Cultural and Linguistic Competency Toolkit - Family PACT

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCultural andLinguisticCompetency ToolkitPrepared by California Family Health Council forCalifornia Department of Health Care ServicesOffice of Family Planning underContract #08-85547Copyright 2007, Rev. 2009, 2012

ContentsIntroduction 4Preface 5Overview 7Definition of Cultural andLinguistic Competence 11Cultural andLinguistic CompetencySelf-Assessment Survey 14Instructions for Administering theSelf-Assessment Survey 15Sample Letter to Staff 20Self-Assessment Survey 21Self-Assessment Survey in Spanish 27Tally Sheet 33Score Sheet 35Understanding Your Results 36Recording Your Results 37Understanding Your Scores 48Developing a Strategic Plan 55Strategies for Improving Training and Staff Development 56Strategies for Improving Agency Capacity 59Strategies for Improving Health Education of Clients 61Strategies for Improving Administrative Issues 63Using the Strategic Plan Form 65Resources 70Cultural Competency 71Health Literacy 74Interpretation in the Health Care Setting 79Outreach and Access 83

IntroductionThis Toolkit on Cultural and Linguistic Competency wasespecially designed for Family PACT providers. Takeadvantage of its easy-to-use assessment tool and its helpfulresources.This introductory section highlights:• An Overview of the Toolkit Contents• A Definition of Cultural and Linguistic Competence

PrefaceThe California Department of Public Health, Office of FamilyPlanning, is providing the Cultural and Linguistic CompetencyToolkit to all Family PACT providers in an effort to assist them inmeeting the Cultural and Linguistic Competence standards listedin the Family PACT Policies, Procedures, and Billing Instructions(PPBI) manual.It reads:PPBI Standard C. Cultural and LinguisticCompetence (PPBI, Page 9.3)1. All services shall be provided in a culturally sensitive manner andcommunicated in a language understood by the client.2. All print and audiovisual materials shall be appropriate for theclient’s language and literacy level.This Toolkit is made up of several components:• Overview. This explains the purpose of the Toolkit and itscomponents.• Definition of Cultural and Linguistic Competence.This definition was created specifically for Family PACTproviders and includes standards for providing culturallyand linguistically competent care.• Instructions for Administering the Self-AssessmentSurvey. This section will help staff administrating thesurvey understand how to administer, compile, analyze,and use the results of the survey to improve the health careservices provided to their clients.Survey. This survey could be administered to all staffworking in a Family PACT provider’s office or agency.• Cultural and Linguistic Competency Self-AssessmentOFP CONTRACT 08-85547PREPARED BY CFHC© 20125

PREFACE• Understanding Your Results. This comprehensivedescription will help agencies analyze the results of the selfassessmentprocess.• Developing a Strategic Plan. This section provideshelpful strategies Family PACT providers can useto improve cultural and linguistic competence bothindividually and organizationally.• Resources. This section of the Toolkit provides a wealthof books, resources, tools, and websites to complementFamily PACT providers’ efforts in this area.By administering the survey and analyzing its results, FamilyPACT providers and their agencies will be able to assess how wellprepared they are in responding to the cultural and linguistic needsof the clients they serve.This Toolkit is designed as an in-house tool to enable FamilyPACT providers to:• Assess the degree to which their agency meets the standardsand requirements of the Family PACT program.• Plan and implement training and support for staff to bettermeet the reproductive health care needs of the clientsserved.• Comply with the Federal Cultural & Linguistic AppropriateServices (CLAS) Standards.The Cultural and Linguistic Competency Self-Assessment Surveyitself is simple yet comprehensive. Its development was informedby the Federal Cultural & Linguistic Appropriate Services (CLAS)Standards to provide agencies with a means of adhering to thesenational standards. The questions are easy to understand andto answer. Using the strategies and resources provided with thisToolkit, Family PACT providers will be able to quickly analyze theresults and develop a strategic plan for improving their services.Family PACT providers can visit the website at www.familypact.org to obtain other resources and tools to assist them in theirefforts to assess their competencies in this area and to develop astrategic plan.OFP CONTRACT 08-85547PREPARED BY CFHC© 20126

OverviewThis Toolkit includes several components that you, as a FamilyPACT provider, are sure to find useful.Definition of Cultural and Linguistic CompetenceThe perfect place to start, this section explains exactly what theFamily PACT program encourages Family PACT providers to doin order to enhance the services they provide. Becoming culturallyand linguistically competent is a win-win proposition.• If your clients find your services more respectful andhonoring of their health beliefs and values, they will feelmore comfortable. These clients will return for services andrecommend them to others in their community.• Your communication with your clients will improve andyou will begin to see better health outcomes and greateradherence to your medical advice.• Your agency will become more accessible to new FamilyPACT clients.Instructions for Administering Self-AssessmentSurveyThis section provides step-by step instructions on how toadminister the Self-Assessment Survey.• The results of this survey are for your internal use only.• The survey results are completely anonymous andconfidential.• Your agency staff will determine how to use the results.OFP CONTRACT 08-85547PREPARED BY CFHC© 20127

OVERVIEW• The results do not need to be reported to Family PACT.Cultural and Linguistic CompetencySelf-Assessment Survey for Family PACT ProvidersThis easy-to-use survey was designed to be filled out by all staffmembers of a Family PACT office or agency. The administrator ofthe survey should:• Copy enough surveys for the staff participating in thesurvey.• Distribute the survey at a staff meeting or other forum.• Allow staff to complete and return the form anonymously.• Compile and analyze the data and present the results at astaff meeting.• Create a strategic plan for improvement.Tip : The survey can be adapted to an online format that staff cancomplete online. You can provide staff with access to a computer,work time to fill it out, and a private space to ensure anonymity.Understanding Your ResultsThis section explains step by step how to analyze your results. Itwill help you:• Compile and analyze survey results.• Prioritize needed changes.OFP CONTRACT 08-85547PREPARED BY CFHC© 20128

OVERVIEWDeveloping a Strategic PlanThis helpful section outlines possible strategies you can use increating a plan to improve the cultural and linguistic competencyof your staff and the way your agency functions. Use this sectionto:• Identify practical activities for reaching your objectives.• Create a strategic plan for enhancing the way you serve yourclients.• Identify and modify existing policies that address yourproposed activities, or create new ones to assist you incarrying out these activities.OFP CONTRACT 08-85547PREPARED BY CFHC© 20129

OVERVIEWResourcesThis section provides a wealth of resources you can use to improvethe way your office or agency provides culturally and linguisticallycompetent services. Featured are resources that can help youragency:• Enhance cultural competency training and staffdevelopment.• Learn more about health literacy and how to assess andupgrade health education for your clients.• Find ways to work with interpreters more effectively in yoursetting.• Improve outreach strategies for your agency.OFP CONTRACT 08-85547PREPARED BY CFHC© 201210

Definition of Cultural andLinguistic CompetenceCultural and linguistic competence is the ability of FamilyPACT providers to understand and respond effectively to thecultural and linguistic needs brought to the health care encounterby the clients, providers, and the organization. Cultural andlinguistic competence requires recognizing and addressing clients’behaviors, values, practices, attitudes, and beliefs as they affecttheir reproductive health care. Being culturally and linguisticallycompetent will lead to improved communication betweenproviders and clients who may be from different ethnic andcultural backgrounds.To demonstrate continual progress, Family PACT providers areencouraged to:• Ensure services received from staff are in a mannercompatible with clients’ cultural beliefs, practices, andpreferred language.• Pursue continuous expansion of individual culturalknowledge and resources.• Recruit staff and board members who reflect the clientpopulation served.• Support ongoing cultural competency training forall staff (front office, clinical staff, management, andadministration) and board members.• Offer and provide language assistance services, includingbilingual staff and interpreter services, at no cost to clientswith Limited English Proficiency.Family PACT providers should also:• Provide easy-to-read client education materials in thelanguages of the clients served.OFP CONTRACT 08-85547PREPARED BY CFHC© 201211

DEFINITION OF CULTURAL ANDLINGUISTIC COMPETENCE• Provide a client-friendly front office with signage posted inthe languages commonly served by the practice.• Develop collaborative partnerships with agencies thatadvocate for and represent the diverse populations in one’scommunity.• Develop a strategic plan that includes activities to enhancethe organization’s commitment to responding effectively tothe cultural and linguistic needs of the population served.Here are some operating assumptions about “culture”:• The word “culture” denotes a group’s patterns of behavior,values, norms, and practices.• Culture is dynamic in that it continually changes.Therefore, staff knowledge and skills in communicatingwith clients of different cultural groups should be addressedon an ongoing basis.• In this document, the term “culture” is not limited todifferent ethnic and racial groups. It is inclusive of othertypes of cultural groupings by religion, sexual orientation,age, disability, and socio-economic status. For example,teens may be considered a cultural group with differenthealth needs than that of adults or children.• The cultural make-up of the clients served by Family PACTproviders also changes continually due to immigrationtrends, levels of acculturation and assimilation, as well asother factors. For example, the length of time clients havelived in the same region, as well as when they immigrated,may affect their health beliefs and practices.Here are two ways to look at cultural and linguistic competence:• Individual cultural and linguistic competence describesthe ability of individual providers and staff to applytheir knowledge of cultural behavior and language wheninteracting with clients from diverse backgrounds.• Organizational cultural and linguistic competence is theway in which the agency makes its services, programs, andOFP CONTRACT 08-85547PREPARED BY CFHC© 201212

DEFINITION OF CULTURAL ANDLINGUISTIC COMPETENCEresources accessible to all clients regardless of their linguisticability and cultural background.In order for Family PACT providers to be effective in workingwithin a culturally diverse community, they need to:• Assess how well all of their agency’s systems, programs,services and resources, staff members, and administratorsmeet the needs of the communities they serve.• Ensure that verbal and written communications areprovided in plain, everyday language that most people canunderstand. This is true no matter what language is used.It is recognized that most people do not understand thetechnical jargon often used by health care professionals andthat it is incumbent on health professionals to speak in away that is easy to comprehend and that builds on a clients’life experiences.• Provide written materials at the 5th grade level or less. Theinformation in an educational material should be providedat a reading level the majority of the client population canread and understand. Research on literacy in the UnitedStates suggests a reading level at the 5th grade or below isthe most appropriate for the general population.Increased cultural and linguistic competence (both individual andorganizational) will improve health care access and service deliveryfor all clients.OFP CONTRACT 08-85547PREPARED BY CFHC© 201213

Cultural andLinguistic CompetencySelf-Assessment SurveyThis Self-Assessment Survey was designed especially forFamily PACT providers. In this section you will find:• Instructions for Administering the Survey• Self-Assessment Survey• Tally Sheet• Score Sheet• Administering the Survey Using Online ToolsEncourage your staff to take advantage of this opportunityto evaluate your effectiveness in this area.

Instructions for Administering theSelf-Assessment SurveyThe Cultural and Linguistic Competency Self-Assessment Surveyfor Family PACT Providers was designed to be administered to allstaff, administrators, and board members of your agency or office.In order to conduct a comprehensive assessment and develop arealistic plan for continued growth in the area of cultural andlinguistic competence, it is recommended that all staff participatein the evaluation of the services they provide to Family PACTclients. This will allow the administrator of this survey to assessthe quality of the services provided at different points of contact,as well as the services provided by different individuals. Eachindividual will bring a different perspective to this process basedon his or her own personal cultural background, and his or herown professional interaction with clients and other staff.The self-assessment process and the analysis should ideally beanonymous and confidential. If you ensure staff anonymityand confidentiality, staff will be more inclined to be honest andforthcoming. This in turn will allow you, the administrator of thesurvey, to better assess your agency’s ability to provide culturallyand linguistically competent services to your diverse clients. Itwill also provide you with the information you need to develop arealistic plan for enhancing these services.The survey tool is divided into four content sections along with afew basic questions about the staff and the client populations youragency serves. The four content sections include:Section One:Section Two:Training and staff development on culturaland linguistic competencyYour agency’s experience and capacityto provide culturally and linguisticallycompetent servicesOFP CONTRACT 08-85547PREPARED BY CFHC© 201215

INSTRUCTIONS FOR ADMINISTERING THESELF-ASSESSMENT SURVEYSection Three:Section Four:Health education materials and services youragency providesYour agency’s administrative strengths andchallengesHow to Administer the SurveyThis simple in-house survey can be completed by all staff membersof your agency. It was specifically designed to elicit your staffmembers’ personal opinions regarding the services provided byyour agency.Here are the steps we recommend for administering this selfassessmentprocess:STEP 1:STEP 2:STEP 3:Review all of the materials prior to administeringthe survey.Obtain commitment from top management andthe Board before administering the survey. Thiswill provide you with the support you will need tonot only administer the survey itself, but also toimplement your strategic plan for continued growthin the area of cultural and linguistic competence.Introduce the survey and the process at a staffmeeting to provide staff with an opportunity to askquestions. Stress the need for full participation andcomplete honesty in order to gain a realistic viewof your agency’s ability to provide culturally andlinguistically competent services.You can use any of the information provided withthis survey to support the need for this type of selfassessment.OFP CONTRACT 08-85547PREPARED BY CFHC© 201216

INSTRUCTIONS FOR ADMINISTERING THESELF-ASSESSMENT SURVEYStress anonymity and confidentiality. Let themknow that answering any of the questions isvoluntary. You should encourage staff to beforthcoming, while emphasizing that their responseswill not reflect negatively on their position or on theagency as a whole in any way. You may choose touse the “Sample Letter” included in this section as atool for you to introduce the survey to your staff.STEP 4:STEP 5:Plan how and when you will administer the survey.Remember to include a process for protectingyour staff’s anonymity and confidentiality. Makecopies of the survey. You can find a copy of thissurvey following these instructions. Or go to www.familypact.org for additional copies.Administer the survey. Remember to makeyourself available for questions staff may have whencompleting the survey.How to Compile and Analyze the ResultsSTEP 1:Decide how you want to organize the results.For example if you want to organize the resultsbased on the different job categories selected bythe participants of the survey, you will want tomake copies of the Tally and Score Sheets for eachindividual grouping. You will also want to codeall of the surveys in order to group them in a waythat will be the most helpful for you to analyze anddevelop a plan. You can find a copy of the TallySheet and Score Sheet immediately following theseinstructions. Or go to www.familypact.org foradditional copies.OFP CONTRACT 08-85547PREPARED BY CFHC© 201217

INSTRUCTIONS FOR ADMINISTERING THESELF-ASSESSMENT SURVEYSTEP 2:STEP 3:STEP 4:STEP 5:Collect the surveys and compile the responses onthe tally sheet provided with this Toolkit. A moredetailed explanation is provided in the section ofthis Toolkit entitled “Recording Your Results.”Analyze the results of the survey by reviewing youraverage score for each individual section of thesurvey.Read the section “Understanding Your Scores” toassist you in understanding the results of the survey.Develop a strategic plan for enhancing the culturaland linguistic competency of the services youprovide. Use the strategies and helpful formsprovided in the section of this Toolkit entitled“Developing a Strategic Plan.” Or you can developyour own strategies for improving the services,programs, and resources for your clients.Administering the Survey OnlineSome agencies prefer to administer the survey online rather thanon paper. Agencies with multiple sites, a large staff, or that do nothave funds allocated for data collection and analysis may find thatadministering the survey online saves time and resources. Agenciesthat do not have a computer available for staff or that do have aperson or department available for data collection and analysismay prefer the paper survey.Please consider the following as you decide if the online method isbest for your agency.• You will need to create (type in questions and answers) thesurvey yourself. The toolkit includes a sample survey, butdoes not provide an online version for your use.OFP CONTRACT 08-85547PREPARED BY CFHC© 201218

• You will need a computer with internet accessibility foryour staff to use when taking the survey.• Several online survey programs (www.surveymonkey.com or www.zoomerang.com to name a few) make theprocess relatively simple, but you will need to purchasea subscription to the service to access the data analysisfeatures.• Online surveys can be easily modified or adapted to fit youragency capacity.• Collecting responses through an online survey can make itmuch easier to conduct data analysis and store results.• To collect impartial data, online surveys have the capacityfor staff members to remain anonymous.OFP CONTRACT 08-85547PREPARED BY CFHC© 201219

Sample Letter to StaffDear [Agency Name] employee:You are being asked to fill out the attached survey on Linguistic and Cultural Competence in order to assessour agency’s practices and better serve diverse communities.Please fill out the attached survey and return it to Administration at your site by [date].The survey is anonymous. We would like to have your personal and honest opinion, so that we knowwhere we can improve.You do not need to total your answers on each page.If you have any comments or suggestions, please write them in the comments section at the end of thesurvey. Thank you very much for your opinions and your assistance improving our service to [AgencyName] patients!OFP CONTRACT 08-85547PREPARED BY CFHC© 201220

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCultural and Linguistic CompetencySelf-Assessment Survey forFamily PACT ProvidersThis self-assessment survey is for internal use of this office to help assess our efforts to provide services to our clients ina manner that accommodates their diverse cultural and linguistic needs. This is not a test. Your responses will beconfidential and will not be used to reflect negatively on you or anyone else in this office. Your participation is appreciatedas it will help us determine effective strategies for providing culturally appropriate services to our clients.Date of Survey: Site Location: Survey #:Please answer each of the questions below by placing checkmarks in the appropriate boxes.Participant Information1.How many years have you worked for this office/ provider?10 years2.What is your primary job area/ category?Front office Back office Administrative Clinical/CounselingWhat languages do you speak and/or read well? (Check all that apply.)Arabic Farsi Mandarin Tagalog3.Armenian Hindi Punjabi ThaiCambodian Hmong Russian UrduCantonese Korean Sign Language VietnameseEnglish Laotian SpanishClient InformationWhat languages do your clients use as their primary languages? (Check all that apply.)Arabic Farsi Mandarin Tagalog4.Armenian Hindi Punjabi ThaiCambodian Hmong Russian UrduCantonese Korean Sign Language VietnameseEnglish Laotian SpanishWhat social, cultural, and special-needs groups does your office serve? (Check all that apply.)5.Adolescents East Indian Lesbian, Gay,Bisexual,AfricanEast European TransgenderAmericanAsian PacificIslanderCaucasianAmericanHearingImpairedLatin/HispanicLow/NonLiterateMalesMiddle EasternNativeAmericanVision ImpairedOFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547Prepared by CFHC, 2012PREPARED BY CFHC© 2012211

Section One: Training and Staff DevelopmentFor each statement, check “Yes” or “No.” If you don’t know or the statement is notapplicable to your position, check the corresponding box.1.During the past year, I have attended at leastone in-service or training that enhanced myknowledge of the ethnic and/or cultural groupsserved by my agency.YesNo2.This past quarter, I have read at least one articlethat has expanded my knowledge of the clientpopulation we serve.YesNo3.Since my hire date, I have had at least onetraining about the various social, cultural and/orethnic issues that affect the health of the clientswe serve.YesNo4.As part of an in-service or other training, I havehad the opportunity to evaluate my own culturaland ethnic beliefs and potential biases.YesNo5.In most circumstances, I am able tocommunicate with people who are different fromme without fear or anxiety.YesNo6.In the past, I have attended training about how tobetter serve clients who are culturally andethnically different from me.YesNo7.8.9.10.I have been trained in how to properly work withan interpreter while maintaining my client’sconfidentiality.Our agency has books, videos, lists of websitesand other resources that staff can use toenhance our knowledge and understanding ofthe clients we serve.In the past year, our agency has conducted atleast one staff training in the area of culturalcompetence.In the last six months, our agency hassponsored at least one activity that has helpedimprove communication and teamwork betweenemployees of different cultural, language, andethnic groups.Yes No N/AYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowCount the number of checked boxes in eachcolumn and enter the total here.Section One SubtotalOFP CONTRACT 08-85547OFP PREPARED Contract 08-85547 BY CFHCFY2011-2012 © 2012Prepared by CFHC, 2012222

Section Two: Agency CapacitiesFor each statement check “Yes” or “No.” If you don’t know or the statement is not applicableto your position, check the corresponding box.11.12.13.14.15.16.17.18.19.20.At our agency, we use a posted sign to identifythe different languages used by our clients.We have trained interpreters easily available forvarious languages, including sign language.As an agency, we have established connectionswith various community cultural, ethnic, andreligious groups to help us better serve ourclients.Our agency has developed a list of variouscommunity resources we can use for referrals tobetter serve clients of various cultural groups.The décor and magazines in our waiting roomreflect the diversity of our client population.The signs in our clinic are in the languages ofthe population groups we serve.Our agency has the capacity to meet the needsof clients who are hearing or visually impaired.Our agency shows its commitment to meetingthe needs of adolescents by using peerproviders or educators, offering hours thataccommodate teens' needs and/or creating ateen-friendly environment.Our agency demonstrates its accessibility andwillingness to help meet the needs of our clientpopulation by offering evening and weekendhours.Our agency demonstrates its accessibility andwillingness to help meet the needs of our clientpopulation by finding ways to assist our clientswith transportation.Yes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowCount the number of checked boxes in eachcolumn and enter the total here.Section Two SubtotalOFP CONTRACT 08-85547OFP PREPARED Contract 08-85547 BY CFHCFY2011-2012 © 2012Prepared by CFHC, 2012233

Section Three: Health EducationFor each statement check “Yes” or “No.” If you don’t know or the statement is notapplicable to your position, check the corresponding box.21.22.23.24.25.26.27.28.29.30.Most client education materials and satisfactionsurveys used by our team are easy-to-read.Most client education materials and satisfactionsurveys used by our team are available in thedifferent languages spoken by our clients.Most intake and clinic forms (forms clients fillout) are easy-to-read.Most intake and clinic forms (forms clients fillout) are available in the different languagesspoken by our clients.Our agency obtains patient and communitymember input to help assess the usefulness andappropriateness of client education materialsused by our agency.As an agency, we evaluate the reading level ofclient materials used by our agency.Our agency has a way to assess the quality,accuracy, and cultural appropriateness of thematerials we use, including translated versions.Our agency has a way to identify those clientswith low-literacy skills who may need assistance.Our agency has identified and used appropriateresources to serve clients who are not able toread in their own language.Our agency is committed to providing healtheducation materials that appeal to the varioussocial, cultural, and special-needs groups weserve.Yes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowCount the number of checked boxes in eachcolumn and enter the total here.Section Three SubtotalOFP CONTRACT 08-85547OFP PREPARED Contract 08-85547 BY CFHCFY2011-2012 © 2012Prepared by CFHC, 2012244

Section Four: Administrative IssuesFor each statement check “Yes” or “No.” If you don’t know or the statement is not applicableto your position, check the corresponding box.31.32.33.34.35.Our agency has developed relationships withlocal schools, training programs, minority healthfairs, or faith-based organizations to recruit newstaff.Our agency consistently collects data on clientrace, ethnicity, country of origin, and spoken orwritten language in health records.Our agency has a person/position withresponsibility for implementing and monitoringcultural competence activities.We maintain an updated profile of thecommunity we serve, including diseasepatterns, demographic, and cultural information.Key staff members of our agency reflect theethnic, racial, cultural, and language diversity ofour client population.Yes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t KnowYes No Don’t Know36.Our agency’s board members reflect thediversity of our client population.YesNoDon’t Knowor N/A37.In my opinion, clinic leadership and staff showappreciation and respect for all co-workers nomatter their cultural and ethnic background.YesNo38.39.40.Our agency has a written plan to implementculturally and linguistically appropriate healthcare services.We have written policies to address concerns orcomplaints voiced by clients regarding unfair orinappropriate treatment due to their race,ethnicity, or the language they speak.Our agency annually assesses our progress inimplementing culturally and linguisticallyappropriate health care services.Yes No Don’t KnowYes No Don’t KnowYes No Don’t KnowCount the number of checked boxes in eachcolumn and enter the total here.Section Four SubtotalOFP CONTRACT 08-85547OFP PREPARED Contract 08-85547 BY CFHCFY2011-2012 © 2012Prepared by CFHC, 2012255

Comments:We appreciate your feedback. Please use the space provided to share any comments or suggestions you may have.Thank you so much for taking the time to fill out this survey!Your answers will be combined with all the other staff members who complete thesurvey. Once we analyze the results, we will use what we find out to improve thetraining of our staff and to improve the kind of care we provide to our clients.Please talk with your supervisor, if you:• Have any questions about this survey.• Have any suggestions for staff training regarding this topic.• Have ideas for improving the way our agency provides care to our clients.• Would like to learn more about cultural and linguistic competency.We truly appreciate any input you can give.OFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547Prepared PREPARED by CFHC, BY 2012 CFHC© 2012266

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCompetencia Cultural y LingüísticaEncuesta de Auto-EvaluaciónPara Proveedores de Family PACTEsta encuesta de auto-evaluación es para el uso interno de esta oficina para ayudar a evaluar nuestros esfuerzos deproporcionar servicios a nuestros clientes de una manera que se adapta a sus diversas necesidades culturales ylingüísticas. Esta no es una prueba. Sus respuestas serán confidenciales y no se usarán para calificar de maneranegativa ni a usted ni a nadie en esta oficina. Agradecemos su participación ya que nos ayudará a determinar estrategiasefectivas para proporcionar servicios culturalmente adecuados a nuestros clientes.Fecha de la encuesta: Sitio: No. de encuesta:Por favor, conteste cada una de las preguntas y marque el cuadrado correspondienteInformación del participante¿Cuántos años ha trabajado para esta oficina / proveedor?1.10 años2.3.¿Cuál es el área / categoría de su función principal?Servicio al cliente Servicio interno Administrativa Clínica/Asesoría¿Cuáles idiomas habla y/o lee bien? (Marque todos los que corresponda.)Árabe Farsi Mandarín TagaloArmenio Hindi Punyabí TailandésCamboyano Hmong Ruso UrduLenguaje deCantonésCoreanoVietnamitaseñasInglés Laosiano EspañolInformación del cliente4.5.¿Cuáles idiomas usan sus clientes como su lengua materna? (Marque todos los que corresponda.)Árabe Farsi Mandarín TagaloArmenio Hindi Punyabí TailandésCamboyano Hmong Ruso UrduLenguaje deCantonésCoreanoseñasVietnamitaInglés Laosiano Español¿A cuáles grupos sociales, culturales y de necesidades especiales sirve su oficina?(Marque todos los que corresponda.)Adolescentes Indios orientales Lesbianas,De Orientegays,MedioAfroamericanosDe Europabisexuales,IndiosOrientaltransgénero americanosIsleño delPacífico asiáticoCaucásicosamericanosConimpedimentosauditivosLatinos /HispanosNivel bajo dealfabetismo /AnalfabetaHombresConimpedimentosvisualesOFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547PreparedPREPAREDby CFHC,BY2012CFHC© 2012271

Sección Uno: Capacitación y desarrollo del personalPara cada declaración, marque “Sí” o “No.” Si no sabe, o si la declaración no corresponde a supuesto de trabajo, marque el cuadrado correspondiente.1.Durante el último año, he asistido al menos a unentrenamiento que mejoró mi conocimiento sobre losgrupos étnicos y/o culturales a los que miagencia sirve.SíNo2.En los últimos 3 meses, he leído al menos un artículoque ha aumentado mi conocimiento de lascomunidades que servimos.SíNo3.Desde la fecha en que empecé este trabajo, he tenidoal menos un entrenamiento sobre los diferentes temassociales, culturas y/o étnicos que afectan la salud delos clientes que servimos.SíNo4.Como parte de un entrenamiento, he tenido laoportunidad de evaluar mis propias creenciasculturales y étnicas, así como los prejuicios quepuedo tener.SíNo5.En la mayoría de las circunstancias, puedocomunicarme con las personas que son diferentesa mí sin miedo ni ansiedad.SíNo6.En el pasado, he asistido a entrenamientos sobrecómo servir de mejor manera a los clientes que soncultural y étnicamente diferentes de mí.SíNo7.He sido entrenado sobre cómo trabajar de maneraadecuada con un intérprete mientras mantengo laconfidencialidad de mi cliente.SíNoNocorrespondea mi puesto8.9.10.Nuestra agencia tiene libros, videos, listas de páginasweb y otros recursos que el personal puede usar paramejorar nuestro conocimiento y comprensión de losclientes a quienes servimos.En el año anterior, nuestra agencia ha realizado almenos un entrenamiento de personal en el área decompetencias culturales.En los últimos seis meses, nuestra agencia hapatrocinado al menos una actividad que ha ayudado amejorar la comunicación y el trabajo en equipo entrelos empleados de diferentes culturas, idiomas ygrupos étnicos.Sí No No séSí No No séSí No No séCount the number of checked boxes in each columnand enter the total here.Section One SubtotalOFP Contract 08-85547OFPFY2011-2012CONTRACT 08-85547PREPAREDPrepared by CFHC,BY2012CFHC© 2012282

Sección Dos: Capacidades de la AgenciaPara cada declaración, marque “Sí” o “No.” Si no sabe, o si la declaración no corresponde a supuesto de trabajo, marque el cuadrado correspondiente.11.12.13.14.15.16.17.18.19.20.En nuestra agencia, usamos un cartel para identificarlos diferentes idiomas usados por nuestros clientes.Tenemos intérpretes capacitados y disponiblesinmediatamente para los diferentes idiomas,incluyendo el lenguaje de señas.Como agencia, hemos establecido enlaces condiversos grupos culturales, étnicos y religiosos de lacomunidad para ayudarnos a servir de mejor maneraa nuestros clientes.Nuestra agencia ha desarrollado una lista de diversosrecursos comunitarios que podemos usar para servirde mejor manera a los clientes de diferentes gruposculturales.La decoración y las revistas en nuestra sala de esperareflejan la diversidad de nuestros clientes.Los señalamientos en nuestra clínica están en losidiomas de los grupos a quienes servimos.Nuestra agencia tiene la capacidad de satisfacer lasnecesidades de clientes con impedimentos auditivas yvisuales.Nuestra agencia muestra su compromiso de satisfacerlas necesidades de los jóvenes mediante el uso deproveedores o educadores jóvenes, ofreciendo horasque se adaptan a las necesidades de los jóvenes y/ola creación de un ambiente cómodo para los jóvenes.Nuestra agencia demuestra su accesibilidad y voluntadde satisfacer las necesidades de nuestros clientes alofrecer servicios durante la tarde-noche y los finesde semana.Nuestra agencia demuestra su accesibilidad y voluntadde satisfacer las necesidades de nuestros clientes alencontrar la manera de ayudarlos con su transporte.Sí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séCount the number of checked boxes in each columnand enter the total here.Section Two SubtotalOFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547PreparedPREPAREDby CFHC,BY2012CFHC© 2012293

Sección Tres: Educación de SaludPara cada declaración, marque “Sí” o “No.” Si no sabe, o si la declaración no corresponde a supuesto de trabajo, marque el cuadrado correspondiente.21.22.23.24.25.26.27.28.29.30.La mayoría de los materiales educativos para clientesy las encuestas de satisfacción usados por nuestroequipo son fáciles de leer.La mayoría de los materiales educativos para clientesy las encuestas de satisfacción usados por nuestroequipo están disponibles en los diferentes idiomashablados por nuestros clientes.La mayoría de los formularios para registrarse yformas clínicas (formas que los clientes llenan) sonfáciles de leer.La mayoría de los formularios para registrarse yformas clínicas (formas que los clientes llenan) estándisponibles en los diferentes idiomas hablados pornuestros clientes.Nuestra agencia obtiene información sobre lospacientes y miembros de la comunidad para evaluar silos materiales educativos para clientes que usamos ennuestra agencia son útiles y apropiados para ellos.Como agencia, evaluamos el nivel de lectura de losmateriales para clientes usados por nuestra agencia.Nuestra agencia tiene la manera de evaluar la calidad,precisión y adecuación cultural de de los materialesque usamos, incluyendo las versiones traducidas.Nuestra agencia tiene la manera de identificar aaquellos clientes con un nivel bajo de alfabetismo quepodrían necesitar ayuda.Nuestra agencia ha identificado y usado los recursosadecuados para servir a los clientes que no puedenleer en su propio idioma.Nuestra agencia está comprometida a proporcionarmateriales educativos de salud atractivos para losdiferentes grupos sociales, culturales y connecesidades especiales a quienes servimos.Sí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séSí No No séCount the number of checked boxes in each columnand enter the total here.Section Three SubtotalOFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547PreparedPREPAREDby CFHC,BY2012CFHC© 2012304

Sección Cuatro: Temas AdministrativosPara cada declaración, marque “Sí” o “No.” Si no sabe, o si la declaración no corresponde a supuesto de trabjo, marque el cuadrado correspondiente.31.32.33.34.35.Nuestra agencia ha desarrollado relaciones conescuelas locales, programas de entrenamiento, feriasde salud para minorías, u organizaciones religiosaspara contratar nuevos empleados.Nuestra agencia siempre recoge datos sobre el clientesobre la raza, origen étnico, nacionalidad, e idiomashablados o escritos.Nuestra agencia tiene una persona/un puesto con laresponsabilidad de aplicar y supervisar las actividadesde competencias culturales.Mantenemos un perfil actualizado de la comunidad queservimos, incluyendo patrones de enfermedades ydemográficos, e información cultural.El personal clave de nuestra agencia refleja ladiversidad étnica, racial, cultural y lingüística denuestros clientes.Sí No No séSí No No séSí No No séSí No No séSí No No sé36.Los miembros de la junta directiva de nuestra agenciareflejan la diversidad de nuestros clientes.SíNoNo sé o nocorresponde37.En mi opinión, los directores y el personal de la clínicamuestran agradecimiento y respeto hacia todos loscompañeros de trabajo, sin importar sus raícesculturales y étnicas.SíNo38.39.40.Nuestra agencia tiene un plan escrito paraimplementar servicios de salud cultural ylingüísticamente adecuados.Tenemos políticas por escrito para abordar laspreocupaciones o quejas expresadas por los clientesrespecto a un trato injusto o inadecuado debido a suraza, origen étnico o al idioma que hablan.Cada año, nuestra agencia evalúa nuestro progreso enla implementación de servicios de salud que soncultural y lingüísticamente adecuados.Sí No No séSí No No séSí No No séCount the number of checked boxes in each columnand enter the total here.Section Four SubtotalOFP Contract 08-85547OFPFY2011-2012CONTRACT 08-85547PREPAREDPrepared by CFHC,BY2012CFHC© 2012315

Comentarios:Agradecemos sus comentarios. Favor de usar el espacio proporcionado para compartir cualquier comentario osugerencia que pueda tener.¡Muchas gracias por tomarse el tiempo para llenar esta encuesta!Sus respuestas se combinarán con las de los otros empleados que llenen elcuestionario. Una vez que analicemos los resultados, usaremos la informaciónobtenida para mejorar la capacitación de nuestro personal y para mejorar el tipode atención que brindamos a nuestros clientes.Favor de hablar con su supervisor si:• Tiene alguna pregunta sobre esta encuesta.• Tiene alguna sugerencia para el entrenamiento de personal sobre estetema.• Tiene ideas para mejorar la manera en que nuestra agencia brindaatención a nuestros clientes.• Le gustaría aprender más sobre las competencias culturales y lingüísticas.Agradecemos sinceramente cualquier opinión que puede darnos.OFP Contract 08-85547FY2011-2012OFP CONTRACT 08-85547PreparedPREPAREDby CFHC,BY2012CFHC© 2012326

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCultural and Linguistic CompetencySelf-Assessment SurveyTALLY SHEETTally Sheet Number:Assessment Date: Site: #Tally Sheet Total:Years: 10 yrsJob Category: Front Office Back Office Admin ClinicalSurvey #1234567891011121314151617181920Add the subtotals persection and enter here.Then transfer to ScoreSheet.Section TotalsSurvey ResultsSection Section SectionOne Two ThreeEnter only the number of “Yes” answers for each section.Tally Sheet Page 1 of 2SectionFourOFP Contract 08-85547FY2011-2012OFP CONTRACT Prepared 08-85547 by CFHC, 2012PREPARED BY CFHC© 201233

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCultural and Linguistic Competency Self-Assessment SurveyTALLY SHEET Page 2 of 2Participant InformationWhat languages do your staff members read and/or speak well? Check all languages that staff members checked and tally the numbers ofstaff members who speak each language.Arabic Farsi Mandarin TagalogArmenian Hindi Punjabi ThaiCambodian Hmong Russian UrduCantonese Korean Sign Language VietnameseEnglish Laotian SpanishClient InformationWhat languages do your clients use as their primary languages? Check any box marked by survey participants. Make a note of how manyparticipants check each box.Arabic Farsi Mandarin TagalogArmenian Hindi Punjabi ThaiCambodian Hmong Russian UrduCantonese Korean Sign Language VietnameseEnglish Laotian SpanishWhat social, cultural, and special-needs groups does your office serve? Check any box marked by survey participants. Make a note of howmany participants check each box.Adolescents East Indian Lesbian, Gay, Bisexual,TransgenderMiddle EasternAfrican American East European Native AmericanAsian Pacific Islander Hearing Impaired Low/Non Literate Vision ImpairedCaucasian American Latin/Hispanic MalesOFP Contract 08-85547FY2011-2012Prepared by CFHC, 20122OFP CONTRACT 08-85547PREPARED BY CFHC© 201234

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESCultural and Linguistic CompetencySelf-Assessment SurveySCORE SHEETAssessment Date: ________________Site (if applicable): __________________________Job Category (if needed): ___________________TallySheet #12345678910Total eachcolumn here.Number ofParticipantsper TallySheetSCORESSection SectionTwo ThreeSectionOne(Transfer the subtotals here from each Tally Sheet. Enter thesubtotals for the appropriate section.)SectionFourPut total number of surveyparticipants in each column.Divide each section total by thisnumber.Average Section Scores:Round to the nearest whole number. Compare the Average Section Scores with the information andexplanations provided in the Toolkit under the section titled Understanding Your Score.OFP Contract 08-85547FY2011-2012Prepared by CFHC, 2012OFP CONTRACT 08-85547PREPARED BY CFHC© 201235

Understanding Your ResultsThis portion of the Toolkit explains how to compile andunderstand the results of the surveys your staff completed.For each section, there is an explanation of what theresponses mean. Included in this section is detailedinformation about:• Recording Your Results• Understanding Your Scores

Recording Your ResultsSTEP 1. Code each completed survey.If you have a large agency, you may want to differentiate thedata you gather between different clinic sites or according to jobcategories. Have the person who collects the surveys write in thesite location.The survey number should be filled out by the staff analyzing thedata. Before you write the survey code in the box, think aheadabout how you may want to use the data. You may want to usea code that will differentiate between staff members according toposition or years of service.STEP 2. Check to see if all the YES responses for eachsection of the survey are accurately subtotaled.Make sure the subtotals for each section are counted and recordedproperly.• Each YES response will count as 1 point. You will not needto transfer the subtotals of the No, Don’t Know, or NotApplicable responses onto the Tally Sheet.See example on page 28.OFP CONTRACT 08-85547PREPARED BY CFHC© 201237

Example:RECORDING YOUR RESULTSOFP CONTRACT 08-85547PREPARED BY CFHC© 201238

RECORDING YOUR RESULTSSTEP 3: Take each completed survey and transfer onlythe YES responses to a Tally Sheet.Each Tally Sheet has room to tally about 20 surveys.• If you have a relatively small office, one Tally Sheet maybe enough.• For larger agencies, you may need to make copies and useseveral Tally Sheets.• If you want to assess the results according to a particularclinic site, job category, or years of service, consider usingdifferent Tally Sheets for each individual grouping.STEP 4: Tally the Participant Information. (Questions 1, 2and 3)The questions about staff characteristics can help you determinewhat types of training or activities are most important for differentgroups of staff, based on longevity, job category, and languageskills.Questions 1 and 2 will be recorded on page 1 of the Tally Sheet.Simply tally how many staff members have checked each answer.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201239

RECORDING YOUR RESULTSQuestion 3 will be recorded on page 2 of the Tally Sheet. Markeach language the survey participants checked off. Record howmany staff members checked each box.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESIf you have a large agency, you may want to consider comparingstaff members in different categories. You can still use the TallySheet for that purpose, but you may have to use a separate TallySheet for each category. Alternatively, you can code each surveyaccording to the characteristics of the respondent.STEP 5: Tally the Client information. (Questions 4 and 5)These questions can be used to:• Determine if staff members have an accurate perception ofthe client populations your agency serves.• Help provide you with a more accurate picture of whatpopulation groups you are currently serving.OFP CONTRACT 08-85547PREPARED BY CFHC© 201240

RECORDING YOUR RESULTSFor each category of social, cultural, language, or special needsgroup you serve, put a check on page 2 of the Tally Sheet. Forevery participant who notes that client group, make a hatch mark.At the end you will be able to see how many groups your staffhas encountered. This information will help you assess whetheror not your current services, programs, and resources meet thereproductive health care needs of all your clients.Example:Decide how best to organize these results. You may want toseparate the results by different clinic sites since each site may servedifferent communities.OFP CONTRACT 08-85547PREPARED BY CFHC© 201241

RECORDING YOUR RESULTSSTEP 6: Record the subtotals of the YES responses foreach section of the survey on the Tally Sheets.Record the four subtotals of the YES responses from each survey inthe appropriate column that matches the section on the survey.• Write only the number of YES responses for Training andStaff Development under Section One.• Write only the number of YES responses for AgencyCapacities under Section Two.• Write only the number of YES responses for HealthEducation under Section Three.• Write only the number of YES responses for Administrationunder Section Four.Here is an example of what the Tally Sheet looks like afterrecording the results of survey number 001.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201242

RECORDING YOUR RESULTSSTEP 7: Record the results of all surveys as described inStep 6.Once you have recorded the results for one survey, go on andtally the next one in the same way, until all the surveys have beenrecorded on a Tally Sheet.ExampleOFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201243

RECORDING YOUR RESULTSSTEP 8: Count the total number of participants whoresponded to the survey, and record that numberat the top of the Tally Sheet.The numbers on the left hand column of each Tally Sheet provideyou with an easy way to count how many participants wererecorded in the Tally Sheet.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201244

RECORDING YOUR RESULTSeach section.For each Tally Sheet, add all the subtotals for “Section One.” Then addall of the subtotals for “Section Two,” and so on. After this step, youshould have four new subtotals, one for each section of the survey.Example:STEP 10: Transfer all Tally Sheet information to the ScoreSheet in the same way.First, write the number of participants represented on each TallySheet. Then, write in the subtotal of the scores for each section.If your office is small, you may only have one Tally Sheet torecord.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201245

RECORDING YOUR RESULTSSTEP 11: Add all the subtotals.First, add the numbers of participants you recorded on each TallySheet. Then, add the subtotals for each section of the Tally Sheetstogether. Write the number of total participants on the rowindicated.Example:OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201246

RECORDING YOUR RESULTSSTEP 12: Divide the totals of each section by the totalnumber of staff members taking part in thesurvey.Once you have the subtotals added together for each section ofthe survey and the number of participants who responded to thesurvey, divide the section subtotal by the number of staff memberswho participated in the survey. This will provide you with anaverage score for each section.Example:Round off to the nearest whole number. For example, if youragency scored 5.3 on the Training Section, your score for thatsection is 5. If your agency scored 2.8, your score for that sectionwould be 3.STEP 13: Compare your Average Section Scores on yourScore Sheet with the ranges provided in thenext section of this Toolkit.You will readily note where your agency’s strengths and challengeslie by comparing your scores with the scoring explanation providedin the following section of this Toolkit, “Understanding YourScores.”OFP CONTRACT 08-85547PREPARED BY CFHC© 201247

Understanding Your ScoresSection One: Training and Staff DevelopmentTraining is essential to improving cultural and linguisticcompetence. Everyone has a worldview and biases. No one canknow everything there is to know about other cultural groups.Thus it is important to learn as much as one can in order toimprove.0-4: If your agency scored an average of 4 or less for thissection, this means that improvements in staff training anddevelopment are highly recommended.• Formulate a comprehensive plan to improve training andstaff development on the topic of cultural and linguisticcompetence.• This plan should include a timeline for various systematicimprovements.• Remember that even small steps toward your goalsare helpful in making the changes needed to provideculturally and linguistically competent services.• Use the suggestions found in Strategies for ImprovingTraining and Staff Development to assist you informulating ways to improve.5-7: If your agency scored an average of 5 to 7 for this section,this means that further improvements in staff trainingand development would enhance your agency’s ability toprovide culturally and linguistically competent services. • Read the suggestions found in Strategies for ImprovingTraining and Staff Development for ideas on ways toimprove. You may already be doing some of the activitiessuggested there.OFP CONTRACT 08-85547PREPARED BY CFHC© 201248

UNDERSTANDING YOUR SCORES• Look at those items that you are not currently doing.• Consider whether it would be feasible to commit toincorporating one or two of those ideas into your agency’straining and development plan.8-10: If your agency scored an average of 8 or more for thissection, this means that, as an agency, you are likelydoing an excellent job in encouraging training and staffdevelopment in this area. However, it is important to:• Make sure there is a consistent plan in place forsupporting on-going staff development and training.• Continue to enhance your staff’s skills in providingculturally and linguistically competent services. It isimportant to remember that culture is dynamic and theneeds of your population will change over time.Section Two: Agency CapacityIt is important to:• Support staff members in their efforts to provide culturallyand linguistically appropriate services.• Support clients by acknowledging that cultural differencesexist and that your agency views these differences in a waythat is respectful and honoring of their culture.By making needed changes in this area, you will enhance the wayyou provide services.0-4: If your agency scored an average of 4 or less for thissection, this means that improvements in the way youragency provides services to your client population arehighly recommended.• Formulate a comprehensive plan to improve your agency’saccessibility and sensitivity to the needs of your clientpopulation.OFP CONTRACT 08-85547PREPARED BY CFHC© 201249

UNDERSTANDING YOUR SCORES• This plan should include a timeline for various step-bystepimprovements.• Remember that making even small steps toward yourgoals are helpful in making the changes needed to provideculturally and linguistically competent services.• Use the suggestions found in Strategies for ImprovingAgency Capacity to assist you in formulating ways toimprove.• Some changes may be easy to incorporate and yet canmake a big difference in your ability to provide theservices your clients really need.5-7: If your agency scored an average of 5 to 7 for this section,this means that further improvements in agency capacityand accessibility would enhance your agency’s ability toprovide culturally and linguistically competent services.• Read through the suggestions found in Strategiesfor Improving Agency Capacity for ideas on ways toimprove. You may already be doing some of the activitiessuggested there.• Look at those items that you are not currently doing.• Consider whether it would be feasible to commit toincorporating one or two of those ideas into the way youragency provides services.8-10: If your agency scored an average of 8 or more for thissection, this means your agency has many strengths in thearea of providing culturally and linguistically competentservices. However, it is important to:• Make sure there is a consistent plan in place forenhancing and upgrading your services as client needschange.• Develop a plan for periodically evaluating your services,systems, and resources.OFP CONTRACT 08-85547PREPARED BY CFHC© 201250

UNDERSTANDING YOUR SCORESSection Three: Health EducationAll clients need information and education given to them in a waythat is easily understood and accepted. Make sure your agencygives your clients the information and education they need tomake informed decisions about their reproductive health care.0-4: If your agency scored an average of 4 or less for thissection, this means that improvements in health educationare highly recommended.• Formulate a comprehensive plan to improve the qualityof health education materials and services you provide forclients.• This plan should include a timeline for various step-bystepimprovements.• Remember that making even small steps toward yourgoals are helpful to making the changes needed to provideculturally and linguistically competent services.• Use the suggestions found in Strategies for ImprovingHealth Education for Clients to assist you informulating ways to improve.5-7: If your agency scored an average of 5 to 7 for this section,this means that further improvements in the quality ofhealth education materials and services would enhanceyour agency’s ability to provide culturally and linguisticallycompetent services.• Read through the suggestions found in Strategies forImproving Health Education of Clients for ideas onways to improve. You may already be doing some of theactivities suggested there.• Look at those items that you are not currently doing.• Consider whether it would be feasible to commit toincorporating one or two of those ideas into your agency’shealth education plan.OFP CONTRACT 08-85547PREPARED BY CFHC© 201251

UNDERSTANDING YOUR SCORES8-10: If your agency scored an average of 8 or more in thissection, this means that, as an agency, you are likely doinga good job in providing health education materials andservices for your clients. However, it would be importantto:• Make sure there is a consistent plan for ensuring thathealth education materials and services are evaluated andimproved.• In that way, your agency can continue to provideexcellent health education materials and services in a waythat best meets your clients’ needs.Section Four: AdministrationFew improvements in providing culturally and linguisticallycompetent services can be made without an administration thatsupports and upholds those values. Make sure your Board ofDirectors and your leadership understand the many benefits ofaddressing this issue, including improved staff interaction, greaterclient satisfaction and health outcomes, and an improved bottomline, among others.0-4 If your agency scored an average of 4 or less for thissection, this means that improvements in the way youradministration promotes culturally and linguisticallycompetent services are highly recommended.• Formulate a comprehensive plan to improve theoverall administrative support of cultural and linguisticcompetency.• This plan should include a timeline for various step-bystepimprovements.• Remember that making even small steps toward yourgoals are helpful to making the changes needed to provideculturally and linguistically competent services.OFP CONTRACT 08-85547PREPARED BY CFHC© 201252

UNDERSTANDING YOUR SCORES• Use the suggestions found in Strategies for ImprovingAdministrative Issues to assist you in formulating waysto improve.5-7: If your agency scored an average of 5 to 7 for this section,this means that further improvements in the way youradministration supports cultural competency wouldenhance your agency’s ability to provide culturally andlinguistically competent services.• Read through the suggestions found in Strategies forImproving Administrative Issues for ideas on ways toimprove. You may already be doing some of the activitiessuggested there.• Look at those items that you are not currently doing,and consider whether it would be feasible to committo incorporating one or two of those ideas into youragency’s overall plan to improve cultural and linguisticcompetency.8-10: If your agency scored an average of 8 or more for thissection, this means that, as an agency, your administrationis likely doing a good job in promoting culturally andlinguistically competent services for your clients.• Make sure there is a consistent plan in place so thatcultural and linguistic competency is maintained andenhanced at your agency.STEP 14: Formulate a plan to improve in those areaswhere your agency may have weaknesses.The next section, “Developing a Strategic Plan,” provides manystrategies for developing a comprehensive plan for improving thecultural and linguistic competence of your staff members and youragency as a whole. Here are some basic suggestions to get started.• Bring together a sub-committee interested in improvingcultural and linguistic competence at your agency.OFP CONTRACT 08-85547PREPARED BY CFHC© 201253

UNDERSTANDING YOUR SCORES• Share the Score Sheet(s) with the average scores of eachsection. Discuss what these scores would indicate.• Prioritize which area or areas need the most improvement.• Read the strategies in this Toolkit in the area or areasselected by your committee for improvement.• Based on these strategies, formulate goals and objectives foreach area that needs improvement; and select a few activitiesyou can accomplish within a specified timeline. Assign arealistic timeline and begin moving to accomplish thoseobjectives and goals. Remember, improving cultural andlinguistic competency is a life-long endeavor that can beginwith small steps.Note: The following section presents various ideas to helpyou get started in formulating a strategic plan forenhancing your agency’s cultural and linguisticcompetency. You can also generate your own ideasand strategies for each area that needs improvement.OFP CONTRACT 08-85547PREPARED BY CFHC© 201254

Developing a Strategic PlanBased on your survey results, formulate goals andobjectives for each area needing improvement. Forexample, let’s say your agency needs to improve itstraining and staff development. Choose a few activitiesyou can accomplish in the next few months. Assign arealistic timeline and begin working toward those goals.A sample Strategic Plan is included at the end of thissection.Based on each section of the survey, this includessuggested strategies for improving:• Training and Staff Development• Agency Capacities• Health Education for Clients• Administrative Issues

Strategies for Improving Training andStaff DevelopmentOngoing training and staff development is essential in improvingthe way your agency provides culturally and linguisticallycompetent services. All staff should have the opportunity toattend a training or in-service on this topic at least once a year. Besure to include this topic in the orientation you provide to newstaff members.Consider incorporating some of the ideas below into your agency’splan to improve its cultural and linguistic competence. Make useof the resources provided with this Toolkit.• Encourage staff to attend cultural competencytraining(s).Promote outside trainings on the topics of healthliteracy and cultural and linguistic competency to yourstaff.Contact your local health department, communitygroups, and organizations to find trainings in your area.Post a training schedule in the break room.Be flexible with schedules to allow staff to take timeaway from their duties to attend training.Develop a written policy that states your agency’scommitment to cultural and linguistic competency andyour requirements regarding staff training in this area.Set aside resources in the budget to support trainingand staff development.• Provide your own training or in-service on cultural andlinguistic competence. Here are some ideas you couldincorporate:Survey employee health beliefs and biases and explorehow they can enhance or hinder communication withclients regarding their health issues.OFP CONTRACT 08-85547PREPARED BY CFHC© 201256

STRATEGIES FOR IMPROVING TRAININGAND STAFF DEVELOPMENTUse communication techniques and role-plays asa way to give staff skill-building practice in goodcommunication.Present information on how social issues, culture,ethnicity, and literacy affect the reproductive health ofclients in their community.Use exercises on relating to clients who are from adifferent racial/ethnic/educational group as part ofthe training. Sometimes people are very culturallycompetent and comfortable with their own culturalgroup, but not with other cultural groups. Trainingand practice can help address this.Select a journal article or a video that can be used tojump-start a group discussion on the topic of culture.This type of activity can easily be conducted during thestaff lunch time.• Orient all newly hired staff to the importance of culturaland linguistic competency.Make sure this topic is mentioned in the orientationprocess and is part of your employee handbook.• Develop a protocol to explain how to work withinterpreters while maintaining client confidentiality.Ensure that this protocol is explained to all staff duringorientation.Provide a refresher of the protocol during a staffmeeting or in-service.Use the resources in the Resource Section of thisToolkit on how to work with interpreters.• Set up a resource library or section in your office withresources on this topic. Staff can use these resources to stayabreast of cultural issues in the communities they serve.Purchase or borrow books, videos, and other resourcesfor your agency.Keep them in the break room or develop a library ofcultural competency materials that staff can use.OFP CONTRACT 08-85547PREPARED BY CFHC© 201257

STRATEGIES FOR IMPROVING TRAININGAND STAFF DEVELOPMENTFocus on obtaining materials that are specific to thepopulations you serve.Develop lists of websites and other resources that wouldbe useful for staff members who want to learn moreabout cultural competency.Review the Resources Section of this Toolkit for specificmaterials and websites that might be useful.• Post articles or subscribe to journals that addressthe issue of cultural and linguistic competency. Somesuggested publications are American Journal of Public Health,Journal of Cultural Diversity, and Managing Diversity. See theResource Section of this Toolkit for other helpful journals andwebsites.• Organize activities where staff can share informationabout their own culture. One idea is to hold a potluck wherestaff brings dishes to share that are traditional or common in theirculture. Have staff explain what the dish is and when and how it isusually eaten. Be creative!OFP CONTRACT 08-85547PREPARED BY CFHC© 201258

Strategies for Improving AgencyCapacityLooking at and improving the way your agency provides services to yourpopulation groups is an important step in ensuring that your servicesare culturally and linguistically competent. Some changes you can makeare relatively simple, but can make a profound difference. Read throughthese suggestions. If you are already doing some of these activities, buildon your strengths. Consider whether some of these activities could alsobecome part of your overall plan. Make use of the Resources providedin this Toolkit.• Make a point of asking clients for their languagepreference when they call for an appointment. This will allowtime to schedule an interpreter so the client will not have to wait tobe seen. Avoid using a family or friend of the client to interpret foryou. It may also be helpful to have a list at the appointment desk ofclients that routinely use your interpreter services.• Encourage staff to record clients’ languagepreferences (the language they prefer to speak may be differentfrom the one they can read) on their medical charts so that thisinformation will be accessible to anyone who encounters this client.• Post a sign at the reception desk with a list oflanguages that clients may speak. Clients can point to thelanguage they speak. Information about where to obtain this typeof sign is included in the Resources Section of this Toolkit.• Contract with a language line or service to provideinterpretation for languages that your staff do not speak. Ifyou contract with a language line, train staff in how to use theline. Encourage and provide incentives for staff members whospeak different languages to become certified medical interpreters.Information about how to go about doing this is included in theResources Section of this Toolkit.• Establish connections with cultural, ethnic, andreligious groups in your community. Visit theirorganizations and see what services they provide that would beuseful for your clients. Develop a list of these resources anddistribute them in the clinic. Make sure staff are aware of theresources and use them to make referrals for clients.OFP CONTRACT 08-85547PREPARED BY CFHC© 201259

STRATEGIES FOR IMPROVINGAGENCY CAPACITYHere are other strategies your agency could utilize:• Make sure that the pictures, décor and readingmaterials in your waiting room are welcoming for peopleof various cultural groups. You can ask your Community AdvisoryBoard for their input on how to accomplish this.• Display signs and posters in the languages that yourclients read. Sometimes this will mean having multiple signs, indifferent languages, to convey the same message.• Consider making changes in your agency’s setting,hours and staffing that will increase the likelihood that teenswill feel more comfortable utilizing your services. Hire peerproviders, educators, or outreach workers. Create a teen-friendlywaiting room or drop-in clinic.• Consider providing early morning, evening or weekendhours to enhance accessibility for people who are not ableto take time off from work or school for an appointment.• Consider providing services at convenient off-sitelocations or with a mobile van. See “Outreach and Access”in the Resources Section for a practical toolkit on providing off-siteservices.• Find ways to assist your clients with transportation ifthat is an issue. See the Resource Section for a helpful report on thetopic of outreach.• Outreach to clients in a variety of ways, including the useof media. See the Resource Section for a useful tip sheet and reporton this topic.• Establish relationships with various groups in yourcommunity. Let them know about your services and programs sothey can refer their constituents to your agency.OFP CONTRACT 08-85547PREPARED BY CFHC© 201260

Strategies for Improving HealthEducation of ClientsHealth education is a core part of the Family PACT program. It isimportant that you communicate with your clients in a way they canreadily understand. This means that the health education materials youprovide need to be easy-to-read and in a language your clients can readand understand. The following suggestions will help you improve yourservices in the area of health education.• Offer materials in all the languages your clients read.• Check with ACS for client education materials in thelanguages your clients read.ACS provides free health education materials to FamilyPACT Providers, and some are available in multiplelanguages.Browse the catalog of client materials online athttp://www.familypact.org/providers/client-educationmaterials/.Place an order by faxing the completed Family PACT OrderForm to 1-888-723-3667.• Use CFHC’s free Online Database of Health EducationMaterials to locate materials based on topic and languagefrom various distributors nation-wide. Go tohttp://www.healthed.org/Inmagic/SearchCatalog.htm.• Establish a Community Advisory Board. You can assemblethe Board with representatives from the cultural, ethnic, andreligious groups in your community. Make sure that there arerepresentatives from each of the main cultural groups that youragency serves. Convene the group periodically to get feedback onthe materials used or the services provided by your agency.• Evaluate the reading level and culturalappropriateness of all forms, surveys, and clientmaterials using established tools, such as the Fry graph or thesample Checklist for Evaluating Health Education Materials foundin the Resource Section of this Toolkit.• Train staff and/or Community Advisory Board membersto assess the quality of the translation and culturalOFP CONTRACT 08-85547PREPARED BY CFHC© 201261

STRATEGIES FOR IMPROVINGHEALTH EDUCATION OF CLIENTSappropriateness of materials. Various consulting groupslisted in the Resources Section of this Toolkit can assist you withthis objective.• Ask your clients about their literacy skills and theirpreferred ways to learn new information. Readinformation to clients who are not able to read in their ownlanguage.• Give copies of materials to your clients and encouragethem to share them with trusted friends, family members orpartners. They can read the information to the client and supportthem on any behavioral change that has been recommended.Other helpful strategies include:• Use a variety of teaching tools to present informationto clients. You may want to consider providing these clientswith audio recordings of the information they need. Pictographicpamphlets and videos can also be useful. To find out more aboutworking with clients who are not able to read, see the the ResourcesSection of this Toolkit.• For visually impaired clients, provide materials in largeprint or in Braille if appropriate. You may consider havingsomeone read forms and brochures to the client. As with all clients,ensure that there is a private space for clients to respond if they areanswering personal questions.• For hearing impaired clients, provide interpreterswho know American Sign Language (ASL) or provideassisted listening devices. If no staff members knowAmerican Sign Language, consider contracting with a translatorto provide ASL services. Provide incentives for staff to learn ASL.Assisted listening devices can also be very helpful for both the clientand the provider.• Provide an array of materials and services that wouldappeal to and meet the needs of various special populations youmay serve.OFP CONTRACT 08-85547PREPARED BY CFHC© 201262

Strategies for Improving AdministrativeIssuesThere are many ways the administration of an agency can improve thecultural and linguistic competence of the agency. Supporting the useof this self-assessment tool, for example, is an important first step. Itis essential to have protocols for orienting and training staff and anongoing plan for improving the way your agency provides servicesto the diverse populations you serve. Here are a few ways that theadministration can enhance services to retain and attract new clients.• Evaluate your hiring practices. If your staff members do notreflect the population you serve, consider how your hiring practicesmay exclude certain groups or give preference to other groups.Evaluate how you could work with community organizations torecruit more staff members that are representative of the clients youserve.• Consider presenting demographic information on yourclient population and staff during a staff meeting. Explainwhich groups are most often served by your agency, and to whichcultural groups staff members belong. In this way, staff memberscan learn more about the cultural groups they serve.• Think about how your Board of Directors is selected. Itmay be that your Board members do not reflect the populations youserve. In that case, consider the process your agency uses to selectBoard members. Work with community organizations to recruitmore Board members who are representative of the communitiesyou serve.• Honor and respect staff and clients alike. Some staffmembers may not feel that all employees are shown appreciationand respect. If this is the case, agency leadership should considermaking needed changes. Specific suggestions for what needs tochange could come from focus groups of staff members or from ananonymous suggestion box.• Develop a strategic plan. If your agency does not havea written plan for implementing culturally and linguisticallycompetent services, your agency leadership or Board of Directorsshould consider developing a strategic plan. Include specific areasOFP CONTRACT 08-85547PREPARED BY CFHC© 201263

STRATEGIES FOR IMPROVINGADMINISTRATIVE ISSUESwhere your agency would like to improve, set goals and objectives,and explain strategies and activities that will help you achieve thesegoals. You can use this Toolkit as a way to begin.• Consider policy and procedure change. Policies andprocedures are the framework of the Strategic Plan that willguide broader systems change in your agency. Policies are theformal guidelines an agency uses to coordinate and execute theiractivities. They help focus attention and resources on high priorityissues. Procedures are the operational processes used to implementpolicies. If policy is “what” your agency does operationally, thenits procedures are “how” you intend to carry out those operatingpolicies.Your agency can also:• Inform your staff of your agency’s strategic plan. Onceyou have a written plan, make sure staff is aware of it by includingdiscussion about it in your orientation process, during staffmeetings or in-service trainings or by occasional memorandums.• Create a way to deal with clients’ concerns orcomplaints. If your agency has a written policy to address clientconcerns or complaints but staff members are not aware of it, youmay need to remind or inform staff of the policy during a staffmeeting or by providing a brief training. If your agency does nothave a written policy regarding complaints, your agency leadershipor Board of Directors should consider developing a grievancesystem. Include specific steps clients can take to file a complaintas well as the process the agency will use to respond to thesecomplaints. Make sure staff and clients are aware of this process.• Annually assess your progress. If your agency annuallyassesses progress in implementing culturally and linguisticallycompetent services but staff members are not aware of it, youmay need to remind or inform them of the process during a staffmeeting.• Incorporate cultural and linguistic competenceassessment into your annual report. Consider includingan annual assessment of culturally and linguistically appropriateservices as part of your annual report as a way to assess progress.Use your written plan for implementing culturally and linguisticallyappropriate health care services to see if you are meeting the goalsthat you set for your agency.OFP CONTRACT 08-85547PREPARED BY CFHC© 201264

Using the Strategic Plan FormSo, now what? Once you have tallied your survey results,determined your average score for each section, and read throughthe various suggestions in the Toolkit for improving your agency’scultural and linguistic competency, what can you do?It is important to gather staff members together to:• Discuss what to do with all the information.• Make a personalized plan based on your agency’s mostpressing needs and available resources.You can use the following form entitled “Strategic Plan” to assistyou in formulating a plan.• For each section of the survey, record your agency’s finalaverage score.• Read “Understanding Your Scores” to interpret that score.Record your notes about your survey results in the box nextto the score.• Brainstorm with staff about what your agency canrealistically do to improve things. Remember, even makingsmall steps can make a big difference.• Then, under “Proposed Activities” for each section, writeone to three activities your agency can commit to doing inthe next few months. You can choose activities suggested inthis section, or you can develop your own.• Consider ways you can turn your “Proposed Activities” into“Policy Change” by either modifying an existing policy orcreating a new one. You can check the box “Needs policychange” if you think your new activities require it.See the next few pages for an example of how one agencydeveloped a plan. A blank copy of the Strategic Plan form is alsoincluded for your use.OFP CONTRACT 08-85547PREPARED BY CFHC© 201265

USING THE STRATEGIC PLAN FORMOFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201266

USING THE STRATEGIC PLAN FORMOFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESOFP CONTRACT 08-85547PREPARED BY CFHC© 201267

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESEnhancing Cultural and LinguisticCompetencySTRATEGIC PLANName of theDateAgency:Section One: Training and Staff DevelopmentScore: Notes on Results:Proposed Activities:1. By _________, _________, we will:month yearNeeds PolicyChange2. By _________, _________, we will:month yearNeeds PolicyChange3. By _________, _________, we will:month yearNeeds PolicyChangeSection Two: Agency CapacitiesScore: Notes on Results:Proposed Activities:1. By _________, _________, we will:month yearNeeds PolicyChange2. By _________, _________, we will:month yearNeeds PolicyChange3. By _________, _________, we will:month yearNeeds PolicyChangeOFP Contract 08-85547FY2011-2012Prepared by CFHC, 20121OFP CONTRACT 08-85547PREPARED BY CFHC© 201268

OFFICE OF FAMILY PLANNINGCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESEnhancing Cultural and LinguisticCompetencySection Three: Health EducationScore: Notes on Results:STRATEGIC PLAN Page 2 of 2Proposed Activities:1. By _________, _________, we will:month yearNeeds PolicyChange2. By _________, _________, we will:month yearNeeds PolicyChange3. By _________, _________, we will:month yearNeeds PolicyChangeSection Four: Administrative IssuesScore: Notes on Results:Proposed Activities:1. By _________, _________, we will:month yearNeeds PolicyChange2. By _________, _________, we will:month yearNeeds PolicyChange3. By _________, _________, we will:month yearNeeds PolicyChangeOFP Contract 08-85547FY2011-2012Prepared by CFHC, 20122OFP CONTRACT 08-85547PREPARED BY CFHC© 201269

ResourcesHere are a number of websites, training tools, and avariety of resources you may find useful when you aredeveloping and implementing your strategic plan forenhancing the cultural and linguistic competency ofyour services.This section includes resources regarding:• Cultural Competency• Health Literacy• Interpretation• Outreach and Access

Cultural CompetencyHelpful WebsitesThe Cross Cultural Health Care Programwww.xculture.orgThe mission of CCHCP is to serve as a bridge betweencommunities and health care institutions to ensure full access toquality health care that is culturally and linguistically appropriate.This site has videos, manuals, and books.National Center for Cultural Competencewww.gucchd.georgetown.eduGeorgetown University Center for Child and HumanDevelopment sponsors the National Center for CulturalCompetence which has many helpful resources and articlesregarding cultural and linguistic competence.National Standards for Culturally and Linguistically AppropriateServices (CLAS) in Health Carehttp://www.cdphe.state.co.us/ps/hcp/form/resources/CLAS.pdfThis site provides a list of the newest CLAS Standards.Office of Minority Healthhttp://www.minorityhealth.hhs.govThis site provides resources from the Center for Cultural andLinguistic Competency in Health Care.OFP CONTRACT 08-85547PREPARED BY CFHC© 201271

CULTURAL COMPETENCYArticles and ManualsCulture Clueswww.uwmedicine.orgThis series of tip sheets from the University of Washington MedicalCenter offers health care providers with practical suggestions forcommunicating with a variety of cultural groups.Cultural Competency and Adolescent Reproductive andSexual Healthwww.advocatesforyouth.orgYouth who face prejudice and discrimination by virtue of theiridentity, life experience, or family circumstances disproportionatelyexperience teen pregnancy and HIV/STI infection. This resourcefrom Advocates for Youth will be useful to many Family PACTproviders.Cultural and Linguistic Competence Policy Assessmentwww.clcpa.infoDeveloped by Georgetown University’s National Center forCultural Competence (NCCC), this guide explains how toincorporate cultural and linguistic competence into clinic policies.A Guide for Advancing Family-Centered Culturally andLinguistically Competent Carewww.gucchd.georgetown.eduThis guide developed by NCCC could serve as a good way tohelp put together your strategic plan for enhancing cultural andlinguistic competency at your office.OFP CONTRACT 08-85547PREPARED BY CFHC© 201272

CULTURAL COMPETENCYA Guide to Planning and Implementing Cultural CompetenceOrganizational Self-Assessmentwww.gucchd.georgetown.eduThis guide explains why it is important to conduct culturalcompetence self-assessment and how to use the results of selfassessment.It was developed by NCCC for health and humanservices organizations.Videos and Training OpportunitiesThe Cross Cultural Health Care Programwww.xculture.orgCCHCP provides many workshop and training opportunities.OFP CONTRACT 08-85547PREPARED BY CFHC© 201273

Health LiteracyHelpful WebsitesAmerican Medical Association Foundation Health LiteracyInitiativewww.amafoundation.orgThis website provides access to a free health literacy newsletter anda variety of tools to enhance health care providers’ capacities toprovide quality care to patients with low literacy skills.Ask Me 3www.npsf.org/askme3This site developed by Pfizer and the Partnership for Clear HealthCommunication is designed for health care providers and forpatients to learn more about how to communicate clearly abouthealth care.California Family Health Councilwww.healthed.orgThis site provides many kinds of services from an online databaseof patient education resources evaluated for literacy by professionalhealth educators to an online store of easy-to-read healtheducation materials.California Health Literacy Initiativewww.cahealthliteracy.orgThis website provides health care providers information aboutHealth Literacy and access to a useful Health Literacy ResourceCenter.OFP CONTRACT 08-85547PREPARED BY CFHC© 201274

HEALTH LITERACYCenter for Health Care Strategieswww.chcs.orgThis site features helpful fact sheets on health literacy.Family PACTwww.familypact.orgThe California Office of Family Planning provides easy-toreadreproductive health materials in multiple languages, bothdownloadable and in print.Institute for Healthcare Advancementwww.iha4health.orgIHA sponsors a yearly conference on Health Literacy and has anumber of easy-to-read handbooks for family self-care.National Institutes of Healthwww.nih.govNIH devotes a section of its website to the importance of healthliteracy.National Institute for Literacywww.nifl.govThis website features information on adult literacy in general aswell as specific information on health literacy.Plain Language Network Internationalwww.plainlanguagenetwork.orgThis website provides free plain-language articles, writing tutorials,Web links, news, networking opportunities, and professionalsupport.OFP CONTRACT 08-85547PREPARED BY CFHC© 201275

HEALTH LITERACYPfizer Clear Health Communication Initiativewww.pfizerhealthliteracy.comSeveral useful resources for health care providers as well asresearchers are available at this site, including the Newest VitalSign and Tips for ProvidersArticles, Books and ManualsChecklist for Evaluating Health Education Materialswww.healthed.orgDeveloped by California Family Health Council, this form focuseson what to look for in a health education material.Clear and Simple: Developing Effective Print Materials forLow-Literate Readerswww.cancer.govThis online manual from the National Cancer Institute is astep-by-step guide for developing easy-to-read print materials.Fry Graphwww.healthed.orgThe Fry Graph and its instructions can be used to test the readinglevel of written materials.Health Literacy: A Prescription to End Confusionwww.iom.eduThis excellent book from the Institute of Medicine outlines thehigh cost of low health literacy, backed by research and case studiesand offers useful solutions.OFP CONTRACT 08-85547PREPARED BY CFHC© 201276

HEALTH LITERACYThe Health Literacy Environment of Hospitals and HealthCenters: Partners for Action: Making Your Healthcare FacilityLiteracy-Friendlywww.ncsall.netThis guide was developed by the National Center for the Study ofAdult Learning and Literacy and the Health and Adult Literacyand Learning Initiative at the Harvard School of Public Health.It offers an approach for analyzing literacy-related barriers tohealthcare access and navigation.Health Literacy from A to Z: Practical Ways to CommunicateYour Health Messagewww.healthliteracy.comThis book by Helen Osborne of Health Literacy Consulting is fullof great resources and tips.Teaching Patients with Low Literacy Skillswww.hsph.harvard.eduThis classic book by Leonard and Cecelia Doak and Jane Root isuniquely helpful. Every Family PACT provider would find thisuseful. Downloadable at no cost the Harvard School of PublicHealth website.Videos, Training and ConsultingCalifornia Family Health Council, Inc.www.healthed.orgThe health literacy experts at CFHC can assist health careproviders in assessing, writing, editing, designing, translating,field-testing, and producing easy-to-read, culturally competenthealth education materials as well as providing training in healthliteracy and clear health communication.OFP CONTRACT 08-85547PREPARED BY CFHC© 201277

HEALTH LITERACYClear Language Groupwww.clearlanguagegroup.comThis excellent consortium’s services include cross-culturalcommunication, consulting, writing, editing, training, andproducing multimedia.Health Literacy Consultingwww.healthliteracy.comHealth Literacy Consulting provides keynote addresses andpresentations, plain language writing and editing services as well asa website with tips on promoting health literacy.Health Literacy: Help Your Patients Understandwww.amafoundation.orgThis excellent in-service training video and toolkit from theAmerican Medical Association Foundation will help your staffunderstand the importance of health literacy and clear healthcommunication.OFP CONTRACT 08-85547PREPARED BY CFHC© 201278

Interpretation in the Health Care SettingHelpful WebsitesNational Association of the Deafwww.nad.orgEffective communication with deaf or hard of hearing people isessential for providing quality health care. This site explains therequirements of Title III of the Americans Disability Act for healthcare providers.ACOG: Assisting Hearing Impaired and Non-English SpeakingPatientswww.acog.org/departments/dept_notice.cfm?bulletin=1726&recno=19Provides background on physicians’ obligations, as well as practicalsuggestions for meeting the needs of heating impaired and non-English speaking patients.National Council on Interpreting in Health Carewww.ncihc.orgThe NCIHC is a multidisciplinary organization based in theUnited States whose mission is to promote culturally competentprofessional health care interpreting as a means to supportequal access to health care for individuals with Limited EnglishProficiency. This site has a series of working papers on this topic.OFP CONTRACT 08-85547PREPARED BY CFHC© 201279

INTERPRETATIONArticles or ManualsThe Art of Interpreting: A Manual for Health Care Professionalswww.acebo.comThis article by Holly Mikkelson provides many practical tips forworking with interpreters in a health care setting.City of Seattle Interpreter Toolkit: A guide to help youprovide interpretation and translation services to multilingualpopulations.www.cityofseattle.netWhile specific to Seattle’s needs, the principles highlighted in thiseasy-to-use guide can be helpful to Family PACT providers. Itfeatures a sample Language Identification Sign.Language Barriers in Health Care Settings: An AnnotatedBibliography of the Research Literaturewww.ncihc.orgThis bibliography from the National Council on Interpretingin Health Care (NCIHC) highlights research on this importanttopic.National Standards of Practice for Interpreters in Health Carewww.ncihc.orgThis document from NCIHC features excellent standards forhealth care interpreters.OFP CONTRACT 08-85547PREPARED BY CFHC© 201280

INTERPRETATIONProviding Language Services in State and LocalHealth-Related Benefits Offices: Examples from the Fieldwww.commonwealthfund.orgThis resource explains strategies for providing language services topeople with Limited English Proficiency. The real world examplesand step-by-step plan make it easy for clinics to make changes.The Role of the Health Care Interpreterwww.ncihc.orgAn interesting article on the topic from NCIHC.Sample Language Identification Cardwww.lep.govFamily PACT providers can use this tool available from the USDepartment of Commerce, Census Bureau to identify a client’slanguage. The client simply points to the preferred language.Telephone Interpreter ServicesCyraCom Internationalwww.cyracom.netCyracom International provides interpretation services via thetelephone. The service is available 24 hours a day, 365 days a year.CTS LanguageLinkwww.ctslanguagelink.comProvides trained and qualified interpreters in any language on-siteand over the telephone, 24 hours a day, 7 days a week.OFP CONTRACT 08-85547PREPARED BY CFHC© 201281

INTERPRETATIONLanguage Line Serviceswww.languageline.comCertified medical interpreters can interpret over 150 languagesover the phone, over video, and in writing.NetworkOmniwww.networkomni.comNetworkOmni provides over-the-phone interpretation, translationand localization, on-site interpretation and consulting services.Training OpportunitiesBridging the Gap Interpreter Handbookwww.xculture.orgThis handbook from Cross Cultural Health Care Program(CCHCP) was designed to accompany a 40-hour training coursefor medical interpreters. It can also be used for interpreterswishing to study on their own.Communicating Effectively Through an Interpreterwww.xculture.orgThis instructional video/DVD is available from CCHCPfor health care providers to learn to work effectively with aninterpreter.OFP CONTRACT 08-85547PREPARED BY CFHC© 201282

Outreach and AccessHelpful WebsitesAdvocates for Youthwww.advocatesforyouth.orgThis site features outreach programs that work.The California Wellness Foundationwww.tcwf.orgThis website highlights how agencies might obtain funding foroutreach programming as well as other resources and tools foroutreach strategies.Engender Healthwww.engenderhealth.orgThis section of the website highlights how to build a successfulmale outreach component.Family Health Internationalwww.fhi.orgThis website highlights community outreach programs with ideascoming from all over the world.Family PACTwww.familypact.orgThis website features a number of resources for building successfuloutreach programs for various client populations.OFP CONTRACT 08-85547PREPARED BY CFHC© 201283

OUTREACH AND ACCESSArticles, Books and ManualsA Clinic For Teens by Teens: The Peer Provider Manualwww.healthed.orgThis manual from California Family Health Council (CFHC)highlights the ins and outs of developing and implementing a peerprovider program.Off-Site Family Planning and Chlamydia Screening Programs:A Toolkit for Developing and Implementing Successful Off-siteProgramswww.cfhc.orgThis practical toolkit from CFHC provides agencies witheverything they need to develop a successful off-site program,from sample Memos of Understanding to equipment and supplieschecklists and everything in between.The Other Half of the Equation: Serving Young Men in aYoung Women’s Reproductive Health Care Clinicwww.guttmacher.orgThis article from the Allan Guttmacher Institute provides helpfulinsight into outreaching to young men.Reaching Out for Success: Family PACT Provider Guide forEffective Outreachwww.familypact.orgThis excellent article from the Family PACT program summarizesthe best outreach practices of Family PACT providers statewide.OFP CONTRACT 08-85547PREPARED BY CFHC© 201284

OUTREACH AND ACCESSThe Source: A Peer Provider Handbookwww.healthed.orgCreated by and for teen peer providers, this reproductive healthmanual from CFHC will be a useful training tool and resourcehandbook for peer providers.Tips for Effective Family PACT Outreachwww.familypact.orgThis tip sheet gives helpful hints for Family PACT providers forsuccessful outreach.Teen Pregnancy Prevention Programs in Californiawww.familypact.orgThis list of California programs funded for teen-pregnancyprevention will help Family PACT providers reach vulnerable andat-risk teens.Videos, Training and ConsultingCalifornia Family Health Council, Inc.www.healthed.orgThe trainers at CFHC can train staff in building successful teenfriendlyprograms, including building successful peer providerprograms.Center for Health Trainingwww.centerforhealthtraining.orgCHT has a number of programs and trainings available includingfree downloads entitled “Blueprint for Male Involvement” and“Client-centered Care Organizational Assessment: How well doesyour agency provide client-centered services?” among other topics.OFP CONTRACT 08-85547PREPARED BY CFHC© 201285

OUTREACH AND ACCESSMeeting the Family Planning Needs of Adolescents and Maleswww.familypact.orgListen to a helpful previously recorded webcast on the topic ofreaching males and teens from the Family PACT program.Reaching Teens: The Essentials of Outreachwww.centerforhealthtraining.orgThis 20-minute video from CHT is an excellent training toolfor staff and provides an overview of the essentials for building asuccessful outreach program.OFP CONTRACT 08-85547PREPARED BY CFHC© 201286