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

1. Does your agency have a mission statement?~ Yes ! go to 1a~ No ! go to 2~ Don’t know ! go to 2~ Declined ! go to 21a. Does your agency’s mission statement express a commitment to provide health care servicesthat are appropriate for the needs of each cultural and linguistic group (represented by yourclients)?~ Yes~ No~ Don’t know~ Declined2. Does your local board of health or other governing body have a subcommittee or other groupresponsible for issues involving services provided to racial, ethnic, and linguistic minority groups?~ Yes~ No~ Don’t know~ Declined3. Does your agency use community advisory boards or other similar entities to address community andclient issues specifically related to the cultural and linguistic groups (represented by your clients)?~ Yes ! go to 3a~ No ! go to 4~ Declined ! go to 43a. Which of the following strategies do you use to recruit members for this community advisoryboard or group?MARK ALL THAT APPLY~ Agency newsletter or publication~ Major regional newspaper~ Community/neighborhood newspapers or publications~ Local bulletin postings (i.e., community centers and other sites)~ Local radio outlets or television broadcasts~ Web sites~ Contact leaders and liaisons involved with community health issues and networks(e.g., consumer groups, advocacy groups, local health officials)~ Other, please specify _______________________________________________~ Don’t know~ None of the above~ DeclinedCOSMOS Corporation, December 2003 3