Good afternoon and welcome to the Webinar for the Heartland RHEC . Region VII. Leveraging CLAS: The National Standards for Culturally and Linguistically Appropriate in Health and Health Care. Today.s webinar will be presented by myself, Darci Graves and my colleague Godfrey Jacobs. We.re very excited to be speaking with you all today and with that I.ll let Mr. Jacobs introduce himself.

Well hello everybody, it.s a real pleasure to be with you today, Godfrey Jacobs here. I serve as the manager of the Health Determinants & Disparities Practice at SRA and one of the things that we do through that practice is manage a contract for the Office of Minority Health called Think Cultural Health. It.s a real pleasure to be with you as I said, particularly as you get ready to begin the next round of registration or enrollment for the ACA. I.ll keep my introduction short and Darci I.ll pass it over to you for your introduction.

Thank you. I am also a member of the Health Determinants & Disparities Practice at SRA International. I have the pleasure of serving as the Senior Health Education & Policy Specialist and between Godfrey and I, we.ve worked on the National CLAS standards for a number of years. And I.m particularly excited to be speaking with you all today because I identify as a Midwesterner at heart and spent the greater part of my life in Missouri and in the Kansas city region in particular. So I.m excited to be speaking to all of you. And with that we.ll move on to the next slide.

I.ll start off by saying that I wanted to acknowledge first of all the other members of our team who have been very helpful and have worked very hard in the past four years to bring forth the new and improved , I think, National CLAS standards, Enhanced CLAS Standards, and they.re listed there on the first slide. And you can move on to the next one in which we want to talk about the Office of Minority Health and its mission, which is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities. As you know, there.s a significant body of research that documents the persistent and widespread disparities experienced by many communities in our nation.

Secretary of Health and Human Services has in the past noted that minorities moving to American are more likely to be sick and less likely to get the care they need. So the Office of Minority Health has several important cultural and linguistic competency initiatives that have addressed these disparities, including over a decade of work with the National CLAS Standards, going back to 1999 when the first set was promulgated.In the next slide I.d like to describe a bit of what is CLAS. If we were in an auditorium I.d ask for a show of hands as to how many people have heard of CLAS and I hope that I would have seen a few hands go up and hopefully as the years go by we.ll see many more of these hands. But CLAS is an acronym for Culturally and Linguistically Appropriate Services. What do we mean by that? We define CLAS as services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs, and are employed by all members of an organization regardless of size at every point of contact. It.s really important to get that point as we talk about CLAS because it really has to be, to be most effective, something that is understood throughout the organization and to which the organization is committed. So it.s important to know that every health care encounter is a cross-cultural interaction. You should consider not only a client.s culture (and I think that this is really an important point as you get ready to register new participants in the ACA) that you should consider not only a client.s culture but also your culture and the culture of your organization because these different pieces have to work together in order to be effectively communicated to the clients that you.ll be working with. So keep this in mind as you seek to respond effectively to the needs of those that you will be registering from diverse communities in your respective service areas.

We can flip to the next slide which you see and we talked about every point of contact. You see the different boxes there which describe the types of contact that we.re speaking about. So we need to think about CLAS, as I said, at every point of contact. CLAS and communication is important during the client-provider encounter but there is much more to the health and health care continuum that includes how to structure these activities and services, establish trusting relationships between counselors and enrollees, target communication to increase effectiveness, and overcome language and literacy barriers. We also need to be aware of education and training related to CLAS and communication and providing easy to understand print and multi-media materials and signage as we partner with the community. So as you look those boxes, think in terms of where do I fit, how do I more effectively get engaged with the client that I am trying to reach. So in the next slide we.re talking now about the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. As you see here, these standards were originally published in the year 2000 and then republished in the year 2013. Sometimes I don.t like to admit it, but I was there for both of these, and it.s been a really, very interesting process. The Office of Minority Health has developed a framework for operationalizing CLAS and it.s called the National CLAS Standards as you see by the heading here. The standards are an important tool for promoting and implementing culturally and linguistically appropriate services and I think you will find that they.re a very important tool for the work that you.re doing as well as you seek to enroll as many people as possible in the ACA. The National CLAS Standards were first developed by the HHS Office of Minority Health in 2000 and in 2010 the Office of Minority Health launched an initiative to update the standards, which incorporated public comment, a literature review, and ongoing consultations with an advisory committee comprised of 36 experts representing a variety of disciplines and organizations.

In April of last year, 2013, we were very excited to release the enhanced National CLAS Standards and we had an opportunity to do so at the White House itself. There are 15 standards and I think the White House issue in terms of doing it at the White House was an indication of the importance that the administration or HHS and the administration place on the standards. So as I was about to say, there are 15 standards each of which is an action step that guides professionals and organizations in the implementation of culturally and linguistically appropriate services. Now I.m going to ask Darci to walk us through some of the new things that came into our enhanced National CLAS Standards and also to take us through the standards as well. Darci.

Great, thank you Godfrey. As a quick aside it.s hard for me to believe but this venn diagram that you see on this slide is a model of discussing cultural and linguistic competency that I developed when I was a faculty member at the University of Missouri, Kansas City School of Medicine. So I really feel like I.ve come full circle as I know members of the staff and faculty at UMKC are also listening on this call.

So as Godfrey said, between 2010 and 2013 the National CLAS Standards underwent an enhancement initiative. This was to make sure that we revisited the National CLAS Standards that we made sure that they were as valid and reliable and useful today as they were when they were first promulgated back in 2000. One of the things that changed was a broadened or expanded definition of culture. In the standards, culture encompasses race, ethnicity and linguistics, as well as geographic, religious, spiritual, biological, and sociological characteristics. Culture is defined as the integrated pattern of thought, communication, actions, customs, beliefs, values and institutions associated wholly or partially with racial, ethnic, or linguistic groups as well as with religious, spiritual, biological, geographical, or sociological characteristics.

Culture is dynamic in nature and individuals may identify with multiple cultures over the course of their lifetime and this definition hence reflects the complex nature of culture as well as the various areas in which culture can be defined and studied across previous, other disciplines.

If you look at the next slide, we have also a definition of the health. Now there was an implicit definition of health in the original iteration of the National CLAS Standards. In this iteration we wanted to be explicit in our definition and therefore when we talk about health and we talk about wellbeing, we.re referring to physical, mental, social and spiritual wellbeing because all of those pieces influence how one.s health is perceived and received.

Moving on to the next slide, we also made sure that the standards were referenced in those health and health care organizations, therefore medicine, behavioral health, mental health, public health, social work, community health centers, emergency health centers and so many more are included and reflected and can use this tool that is the National CLAS Standards. And then on the next slide we can see what is the purpose or what is the intention of the National CLAS Standards and it.s to advance health equity, improve quality of services, and to help eliminate the health and health care disparity.

Now with that said, now we.re going to talk about the National CLAS Standards themselves and when we look at the next slide you can see how the National CLAS Standards are organized. There.s a myriad of reasons as to why they are structured like this but again to underscore what Godfrey said, the National CLAS Standards are really to serve as a tool for you and your organization to operationalize the concept of cultural and linguistic competency because it.s great when we all sit down and say .Let.s make it more culturally appropriate. or .Or let.s make this more acceptable to our linguistic community members who have English as a second language. but how do I go about doing that? How do I do that every point of contact? How do I make sure that everything we do is culturally and linguistically appropriate? So we hope that this tool can be used not only by the individuals on the line who are working to enroll individuals with the ACA starting next month but also other organizations in the Heartland region who are working to connect with, to provide services to, and to improve the wellbeing of all of our community members.

So the National CLAS Standards are comprised of 15 standards that inform and facilitate the implementation of culturally and linguistically appropriate services. As you can see, there is a principal standard or Standard number 1 that serves as an overarching goal for all of the other standards. The remainder of the standards are structured into three overall themes .

Governance, Leadership, and Workforce Communication and Language Assistance and Engagement, Continuous Improvement, and Accountability Now in the next slide we look at the principal standard itself. And the principal standard frames the essential goal of all the standards. Therefore conceptually if all of the other 14 standards are adopted, implemented, and maintained, then the principal standard will in itself be achieved. What do we mean by providing effective, equitable, understandable, and respectful quality care and services? Well that means that help to create a safe and welcoming environment at every point of contact that fosters an appreciation of diversity in individuals and provides patient and family-centered care and ultimately can improve the perceived access to care. It allows an organization to meet the communication needs so that individuals understand the health care and services that they are receiving, can participate effectively in their own care and make informed decisions. And then finally, by meeting the standards you will be helping your organization eliminate discrimination in health and health care disparities. The first theme of the National CLAS Standards is Governance, Leadership, and Workforce which emphasizes the implementing of CLAS. It.s a responsibility of the entire system. Implementing CLAS really requires the investment, support and training of all individuals within an organization. The impetus for implementing CLAS can and often does come from the bottom up, however an organization.s leadership shapes the culture of the organization through its priorities, expectations, and the behavior that it models. Therefore the impetus for implementing CLAS should also come from the top down. The standards teach us that implementing CLAS at every point of contact is critical to improve quality of care and avoid this type of situation.

The standards within Theme 1 include the following:

Standard 2 underscores that CLAS must permeate every aspect of the organization from the top down and the bottom up, and we know that leadership in large part determines whether the organization.s culture will embody quality, safety, and CLAS. Standard 2 can help organizations provide adequate resources to support and sustain CLAS initiatives as well as to model an appreciation and respect for diversity, inclusiveness in all beliefs and practices.

Standard 3 has to do with recruiting, promoting and supporting a diverse governance leadership and workforce. It will help organizations to create an environment in which culturally diverse individuals feel welcomed and valued as well as introduce multi-cultural perspectives into planning, design, and implementation of CLAS. Finally, Standard 4 has to do with educating and training governance in leadership and workforce which will help organizations prepare and support a workforce that works well with diverse population as well as assessing the progress of staff in developing cultural, linguistic, and health literacy competency.

In Theme 2 we address communication and language assistance. And one of the areas I know that Godfrey referenced earlier in speaking with individuals in Region 7 was overcoming language and literacy barriers and we really think that these four standards in particular can assist with that.

Communication and Language Assistance provides guidance on how to effectively meet patient communication needs including sign language, brail, oral interpretation, and written translation. In addition, the standards in this theme will help organizations comply with Federal requirements such as Title 6 of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, and other relevant Federal, State, and local requirements to which you may need to adhere. To dive deeper into Theme 2, Standard 5 has to do with offering communication and language assistance which helps an organization make sure that individuals with limited English proficiency and/or other communication needs have equitable access to health service. It also allows organizations to improve patient safety and reduce medical errors related to miscommunication. Standard 6 has to do with informing individuals of the availability of language assisted services which will help organizations inform individuals with limited English proficiency in their preferred language that language services are readily available at no cost to them. And it will also facilitate access to language services. On the next slide we.ll see the other two standards in this theme . Standard 7 and Standard 8. Standard 7 has to do with ensuring the competence of individuals providing language assistance, which will help organizations provide accurate and effective communication between individuals and providers as well as empowering individuals to negotiate and advocate for important services by effective and accurate communication with health and health care staff.

Standard 8 has to do with providing easy-to-understand materials and signage. It will help organizations make sure that the readers of other languages and individuals with various health literacy levels are able to understand and access care and services as well as enabling all individuals to make informed decisions regarding their health and their care and service options.

The next and final theme of National CLAS Standards is Theme 3, which has to do with engagement, continuous improvement, and accountability. This theme underscores the importance of establishing both individual and organizational responsibility for implementing CLAS. Effective delivery of CLAS demands actions across an organization. This theme focuses on the support necessary for adoption, implementation, and maintenance of culturally and linguistically appropriate policies and services regardless of one.s role within an organization or practice. All individuals are accountable for upholding the values and the intent of the National CLAS Standards. So that means not only at the C-Suite but as well as individuals who are working in the reception desk or as parking lot attendants or the like, everyone has a role to play when it comes to implementing and living the National CLAS Standards. As we move into the next slide we dive deeper into Theme 3. Standard 9 has to do with infusing CLAS throughout the organization.s planning and operations so this will help organizations make CLAS central to organizations. service, administrative and supportive functions as well as link CLAS to other organizational activities, including policy, procedures and decision-making related to outcome accountability. So really this comes down to making sure that all of the plans that your organization is developing are in and of themselves culturally and linguistically appropriate; having a plan for CLAS but also making sure that all of your plans have CLAS within them. So this isn.t an add-on but a way of modifying what it is that you currently do.

Standard 10 has to do with conducting organizational assessments and this will help an organization assess the performance and monitor progress in implementing the National CLAS Standards; obtaining information about the organization and the people it serves, which can be used to tailor and improve services.

And we move on to Standard 11 which has to do with collecting and maintaining demographic data which will help organizations accurately identify population groups within a service area and monitor individual means, access, utilization, quality of care, and outcome pattern. And this will also help with organizations when you.re trying to do effective outreach. You need to know who you.re doing outreach to. When you combine this reliable demographic data with working with those individuals in the community, you can create the material, you can create messages to build trust and rapport and to craft messages that will truly resonate with the audience that you.re attempting to work with. Standard 12 has to do with conducting assessment of community health, assets, and needs, which helps an organization determine the service, assets, and needs of the population in the service area, or needs assessment; identify all of the services available and non-available to the population in the service areas, which can be conceived of in a resource inventory and a gaps analysis. And finally, determine what services to provide and how to implement them based on the results of your community assessment.The last three standards in Theme 3 and of the standards themselves are 13, 14, and 15.Standard 13 has to do with partnering with the community and this is what I was just referencing moments ago. This will help organizations provide responsive and appropriate service delivery to a community and it will empower members of the community in becoming active participants in the health and health care process by keying in to key decision makers, by working with community-based organizations that the community trusts and works with, then your organization can improve things as well and as well as that connection.

Standard 14 has to do with creating conflict and grievance resolution processes that are culturally and linguistically appropriate themselves. And this will help organizations facilitate open and transparent two-way communication and feedback mechanisms and individuals and organizations. This will allow us to anticipate, identify, and respond to cross-cultural needs. Standard 15 has to do with communicating the organization.s progress. This will help organizations convey information to intended audiences about effort and accomplishments in meeting the National CLAS Standards as well as building and sustaining communication on CLAS priorities and foster trust between the community and the service setting.

This is Godfrey again. I know that this is a lot to digest and for those of you who have not been exposed to the CLAS standards before I know you.re probably saying .Wow what.s all this stuff?.

But there are ways for you to take it in smaller pieces and I.ll point that out in a minute, because all of these standards are available on our website, and we also have, as you will see later, a blueprint that will help to explain that even further. Therefore, I want to turn to the next issue of resources and to talk a little more about where you can turn for National CLAS Standards, the blueprint and indeed more. I mentioned earlier about Think Cultural Health as the project that we implement for Office of Minority Health and that sponsored website, I think that.s showing on the top of this slide, here you will find lots of what I think are good things from which you choose. We have a suite of e-learning programs which has free online continuing education. We have the CLAS clearing house which is a key-word searchable database of resources. We have a thing we call Join The CLCCHC which provides you with a newsletter calendar and other educational materials. And of course we have the National CLAS Standards and the blueprint.So this cultural health site is a valuable resource for you as you continue to learn more and more about and implement the National CLAS Standards. We.ve become a trusted site for health professionals to turn to for information on education related to CLAS and health equity.In addition to housing the CLAS standards and the blueprint . and the blueprint by the way describes each of the standards and its purpose along with some of the strategy and resources for implementing each standard. It was interesting as I was listening to Darci go through the standards. I was reflecting on how those standards were condensed from the thousands of hours of discussion that we had with our National Project Advisory Committee. So within those standards there are some really well thought through things that obviously we could spend many hours on each one so that.s why we did the blueprint so that you could have a chance to yourself examine the issues inherent within each of these standards and find ways that it applies to your daily activities.

So I hope you.ll visit all the resources that are listed in the blueprint. And they.re available, as I said before, through our clearinghouse and readily available for you to absorb.
In the next slide I think we are depicting the blueprint itself . yes there it is. I think it will give you a good navigation through these National CLAS Standards. And in there you.ll find a case for CLAS, the enhancements themselves, a standard-by-standard chapter on purpose, description, strategies, and resources. This blueprint was designed to provide individuals, agencies, and organizations of all kinds the guidance to implement the National CLAS Standards. So I really hope that you will have an opportunity to go to this website and download this stuff free of charge and use it as you see fit.
That actually ends the presents. In the next slide what I want to say is that we really would love to hear from you because its people in the field that help us to better interpret the needs that arise from day-to-day as the CLAS standards get implemented. There is a very active implementation activity or initiative going on with OMH and ourselves working together as a team in various parts of the country and various kinds of activities to try and get these standards better understood and hopefully more widely implemented.
So let us hear how CLAS is going at your home organization and in your area. As I said before, we are interested in the documents you create, the information you share and you.re opening doors to the world. As I said at the beginning, I would have asked for a show of hands, hopefully some of you are in fact implementing these standards and are familiar with them and if you.re not, I really want to urge you to begin the journey because remember that cultural competence is not a destination but a journey and each day we learn something a little more and a little more and we.re able to work with our clients a little better, to understand their situations better, to interpret the issues that they face better. And I think that using that kind of approach will actually increase the number of people that you.ll be able to enroll in the ACA. So with that we.ll close unless Darci has anything you want to add?

At this time if anyone would like to ask a question, please press * and then the number 1 your telephone keypad. Press * and then the number 1 on your telephone keypad if you.d like to ask a question. And there are no questions in queue at this time.

Okay, here is a question from the chat box.

Question: Can I order multiple copies of the blueprint? I.d like to distribute to partners.

Well as Godfrey intimated, if you go to the Think Cultural Health website and complete a brief registration form, you can download the entirety of the blueprint or specific standards depending on what your organization is most interested in, and obviously you can print multiple copies for distribution amongst your organization. So hopefully that can help with that individual.s question. But we have the web-based version for those who are interested in bookmarking on your computer for easy access that way or you can print hardcopies from the website to facilitate access for multiple individuals within your organization.

We will be able to share a copy of the PowerPoint today if you care to email us at AdvancingCLAS@thinkculturalhealth.hhs.gov. We.d be happy to provide you with a PDF version of this and a copy will also be emailed to you all.

There is also an evaluation for this webinar. If you fill out the survey, please click on the link that is to be posted in the chat box and send in your feedback regarding your experience on this webinar. The link will be available for approximately 10 minutes and the link is up now.

So yes you will receive copies of the PowerPoint and copies of the blueprint is available both in web and PDF form from the Think Cultural Health website.

Do we have any additional question?

We do have a question Ms. Graves.

This is Gerald Verley at the UMKC. My question for you is that what do we have available for us the benchmark, how we.re doing as we apply the standards?

You mean as you go from point to point, you mean is there are tool to help you benchmark this?

Yeah or is there a best practice or an organization that demonstrates best practice or.?

Well there are several organizations that are implementing the CLAS standards now. And one of the things that we want to do and are doing in fact is beginning to have an evaluation protocol that will help us understand better how those different organizations are implemented in CLAS and indeed the best practices that come out of that. So that will become available and it will be available for people like yourself to use in whatever fashion you choose to, even in terms of looking at how they did it or learning from the lessons they learned from implementation.

Okay, thank you.

Sure.

And that was our last question

Okay.

Is there anymore on this?

No.

Okay, well it's been wonderful speaking to you.

If questions occur to you at a later time, please do not hesitate to email us at the AdvancingCLAS email address. It certainly has been a pleasure speaking with you all today.

[Another question came in from the phone line from Herman Edwards but there was no sound from the caller and the call was released by the operator.]

We also received another question in the chat box about providing navigators and assistors practical tips for using these in their outreach efforts.

I think where I would recommend starting is one, figuring out who is exactly in your communities that you.re trying to target, connecting with possible leaders in those areas, partnering with other organizations in your communities whether that be school districts or churches, synagogues, and the like, and working with them to establish that trust, to establish that relationship to make sure that your messages are being handled and received in appropriate channels.

Look for distribution channels that touch on a variety of communication needs and community needs, so whether that be .Minority-run. newspapers or radio stations that are done in multiple languages. Finding out how those communities receive their information, how do you find them and how do they find you, and how do they know that you are a trustworthy organization. So really making sure that you.ve established those rapports, making sure that the navigators and assistors have the appropriate training.

And I would add, understanding the needs of the communities that you are outreaching to. It.s really within the CLAS standards, especially in the accountability standards, you.ll find guides to help you establish what types of information that you need to collect, what types of information that you need to share, and what kind of communication you need to have with those in the community who you need to be outreaching to and with whom you need to be communicating.

The more credibility that you can establish in terms of showing a sincere interest in the needs of the community I think, the better the services you can provide will be and the more responsive the community will be to the services that you provide.

Yeah. So thank you very much for that question.

We.ve received another question on whether it would be feasible to connect University Research Centers with OMH to ensure that CLAS is implemented in research which often includes health measurements and health protocol.

Yes indeed. That.s exactly one of the things we want to establish and its part of our implementation initiative. Now I.m not claiming that it has been established but I am saying that we have every intention of pursuing that. In fact, we have a couple of Universities already that have shown interest in doing just that, not only with our CLAS standards but with some of the curricula that are also available on our website, specifically the physicians curriculum and also oral health curriculum, I know health academic centers are already working with us in terms of doing some implementation issues.

So I.m rather excited about that possibility and the extent to which we would be able to get this into the curricula of these medical and dental and other health care organizations or institutions.

I would add to that a number of HHS organizations or agencies that fall under the umbrella of Department of Health and Human Services or HHS, are beginning to include CLAS in their request for proposals, in their granting applications, in their funding opportunities. So, most the time or many of the times that a Federal grant application or a Federal request for proposals is calling for inclusion of either the National CLAS Standards or for the representation or inclusion of culturally and linguistically appropriate services. The National CLAS Standards are an absolute viable tool to show how you.re implementing CLAS or how you.re meeting the requirements within that grant application or within your reporting effort on and for that grant.

And I think that.s a growing trend. You.re going to see more and more requirements to include or to be not just committed but actually implementing CLAS in the programs that are being applied for funding in the grant programs that the Federal Government funds, that HHS funds more specifically.

Well look, I don.t know how we might be able to do this but I really would be keenly interested in hearing from any of you as to how these tools or systems, if it.s possible to gauge this, to what extent it helps you sign up more people or how many people perhaps they helped you in signing up. And I understand right now it would not be a scientific approach but sometimes these ad hoc reports can be very useful as well.

Yes. Just so you all are aware the PDF of this webinar.s slides has been shared in the chat box, so all you have to do is click on that PDF link and you will be able to save it on your desktop and have a quick and easy reference on the National CLAS Standards.

Do we have any other questions on the phone or does anyone else want to submit a question via the chat box.

Just as a reminder, please press * and the number 1 on your telephone keypad if you will like to ask a question. Press * and the number 1 on your telephone keypad. And there are no questions in queue at this time.

Okay, thank you very much.

Well, thanks everybody for participating today and good luck in the months ahead.

Yes, good luck with the enrolment or whatever your organization.s mission is. We hope that you find the National CLAS Standards a rich and reliable tool that you can use to improve regardless of your organization.s mission to improve the culturally and linguistically appropriateness of the care and services that you provide.

Again, please do not forget to fill out your survey for this webinar. The link appears a couple of times in the webinar.s chat box. The PDF of the slides is available for download in the chat box. And if you have any additional questions, please feel free to email either Godfrey or I at AdvancingCLAS@thinkculturalhealth.hhs.gov or to reference any other resources including the National CLAS Standards that we talked about today during the presentation. Please visit the website www.thinkculturalhealth.hhs.gov.

Thank you again for spending this hour with us and enjoy the remainder of your day. Thank you so much.

Goodbye everybody