally and linguistically
appropriate policies and practices on an ongoing
basis.
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Periodically query staff about their perceived learning needs in the
area of cultural and linguistic competence.

Designate interested and knowledgeable staff the responsibility of
coordinating in-service training/professional development.

Provide cross- and discipline-specific training in cultural and
linguistic competency that is responsive to staff’s expressed
interests, needs, and learning styles.

Keep abreast of current trends and emerging evidence about
culturally and linguistically competent care to include in all inservice training and professional development efforts.

Staff performance evaluations should include criteria that addresses active
participation in and completion of training/professional development activities.

Support professional development by offering varied modalities for learning (e.g.
Web-based, self-directed and self-paced curricula, coaching and mentoring,
continuing education, journal/book clubs, discussion groups) .

Address cultural and linguistic competency as a routine component of staff
meetings and retreats.
Establish meaningful incentives and special recognition awards for
cultural and linguistic competency within the organization.
Offer language assistance
to individuals who limited
English proficiency and/or
other communication
needs, at no cost to them,
to facilitate timely access
to all health care and
services.

Conduct an annual assessment of languages (other than English)
spoken within the geographic locale served by the organization
to ensure language access. Include data on the population of
people who are deaf or hard of hearing.

Update the organization’s language access plan on an annual
basis. Ensure that there are adequate resources (fiscal and
personnel) for the provision of language access services.

Ensure that all staff are knowledgeable of organizational policy,
procedures, and practices for language access, including
individual responsibility according to job function.

Ensure that language access services include sign language
interpretation.
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Ensure that all legally binding documents are professionally
translated into the languages spoken by the patient/client
population. Such documents may include, but is not limited to,
consent forms, confidentiality and patient rights statements,
release of information, eligibility and applications for services.

Ensure that medical orders, patient education, and health/mental
health promotion resources are translated into the languages
spoken by the patient/client population. Such documents should
also be offered in Braille.
Inform all individuals of the
availability of language assistance
services clearly and in their
preferred language, verbally and in
writing.

Post signage in prominent locations stating patients’/clients’
rights to receive language access services (at no cost) in the
health/mental health facility.

Ensure that staff provide both verbal and written notification
of patients’/clients’ rights to receive language access services
at no cost.
An elderly African American woman newly diagnosed with HIV
presents for the first time at Clinic A. She approaches the
receptionist’s desk and hands her the appointment slip.
The twenty year old receptionist takes it, and while looking at her
computer screen says rather loudly “You’re Mary Smith. Well Mary I
need you to complete this intake form and bring it back to me. Here
you go Mary, here’s a pen and here’s the form.”
The African American woman does not take the forms instead she
turns on her heels and walks out.
Anybody want to guess what communication glitch might have
occurred here.
National Center for Cultural Competence,
Georgetown University Medical Center
Goulda Downer, Ph.D., RD, LN, CNS - Principal
Investigator/Project Director (AETC-NMC)
Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC,
CTN-A, FAAN
I. Jean Davis, PhD, DC,PA
Denise Bailey, MEd.
National Center for Cultural Competence,
Georgetown University Medical Center
1840 7th Street NW, 2nd Floor
Washington, DC 20001
202-865-8146 (Office)
202-667-1382 (Fax)
Goulda Downer, Ph.D., RD, LN, CNS
Principle Investigator/Project Director (AETC-NMC)
www.AETCNMC.org
HRSA Grant Number: U2THA19645
National Center for Cultural Competence,
Georgetown University Medical Center