Hello, my name is Crystal Barksdale, and I.m a senior research analyst in the Health Determinants and Disparities Practice at SRA, International. I.m glad to be with you today to talk about culturally and linguistically appropriate services in oral health, and one of the newest resources on the U.S. Health and Human Services. Office of Minority Health.s Think Cultural Health website designed specifically for oral health professionals, called the Cultural Competency Program for Oral Health Professionals.

Today we are going to be talking about What are culturally and linguistically appropriate services (CLAS) and the National CLAS Standards? The Cultural Competency Program for Oral Health Professionals E-learning Program, and The Cultural Competency Program for Oral Health Professionals Small Group Program. And then I.ll talk a little bit about Think Cultural Health.

The HHS Office of Minority Health works to improve the health of minority populations through the development of health policies and programs that will eliminate health disparities. As you may know, there is a significant body of research that documents the persistent and widespread disparities experienced by many communities in our nation. The Secretary for Health and Human Services has noted that .minorities and low income Americans are more likely to be sick and less likely to get the care they need.. The Office of Minority Health has several important cultural and linguistic competency initiatives to help address these disparities, including Think Cultural Health and the National CLAS Standards.

So, first, let.s talk a bit about CLAS, or culturally and linguistically appropriate services.

What is CLAS? Services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs and employed by all members of an organization (regardless of size) at every point of contact.

CLAS is just another way to think about cultural and linguistic competency. When we talk about CLAS and cultural and linguistic competency, we are talking about the same concepts and strategies. It.s important to note that every oral health care encounter is a cross-cultural interaction: you should consider not only your patients. culture, but also your own culture and the culture of your workplace. Keep this in mind as you seek to respond effectively to the oral health needs of diverse communities in your service area.

When we talk about responsive care, we mean that the care and services you deliver should take your patient.s cultural beliefs, communication and language preferences, health and oral health literacy, and other needs into account.

And what do we mean by .CLAS at every point of contact?. We are emphasizing the point that cultural and linguistic appropriateness does not simply start and end during the first face-to-face clinical encounter . it is necessary at every point of patient contact, from the scheduling of the first appointment to soliciting and receiving patient feedback.

I wonder out there. Has anyone heard of the National CLAS Standards? If not, lets talk a little but about them.

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care from the HHS Office of Minority Health are a set of recommend action steps that help health and health care organizations and providers, deliver services and care that are effective, equitable, understandable, and respectful to those served.

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. The Standards were then re-published in 2013 following a public comment period, a literature review, and ongoing consultations with an advisory committee comprised of 36 subject matter experts, including several interpreters and other language assistance experts. Since the Standards. development, there have been many advancements in the fields of health equity and cultural and linguistic competency, including the Surgeon General.s Report on Oral Health.

The National CLAS Standards offer a blueprint for providing effective, understandable, and respectful services at every point of contact . from the time the patient schedules his or her first appointment, to follow up and routine care.

There are 15 Standards, organized under a principal standard and three themes: The Principal Standard frames the essential goal of all of the Standards. Conceptually, if the other 14 Standards are adopted, implemented, and maintained, then the Principal Standard will be achieved. (Note: the Principal Standard reads: 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). Let.s talk briefly, about each theme.

Theme 1 is Governance, Leadership, and Workforce, which was previously Culturally Competent Care, provides greater clarity on the specific locus of action for these Standards. This theme emphasizes that implementing CLAS is the 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, comes from the bottom up. However, it is the organization.s leadership that shapes the culture of the organization through its priorities, expectations, and the behaviors that it models. Therefore, the impetus for implementing CLAS should also come from the top down.

Theme 2, Communication and Language Assistance (previously Language Access Services) broadens the understanding and application of appropriate services to include all communication needs and services, including sign language, braille, oral interpretation, and written translation. The standards in this theme will help organizations comply with requirements such as Title VI of the Civil Rights Act of 1964; the Americans with Disabilities Act of 1990; and other relevant federal, state, and local requirements to which they may need to adhere.

Theme 3 is, Engagement, Continuous Improvement, and Accountability (instead of Organizational Supports, which is what it was previously called). 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 supports necessary for adoption, implementation, and maintenance of culturally and linguistically appropriate policies and services regardless of one.s role within an organization or practice. Again, all individuals are accountable for upholding the values and intent of the National CLAS Standards.

So, what is the purpose of the enhanced National CLAS Standards? The purpose of the National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities. The Standards establish a blueprint for health and health care organizations to implement and provide culturally and linguistically appropriate services.

So, briefly. Why does CLAS matter?

Here you see two quotes, once from Dr. Martin Luther King Jr. and one from the Former Secretary of U.S. Department of Health and Human Services, illustrating the importance of CLAS. The combined cost of health inequalities and premature death in the U.S., a couple of years ago was estimated at approximately $1.24 trillion. Eliminating health disparities for minorities would have reduced direct medical care expenditures by $229 billion in 2003 and 2006.

More directly related to oral health, the Former Assistant Secretary for Health noted that .There is a silent epidemic of dental and oral diseases that burden millions of children and adults.. And Former Surgeon General, Dr. David Satcher, noted, ..There are profound and consequential disparities in the oral health of our citizens.. This is why CLAS matters.

We also note CLAS matters because of the changing and projected changes in demographics in this country. I am sure we have all heard that by 2050 those racial and ethnic groups that are now considered .minorities. will become the majority in terms of population size. In many states and the District of Columbia, this has already happened.

CLAS matters, especially in oral health, because of its potential to help reduce oral health disparities. Such disparities not only affect patient.s quality of life, but also have more significant and fatal implications. For example, the case of Deamonte Driver, in Maryland, illustrate the need for CLAS in oral health care to help improve access to quality oral health care among vulnerable and undeserved populations.

Deamonte was 12-year old boy that died in 2007. Reportedly, he had an abscessed tooth . the bacteria from the tooth traveled to his brain, causing him to become sick, require 2 brain surgeries, and ultimately, die. It is suggested that an $80 procedure . extracting the damaged tooth, could have saved him. Deamonte died because of the numerous barriers to dental care often faced by vulnerable and underserved populations (which is low-income populations, racial and ethnic minorities). These barriers include:

Lack of dental insurance

Lapses in coverage

Poor communication between patient and provider, and

Lack of providers accepting Medicaid

According to the Kaiser Family Foundation, tooth decay is the most common chronic illness among school-aged children across the country, and racial and ethnic children are at increased risk of having elevated decay. Deamonte is not the only victim . Kyle Willis, a 24-year-old single father in Cincinnati, OH also died from an infection that spread to his brain, originating from a wisdom tooth that needed to be pulled. He did not have health or dental insurance, could not afford the dental procedure, nor the cost of antibiotics.

Even in the midst of financial barriers that providers may not be able to address directly, the provision of culturally and linguistically appropriate services can help providers communicate more effectively with patients about the importance of oral health care, the consequences of lack of care, and how to access care and navigate the dental system to get the help they need.

So, CLAS matters too because it helps you improve the quality of your oral health care by helping you do a number of things. First, it helps you Build trust: through trying to understand your patient.s cultural values and preferences related to oral health care, and maintaining a non-judgmental stance, you are working to develop rapport and relationship with your client that is based on mutual respect . this can help you better address your patient.s concerns and misperceptions about treatment, thus building trust in your practices.

CLAS also helps you Personalize care: by acknowledging and incorporating your patient.s values, beliefs, and preferences into care, you are better able to personalize or individualize care.

CLAS can also help you improve the quality of your health care by Improve adherence: Providing CLAS can also help reduce miscommunication between you and your patients, and those who lave low oral health literacy. In turn, by improving communication between you and your patients, you can improve the likelihood they will be more adherent to treatment recommendations.

And finally, CLAS can help you improve the quality of your oral health care by helping you Increase patient satisfaction: through establishing a more trusting relationship that provides personalized care, and one in which the patient adheres to your treatment recommendations (and thus presumably has better oral health outcomes), the patient will be more satisfied with the care provided.

So, now we turn to the Cultural Competency Program for Oral Health Professionals.

The Cultural Competency Program for Oral Health Professionals, which launched on April 17, 2014, is the first HHS Office of Minority Health e-learning program based on the enhanced, or the 2013 version of the National CLAS Standards. All program courses are informed by the enhanced National CLAS Standards.

The overall purpose of this e-learning program is to provide oral health professionals, which is dentists, dental hygienists, dental assistants, and other oral health professionals with the knowledge and skills to deliver culturally appropriate and responsive oral health care to culturally and linguistically diverse populations they serve. The e-learning program is delivered in an asynchronous format so live, real-time teaching and assistance is not available; however the eLearning program is available online 24/7, 365 days of the year.

The eLearning program is recognized by ADA CERP and is accredited through Professional Learning Services, LLC and Cine-Med. Participants who are eligible may earn 2 credits for each course completed within the eLearning program.

The Cultural Competency Program for Oral Health Professionals e-learning program is built on the premise that providing culturally and linguistically appropriate services is good for both the oral health professional and the patient. The CCPOPH was designed to help providers deliver of a higher quality of care. Through learning more about how your patients perceive oral health, oral health care, and oral health professionals; you can better figure out the best ways to address misperceptions that affect your patients. oral health care behavior and willingness to follow treatment recommendations.

The e-learning program is also meant to help you expand your patient base - you can attract new patients because you.re better able to service culturally and linguistically diverse populations. For example, by increasing the number of staff who are culturally and linguistically diverse, you can gain a positive reputation in the community. This reputation will not only attract new patients, but also encourage existing patients to return.

The eLearning program helps you decrease clinical errors. Cultural and linguistic misunderstandings between you and your patients can lead to significant clinical errors, which could be quite costly. For instance, giving your patient educational and treatment materials in his or her preferred language or using a trained interpreter during the visit can greatly reduce the possibility of misunderstandings and, therefore, errors. CLAS can also help you better respond to patients differences in oral health literacy.

And finally, the eLearning program is designed to helps providers gain essential tools to help recognize and lessen the racial and ethnic health care disparities that persist in oral health.

This slide provides you with an overview of the highlights of the Cultural Competency Program for Oral Health Professionals. The program consists of 3 courses, and in each course there is a video case study and there.s other features to enhance the learning process - such as Filling in the Gaps. box, a .Cultural Connections. box which provides additional information about different cultural and ethnic groups, and .Think About It. questions designed to help you reflect on the material.

So what, specifically, do you learn in the Cultural Competency Program for Oral Health Professionals ? This is breakdown of the three courses. The e-learning program has three Courses that cover the basics of cultural and linguistic competency, to practice management strategies that can improve cultural and linguistic appropriateness, to culturally and linguistically appropriate communication strategies. Each course designed to take approximately 2 hours.

This slide provides an overview of the learning objectives of Course 1. The primary goal of Course 1 is to orient the user to the concepts of culture, cultural and linguistic competency, and CLAS. The secondary goal is to establish the context for why this is important in oral health care . done through discussing the benefits, disparities, and barriers to care.

Course 2: Culturally and Linguistically Appropriate Oral Health Practice Management, provides the user with tools and information to help, again, thinking about what culturally and linguistically appropriate services would look like in his or her practice environment. Practice management strategies are provided to assist the user in the initial process of providing CLAS and to describe more advanced options to pursue to establish a practice environment that is culturally and linguistically appropriate.

And finally, Course 3: Communication and Messaging in the Dental Chair, provides the user with specific communication practices that are culturally and linguistically appropriate. The secondary goal of this course is to help the user understand the fundamental role communication plays in providing culturally and linguistically appropriate services.

As I mentioned before, each Course, in the Cultural Competency Program for Oral Health Professionals eLearning program, has a video case study that is meant to reinforce some of the major concepts introduced in each Course. Here you see a screenshot of what the Video Case Study page looks like.

In addition to the e-learning program, we recently released The Cultural Competency Program for Oral Health Professionals Small Group Program! The Small Group Program offers users an opportunity to complete the CCPOHP in an in person, small group format, while still earning up to 6 continuing education credits (or 2 credits per course completed).

The small groups are led by users who have completed the Cultural Competency Program for Oral Health Professionals and additional brief training on facilitation, to become CCPOHP Small Group Facilitators! Anyone who completes the Cultural Competency Program for Oral Health Professionals eLearning program can become a CCPOHP Small Group Facilitator! Please Contact us for more information about this option!

So, now I want to tell you a bit about Think Cultural Health and where The Cultural Competency Program for Oral Health Professionals is housed. Think Cultural Health is a flagship initiative of OMH, that offers free e-learning continuing education programs, resources, and other tools to promote cultural and linguistic competency in health care. The Cultural Competency Program for Oral Health Professionals joins an existing suite of e-learning programs.

Other programs are targeted to Physicians, Nurses, and Disaster Personnel. You can find The Cultural Competency Program for Oral Health Professionals eLearning program at ThinkCulturalHealth.HHS.Gov, and click Continuing Education.

I would like to acknowledge the contributions of all those who have worked on this project and The Cultural Competency Program for Oral Health Professionals.