Cultural competency

2013

VAFCC & VRHA

Joint Conference

Valerie McAllister

CLAS Specialist

Office of Minority Health and Health Equity

Workshop Objectives

• Enhance participant’s awareness of the best practices

in providing culturally appropriate services to Virginia’s

increasingly diverse communities

• Increase participant’s knowledge of laws that drive

services to the limited English proficient (LEP)

population

• Provide resources to assist participants in working more

efficiently and effectively across cultures

2

Did You Know?

Virginia trends...between 1990 – 2006

the Asian population more than doubled

the Hispanic population almost tripled

between 2000 - 2006

Virginia health districts served patients who spoke nearly 100 different languages in 2008.

During 2008 VDH utilized the language translation service for 11,338 calls.

3

Commonwealth of Virginia

Racial / Ethnic Distribution

in Virginia 2009

69.69

19.67

0.34

4.86

0.07

2.78

2.59

White Black American Indians Asian

Native Hawaiian Some Other Race Two or More Races

4

LEP’s Effect on Health Care

Without effective language services, patients with limited English proficiency:

• May have less access to primary care

• May be less likely to receive follow-up appointments after Emergency Department visits

• May be less likely to understand their diagnoses, medications, and follow-up instructions

• May be less satisfied with care received

• May not receive equivalent levels of preventive care

5

Effective Health Communication—

Not Just for Clinicians Understanding and delivering effective health communication is the charge of all health care professionals from all parts of your organization

•Dentist

•Physicians

•Nurses

•Direct Service

•Social Workers

•Front-Office

•Patient Relations

•Billing

•Pharmacists

•Medical Interpreter

Each individual involved in a health care encounter is a key player in ensuring that information is not only delivered to the patient, but is understood by the patient.

6

Unified Health Communication:

Like a Three-Legged Stool

• Unified health communication is the seat of the stool, and health literacy, cultural competency, and LEP are the legs.

7

The Importance of Health

Communication

8

Communication Resources

for LEP Individuals Individuals Right to Know

Interpreting

Translation

Assistive Technology/Communication Tools

Signage

Way-Finding (Navigation)

Community Involvement

Training

9

Civil Rights Act of 1964

• Applies to federally funded institutions or programs

through direct or indirect funds

• Prohibits discrimination based on race, color, or

national origin

• Ensures equal access to services and benefits

10

Regulatory Requirements and Compliance

Standards

• Title VI Civil Rights Act of 1964

• National CLAS Standards for Health and Health

Care, 2012

11

To Whom Does Title VI Apply?

“Covered entities” include all recipients of federal

financial assistance through:

• Grants

• Loans

• Contracts

• Training

• Use or donation of equipment or property

• Indirectly through state agencies, county agencies,

private agencies

12

Title VI of the Civil Rights Act of 1964

Recipients of federal financial assistance shall not:

• Deny an individual a service, aid, or benefit

• Provide a benefit, etc. which is different or provided in

a different manner

• Subject an individual to segregation or special

treatment

13

Executive Order 13166

Title VI

Civil Rights Act of 1964 • Ensures access to interpreting services free of charge

• Discourages use of family, friends, minors as

interpreters

• Stresses the importance of language testing and trained

interpreters

14

HHS LEP Policy Guide

• Clarifies the principles of Title VI with respect to LEP

persons

• Details reasonable policies and procedures to ensure

meaningful access to services

• Copies are available on OCR’s website:

www.hhs.gov/ocr

15

National CLAS Standards

Purpose

• Advance Health Equity

• Improve Quality

• Eliminate Health Care Disparities

Themes

• Principal Standard

• Governance, Leadership, and Workforce

• Communication and Language Assistance

• Engagement, Continuous Improvement and

Accountability

16

What are Culturally and

Linguistically Appropriate

Services?

17

Who Are Our Consumers?

• Economically disadvantaged

• Limited language competence

• Racial and ethnic minority

• Cultural isolation

• Geographic isolation

• Disability

• Age vulnerability

18

The Risks of Using Untrained

Interpreters

• Unknown language competency

• No orientation to medical interpretation

• No or little knowledge of medical terminology

• Previous relationship with patient

• Relationship with patient could compromise the quality of the session

19

Maintaining Control of the

Encounter

The provider can do a lot to enhance the quality of the session:

•Empower the Patient

•Greeting in Native Language

•Body language

•Casual Conversation

•Eye Contact (When appropriate)

•Remember that everything said is interpreted

20

Maintaining Control of the

Encounter

Ask questions directly to your patient

Ask open ended questions

Speak about one problem or symptom at a time

Avoid using slang or idioms

“Up and at ‘em”

“I’m feeling under the weather”

“Barking up the wrong tree”

“Up the creek without a paddle”

“A tough nut to crack”

21

Children as Interpreters

• Imbalance of power

• Lack of Maturity

• Lack of Language Proficiency

• Uncomfortable role

• Negates confidentiality

22

Programs and Services Supported

Through CLAS Funding

23

CLAS Resources

24

25

Culturally and Linguistically Appropriate

Services (CLAS) CLAS Act Website (CLASActVirginia.org)

Culturally and

linguistically

appropriate health

care information

Multicultural

health and

human

service

programs

Translated

patient

education

information

Language

Identification

Poster

Studies, data,

research

reports and

assessment

tools

Policies,

regulations

and laws

Conferences,

trainings and other

events

26

Culturally and Linguistically Appropriate

Services (CLAS) Virginia Medical Interpreter Collaborative (VMIC)

VMIC: A collaboration of

community partners

passionate about

meeting the needs of

the limited English

proficient (LEP)

community

www.vmicn.org

27

Culturally and Linguistically Appropriate

Services (CLAS) Virginia Medical Interpreter Database (VMID)

Virginia Medical Interpreter Database (VMID)

• Database of trained Medical Interpreters in Virginia

• An avenue for trained Medical Interpreters to offer their skills

• Links to culturally and linguistically appropriate resources

28

VDH CLAS Initiatives

Navigating the U.S.

Heath Care System

The Language

Identification Poster

29

The Navigating Toolkit is Available in

4 Languages

30

2010 Virginia Language Needs Assessment

31

Identifying Your Patient’s

Language

You can’t provide language assistance to your patients

with LEP until you know what language they speak

32

VDH Health Districts

33

Health Equity & Culturally Appropriate

Health Training Series

34

OMHHE

As you can see Culturally and Linguistically Appropriate Services

is a link that connects all that we do!

35

For More Information, Contact:

Valerie McAllister

Office of Minority Health and Health Equity

Division of Multicultural Health & Community

Engagement

CLAS Specialist

http://www.vdh.virginia.gov/healthpolicy/index.

htm

valerie.mcallister@vdh.virginia.gov

(804) 864-7437

36

Questions

37