Welcome to the November edition of Think Cultural Health News! We are excited to bring you this behavioral health-themed e-newsletter. In this edition, you will learn more about the role of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care in behavioral health. The National CLAS Standards provide a set of action steps that help organizations provide effective, equitable, understandable, and respectful quality care and services.

Across the United States, behavioral health systems are using the National CLAS Standards to advance heath equity, improve quality, and help eliminate disparities. This e-newsletter will share updates from several of our colleagues in the field on their adoption of the National CLAS Standards.

Thank you for your commitment to advancing culturally and linguistically appropriate services! We invite you to share with us your questions, experiences, and lessons learned at AdvancingCLAS@ThinkCulturalHealth.hhs.gov.

By: Roslyn Holliday Moore, MS (HHS SAMHSA; member of the National Project Advisory Committee for the National CLAS Standards ), Miatta Echetebu (HHS SAMHSA), Cheri Wilson, MHS (Johns Hopkins University)

The release of the U.S. Department of Health and Human Services' (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities was a catalyst for the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) to review and enhance efforts to promote culturally and linguistically appropriate behavioral health care. SAMHSA developed a disparity impact strategy as a direct response to the Secretarial priority that includes a requirement for grantees to submit a disparity impact statement to outline how they will address disparities in the access, use, and outcomes of grant program activities.

Adherence to the National CLAS Standards is an embedded requirement of the disparity impact statement to ensure culturally and linguistically appropriate behavioral health care. SAMHSA's Office of Behavioral Health Equity (OBHE) initiated an iterative process to develop training materials and supports to increase capacity to apply the National CLAS Standards across the broad spectrum of behavioral health treatment and social service settings.

SAMHSA's OBHE collaborated with the Hopkins Center for Health Disparities Solutions to adapt an organizational cultural competence self-assessment tool for behavioral health, the Behavioral Health and Social Services 360 (BHSS360), that measures diversity in terms of age, race, ethnicity, nationality, language, religion/spirituality, gender identity, sexual orientation, disability, and military status. The tool is fully aligned with the National CLAS Standards and provides a 360-degree view from the perspective of administrators, clinicians/providers, administrative/clerical staff, and clients. The tool was developed for use in a continuous quality improvement process to assist organizations and communities in several organizational assessment activities.

The BHSS360 has been administered to SAMHSA grantees in three states thus far, with a total of 450 surveys completed during the early rollout phase of the effort. Preliminary results are being examined for emerging "best practices" and alignment with technical assistance resources to support innovative strategies for leveraging the National CLAS Standards to promote positive behavioral health outcomes.

The implementation of the National CLAS Standards in behavioral health care settings has increased significantly through SAMHSA's efforts to promote behavioral health equity along with the availability of an organizational cultural competence self-assessment tool tailored for behavioral health. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities, and the National CLAS Standards are important guideposts for achieving that mission across the nation's diverse populations.

By: P. Qasimah Boston, DrPH (Florida Office of Substance Abuse and Mental Health) and Ivette A. Lopez, PhD (Florida A&M University)

Behavioral health systems in the United States need to be guided by the National CLAS Standards. In Florida, implementation of the National CLAS Standards requires a synergistic approach, within arenas that include state, regional, and local sectors, and within a variety of helping community sectors. The sectors include those working in state agencies, managing entities, and provider agencies, as well as those receiving behavioral health services and their families. These expansion sectors also include educational institutions, community organizations, and local city structures. For the state of Florida, this has meant the development of a state Cultural and Linguistic Competence Planning (CLC) Team, a state CLC Committee, the identification of state CLC representatives, and the helping community support (see Figure 1). The development of CLC materials has encouraged the true collaboration of those who provide mental health services so needed by diverse communities of Florida. The development of cultural and linguistic competence-related materials has also provided support to educators of the behavioral health workforce.

For behavioral health systems to be successful in the provision of culturally and linguistically responsive approaches, the utilization of the National CLAS Standards is useful as a methodology or strategic approach. The National CLAS Standards are helping to expand CLC in Florida. The Standards provide a blueprint for a unified and strategic approach, which is being used across regions to expand CLC and to develop a statewide CLC strategic plan. Without the unified approach, expansion throughout the whole state would be challenging at best. This approach also contributes to SAMHSA’s work to build a multidisciplinary behavioral health approach that helps Americans determine effective treatments for themselves and their families. The National CLAS Standards help provide a framework for CLC expansion across the state, uniformly, and the National CLAS Standards allow for tailoring to the specific needs of the Florida regions. Florida is the fourth most populous state in the country. The size and cultural, linguistic and geographic diversity of the 67 counties poses many challenges to providing consistent quality of care. Without the application of cultural and linguistically appropriate standards, health inequities will continue to thrive.

Figure 1: Florida CLC Expansion Implementation Effort
Acronyms in Figure 1:
CLC: Cultural and Linguistic Competence
SAMH: Substance Abuse and Mental Health
SOC: System of Care

By: Tawara Goode, MA (NCCC; member of the National Project Advisory Committee for the National CLAS Standards)

The National Center for Cultural Competence (NCCC) at Georgetown University's Center for Child and Human Development is working with state public health departments in Delaware and Mississippi to conduct cultural and linguistic competence organizational assessment processes. The Public Health Accreditation Board (PHAB) requires an assessment of the health department's social, cultural, and linguistic competence in providing public health programs to specific populations with higher health risks and poorer health outcomes. The PHAB recommends the NCCC's Cultural and Linguistic Competence Policy Assessment (CLCPA) and the National CLAS Standards to fulfill this requirement.

The NCCC is administering the CLCPA and a structured interview protocol based on the National CLAS Standards to conduct the assessment processes for the Delaware Division of Public Health and the Mississippi State Department of Health. The NCCC is also assisting the Mississippi State Department of Health, through a grant funded by the HHS Office of Minority Health, to conduct a department-wide professional development series on cultural and linguistic competence and the implications of the National CLAS Standards in public health.

The National Center for Cultural Competence (NCCC) and Think Cultural Health have created a virtual Learning Community to support the implementation of the National CLAS Standards in behavioral health systems and services. The Learning Community is designed to help members gain an in-depth understanding of the Standards and work with other Learning Community members to share and develop strategies for implementation. The Learning Community employs distance technology to convene via interactive, web-based learning sessions that include reading assignments, team teaching, discussing, and field testing.

Do you have an event you would like to share with the TCH team and other members of the CLCCHC community? Submit the event to our Community Calendar.

HHS does not endorse or recommend any commercial products, processes, or services. The views and opinions of authors expressed in this e-newsletter do not necessarily state or reflect those of the U.S. Government, and they may not be used for advertising or product endorsement purposes.