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

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Appendix B-1Overview of Eight CLAS DomainsDomain 1: Organizational GovernanceThis domain is intended to measure the extent to which a commitment to providingservices that address the specific needs of culturally and linguistically diverse populationsis reflected through the organization’s governing structures and bodies. The existence ofcommittees, staff positions, and advisory boards that focus specifically on racial, ethnic,cultural, and linguistic minority health care issues indicates a level of formalization andcommitment to health care quality by the organization.Similarly, decision-making bodies within an organization should reflect the cultural(including racial and ethnic) composition of the population served by the organization(Cross et al. 1989; Roberts et al. 1990). By representing the community within thegoverning bodies, the needs of the community will likely influence policy formation anddecision making, thereby rendering services that meet the particular needs of communitymembers (NLBHW 1996; Roberts et al. 1990).Domain 2: CLAS Plans and PoliciesThe types of formal policies in place that express a commitment to diversity alsoindicate a certain organizational commitment to providing quality health services to diversepopulations. Policymakers and health plan executives may set a standard of culturalcompetence, cultural sensitivity, and responsiveness by incorporating such goals into theirorganizations’ written mission statements (Cross et al. 1989). Similarly, formal policiesmay be developed and implemented which govern translation and interpretation servicesprovided by the organization. Such policies set organizational standards and protocols forservice delivery, which in turn improve the quality of care at the service level.Moreover, utilizing staff and community input on CLAS-related planning and policydevelopment is important for understanding the needs of staff and patients and effectivelyaddressing those needs, thereby improving overall health care quality. Communityadvisory boards are useful to health care organizations, including MCOs, for designing andconducting community needs assessments, planning and designing services, monitoringand evaluating quality of services, and developing organizational protocols and policies foraddressing the needs of culturally and linguistically diverse populations.COSMOS Corporation, December 2003 B-1
Domain 3: Culturally Inclusive Health Care Environment and PracticesThis domain captures characteristics of care that are related to (non-communication)cultural barriers experienced throughout the health care continuum. 1 In this sense, patientcare is not limited to services provided during the clinical encounter. Rather, key elementsand study variables under this domain include conditions and services provided thataddress cultural barriers across the continuum of care.The cultural barriers that exist between providers and patients can be reduced oreliminated through the implementation of culturally appropriate services (Julia 1992;Lieberman 1990; Marin 1993; Moore 1992; Redmond 1990). Such services requireproviders who are knowledgeable about the cultures of their patients, i.e, their customs,beliefs, and languages (Clermont et al. 1993; Dillard et al. 1992; Fernandez-Santiago 1994;Krajewski-Jaime 1993; Pruegger and Rogers 1994; Redican 1994). Effective assessmentand treatment require a sensitivity to, and recognition of, cultural patterns related to foodpreferences, spiritual beliefs, and health practices in order to develop a practical treatmentregimen that will result in compliance. Also, health care organizations may encouragetheir providers to utilize diverse or complementary clinical practices during patientassessment and treatment (e.g., using acupuncture or acupressure treatments, prescribingherbal therapies, or collaborating with culturally-specific healers).The physical environment also is important to patients’ level of comfort and trust.The signage, graphics, and brochures in service areas may reflect the racial, ethnic,cultural, and linguistic composition of the populations served. Similarly, culturallysensitive strategies may be implemented to improve patient care for diverse populations.These strategies may include offering dietary options in food service areas that reflect thecultural beliefs and behaviors of the populations served, or offering facilities or services toaccommodate diverse religious faiths.Domain 4: Quality Monitoring and Improvement (QMI)This domain captures an organization’s processes and strategies for monitoring andimproving quality of services provided to culturally and linguistically diverse populations.Community and staff needs assessments are conducted to determine appropriate programsand services for implementation (Cross et al. 1989). Routine assessments and evaluationsmay be employed to continually monitor and improve quality of services. QMI activitiesthat are typically used by organizations to improve health care quality are covered in thisdomain and include: consumer satisfaction surveys, grievance and complaint tracking,1 Characteristics of care related to communication barriers (across the health care continuum) arecovered in Domain 8 (Communication Support).COSMOS Corporation, December 2003 B-2
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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 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: Appendix B-1Overview of Eight CLAS
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
Page 73 and 74: Appendix DStaffing Questionnaire
Page 75 and 76: A. QUALITY MONITORING AND IMPROVEME
Page 77 and 78: B. MANAGEMENT INFORMATION SYSTEMS (
Page 79 and 80: 7. Please indicate, if you know, th
Page 81 and 82: 1c. Please indicate for which categ
Page 83 and 84: 6. Please indicate for which catego
Page 85 and 86: 10. Which of the following topical
Page 87 and 88: 17. Which of the following benefits
Page 89 and 90: 4. Which of the following strategie
Page 91 and 92: Appendix EClient Services Questionn
Page 93 and 94: A. QUALITY MONITORING AND IMPROVEME
Page 95 and 96: 6b.Which of the following community
Page 97 and 98: 3. Please report or estimate what p
Page 99 and 100: 3. Which of the following practices
Page 101 and 102: Oral Interpretation Services10. Whi
Page 103 and 104: 16. At which of the following key e
Page 105 and 106:
3. Which of the following kinds of
Page 107 and 108:
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
Page 115 and 116:
complex and uncertain at the time t
Page 117 and 118:
1. Incorporate a confirmation pre-c
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Exhibit 2DATA COLLECTION PROCESSSen
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