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

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Quality Monitoring and Improvement and Data Collection. To measure progress inproviding CLAS, health care organizations should periodically collect quality monitoringand improvement (QMI) data on community characteristics and needs (Cross et al. 1989;Washington State Department of Health 1998). Such QMI self-assessments shouldinclude the organization’s past and present performance in attempting to provide culturallyand linguistically appropriate services across several areas of care (Kim et al. 1992).Patient focus groups and patient satisfaction surveys are examples of methods used formonitoring CLAS quality (NPHHI 1998). Moreover, the routine collection and analysis ofrace and ethnicity data on the populations served is vital for effectively monitoring qualityof care (Kim et al. 1992; NLBHW 1996; NPHHI 1998; Perot and Youdelman 2001; Smith1998).Staff Diversity. Another key component of culturally competent health care ishaving a racially, ethnically, culturally, and linguistically diverse staff (Washington StateDepartment of Health 1998). Such diversity should be reflected at various staff levels andfor various staff types. Although diversity is important regarding staff composition, it maybe even more important that staff reflect or represent the racial, ethnic, cultural, andlinguistic composition of the population served. (Kim et al. 1992). An additional staffingissue related to culturally competent care involves strategies for recruiting and retaining adiverse and culturally competent staff (NLBHW 1996; NPHHI 1998; Texas Department ofHealth 1998b).Staff Cultural Competence Training. In addition to recruitment, another strategy fordeveloping culturally competent staff is to provide them with training. Staff training incultural competence can serve “to enhance total system performance” (NLBHW 1996).Cultural competence training can be provided to staff on a continuous basis and mayaddress such topics as health care issues of specific ethnic groups, concepts of culture andCLAS, and ways to utilize community resources (Cultural and Linguistic Standards TaskForce 1997). Furthermore, policymakers can encourage or require staff training (for allstaff levels) in culturally appropriate service provision and can also set standards for thequality and content of such training (Cross et al. 1989; Washington State Department ofHealth 1998).Linguistic Support Services. Communicating with patients in their own languagehas been shown to improve: patient compliance and understanding of their disease(Manson 1988); patient self-reported well-being and functioning (Perez-Stable et al.1997); and access to primary care and preventive services (Jacobs et al. 2001). Studiesindicate that patients whose main spoken language is not English are less likely to receivetimely eye, dental, and physical examinations (Kirkman-Liff and Mondragon 1991). Also,patients with LEP have been shown to have fewer physician visits (Pitkin Derose andBaker 2000); and are less likely to return for follow-up visits after being seen in theemergency room, when compared to patients with English proficiency (Todd et al. 1993).COSMOS Corporation, December 2003 2-9
Given these persistent disparities in health care, the provision of translated writtenmaterials and oral interpretation services (e.g., bilingual provider or interpreter) to LEPpopulations are essential components of CLAS (NLBHW 1996; NPHHI 1998).2.2 MCOs STUDY CONCEPTUAL FRAMEWORK REVIEW AND REVISIONThe first step in the development of the LPHA CLAS self-assessment tool was forthe project team, OMH staff, and the two project advisory groups to identify a CLASconceptual framework from which the self-assessment tool could be constructed. Sinceone of the objectives of the CLAS in MCOs study was to lay the groundwork andcontribute to the broader field by identifying areas of study that are essential for allassessments of CLAS in any health care setting, the project team and the PEP and PAGmembers recognized the applicability of the CLAS in MCOs study’s conceptualframework to construct the CLAS in LPHAs self-assessment tool. The study domainsidentified in the MCOs study’s conceptual framework comprised independent, mutuallyexclusive categories that allow examination of a broad range of services that can bedescribed as culturally and linguistically appropriate. The eight domains (identified asessential components of CLAS) included:! Organizational Governance;! CLAS Plans and Policies;! Culturally Inclusive Health Care Environment and Practices;! Quality Monitoring and Improvement (QMI);! Management Information Systems (MIS);! Staffing Patterns;! Staff Training and Development; and! Communication Support.The PEP and PAG members reviewed the conceptual framework used in the CLASin MCOs study (see Appendix B). Deliberations centered around the completeness of allpossible types of CLAS. In addition, lessons learned from the MCOs study were used tomodify and improve the framework. Members of the PEP and PAG recommended toadopt the CLAS in MCOs framework, and revise it to be appropriate for the LPHA setting.The (revised) CLAS conceptual framework for LPHAs is provided in Exhibit 2-2.One notable revision was made to the conceptual framework as a result of lessonslearned in the CLAS in MCOs study. A recommendation from the CLAS in MCOs studywas to replace the term “Patient Care” (Domain 3) with a more appropriate term such as“Culturally Inclusive Health Care Environment and Practices.” The term “patient care”was determined to be potentially misleading in that the measures under this domain are notCOSMOS Corporation, December 2003 2-10
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 and 10: LPHAs include: adult and child immu
Page 11 and 12: Professions Education Partnership A
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: 2.1.6 Identifying Key Components of
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
Page 65 and 66: 3b. Which of the following are refl
Page 67 and 68: 6. Does your agency have a formal p
Page 69 and 70: 10. Which of the following describe
Page 71 and 72: 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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