Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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under the three core functions of public health 3 require effective and meaningfulcommunication, between LPHAs and the community (Harrell 1994).LPHAs that provide CLAS accommodate differences in language and culture andoffer language assistance services such as interpreters or bilingual providers. LPHAs alsomay provide staff with cultural diversity training and provide clients with culturallysensitive health care services. Together, these services may improve health and decreasedisparities, because health care providers increase their ability to understand and treat aculturally diverse clientele with varied health beliefs and practices, thus improvingaccuracy of diagnoses and selection of appropriate treatment (Becker 1980).1.4 PROJECT BACKGROUND AND OBJECTIVESIn 1983, the annual issue of Health, United States (the report card on the health statusof the American people) documented significant progress in the overall health picture ofthe Nation (National Center for Health Statistics NCHS 1983). The report reinforced thefact that there were continuing disparities in the burden of death and illness experienced byracial and ethnic minority Americans as compared with the U.S. population as a whole—adisparity that has existed ever since accurate federal record keeping began more than ageneration ago. In response to the report findings, a Task Force was established by the thenSecretary of DHHS to investigate the health problems of African Americans, NativeAmericans, Hispanics, and Asian/Pacific Islanders. The Task Force was charged withreviewing and analyzing the departmental programs and range of resources available toaddress the health problems of racial and ethnic minorities, and with recommending waysfor the department to exert leadership, influence, and initiative to close the existing gaps.The result of the Task Force’s efforts and deliberations was presented to the Secretaryin August 1985 in the “Report of the Secretary’s Task Force on Black and Minority Health”(Heckler 1985). This report subsequently led to the establishment of OMH in 1986 withinthe Office of the Assistant Secretary for Health (now the Office of Public Health andScience), headed by the Deputy Assistant Secretary for Minority Health. ThatOffice—which was legislatively established under the Disadvantaged Minority HealthImprovement Act of 1990 (Public Law 101-527) and reauthorized under the Health3 Essential public health services include: monitor health status to identify community health problems;diagnose and investigate health problems and health hazards in the community; inform, educate, and empowerpeople about health issues; mobilize community partnerships to identify and solve health problems; developpolicies and plans that support individual and community health efforts; enforce laws and regulations thatprotect health and assure the provision of health care when otherwise unavailable; link people to neededpersonal health services and assure the provision of health care when otherwise unavailable; assure acompetent public health and personal health care workforce; evaluate effectiveness, accessibility, and qualityof personal and population-based health services; and conduct research for identifying new insights andinnovative solutions to health problems (Public Health Functions Steering Committee 1995).COSMOS Corporation, December 2003 1-5
Professions Education Partnership Act of 1998 (Public Law 105-392)—has since served asthe focal point within the Department for the implementation and monitoring ofrecommendations originating from the Report of the Secretary’s Task Force, and forproviding leadership and coordination of an accelerated national assault on the persistenthealth disparities between racial and ethnic minorities and the rest of the U.S. population.In response to the persistent health disparities experienced by the nation’s minoritypopulation and in keeping with its mission, OMH funded the CLAS in LPHAs project todevelop a self-assessment tool that could be used by LPHAs to gather data which providesa description of their organizational CLAS provision. This tool was designed to assistLPHAs in their quality monitoring and improvement efforts. Using the tool will helpLPHAs to develop appropriate policy and programmatic responses that meet the uniquehealth needs of the culturally and linguistically diverse populations they serve. Given thatthis was a first attempt to develop a comprehensive self-assessment tool to measure CLASwithin LPHAs, it was important to use a conceptual framework that represents acomprehensive set of essential CLAS components across the health care continuum. Thus,the project employed the CLAS conceptual framework and its corresponding instrumentsand protocols previously developed and tested in OMH’s CLAS in MCOs study (OMH2003b).The CLAS in MCOs study was completed in 2003, but was initiated prior to thedevelopment and release of the national recommended standards for CLAS. The CLAS inMCOs study produced a conceptual framework that identifies the essential components ofCLAS in health care settings across eight assessment domains, as well as a threecomponentinstrument to measure organizational CLAS provision which was tested andimplemented in MCO settings. Study results offer a rich description of the nature andextent of CLAS provision reported by a sample of MCOs in the U.S. In addition,promising CLAS practices reported a number of MCOs are highlighted. The study’s fullreport (that includes the CLAS conceptual framework, the study design and data collectionmethods and instruments, and study results) is available at the OMH Internet web site. 4As described above, this project to develop a CLAS self-assessment tool for LPHAs isgrounded in the successes and lessons learned from the MCOs study. The CLASconceptual framework and the three-component instrument were revised for this projectbased on lessons learned during the conduct of the MCOs study and were modified to beappropriate for implementation in LPHA settings.An important project objective was to educate health professionals in LPHAs abouttheir organizational CLAS practices. The goal was to design a self-assessment tool whichinforms LPHAs during the course of data collection by including a broad range of response4 http://www.omhrc.gov/inetpub/wwwroot/cultural/whatsnew.htm.COSMOS Corporation, December 2003 1-6
Page 1 and 2: Developing a Self-Assessment Toolfo
Page 3 and 4: ContentsChaptersPage1. Introduction
Page 5 and 6: Chapter 1Introduction
Page 7 and 8: While many LPHAs currently provide
Page 9: LPHAs include: adult and child immu
Page 13 and 14: Chapter 2Methodology for Developing
Page 15 and 16: Public Health Practice Program Offi
Page 17 and 18: assess their own beliefs and have k
Page 19 and 20: communicate with, and clearly under
Page 21 and 22: 2.1.6 Identifying Key Components of
Page 23 and 24: Given these persistent disparities
Page 25 and 26: (Exhibit 2-2, Continued)DOMAIN / KE
Page 27 and 28: limited to the actual clinical enco
Page 29 and 30: Chapter 3Project Results and Recomm
Page 31 and 32: local board of health. PEP and PAG
Page 33 and 34: numerous promising CLAS practices a
Page 35 and 36: References
Page 37 and 38: Becker, M.H., and L.A. Maiman, “S
Page 39 and 40: Frye, B., “Health Care Decision M
Page 41 and 42: Marin, G., “Defining Culturally A
Page 43 and 44: Perkins, Jane, “Overcoming Langua
Page 45 and 46: U.S. Bureau of the Census, “Censu
Page 47 and 48: Appendix AMembership Lists of the P
Page 49 and 50: Appendix A-1Developing a Self-Asses
Page 51 and 52: Appendix A-2Developing a Self-Asses
Page 53 and 54: Appendix B-1Overview of Eight CLAS
Page 55 and 56: Domain 3: Culturally Inclusive Heal
Page 57 and 58: understanding of diversity issues i
Page 59 and 60: Appendix B-2Conceptual Framework fo
Page 61 and 62:
Appendix CLPHA Director or Designee
Page 63 and 64:
Pre-Interview Script for LPHA Direc
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3b. Which of the following are refl
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6. Does your agency have a formal p
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10. Which of the following describe
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Post-Interview Script for LPHA Dire
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Appendix DStaffing Questionnaire
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A. QUALITY MONITORING AND IMPROVEME
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B. MANAGEMENT INFORMATION SYSTEMS (
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7. Please indicate, if you know, th
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1c. Please indicate for which categ
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6. Please indicate for which catego
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10. Which of the following topical
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17. Which of the following benefits
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4. Which of the following strategie
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Appendix EClient Services Questionn
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A. QUALITY MONITORING AND IMPROVEME
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6b.Which of the following community
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3. Please report or estimate what p
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3. Which of the following practices
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Oral Interpretation Services10. Whi
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16. At which of the following key e
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3. Which of the following kinds of
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Appendix FPilot Test Response Form
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RESPONDENT EVALUATIONOF THE QUESTIO
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Appendix GCLAS in MCOs Study Data C
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position, as titles will likely var
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complex and uncertain at the time t
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1. Incorporate a confirmation pre-c
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Exhibit 2DATA COLLECTION PROCESSSen
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