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

4. From which of the following additional groups does your agency utilize input on policies related toservices specifically for culturally and linguistically diverse groups?MARK ALL THAT APPLY~ State Department of Health~ Other State agency~ Management and supervisors within your local health agency~ Physicians, nurses, other clinical staff~ Client services staff~ Front line personnel (appointment clerks, receptionists, secretaries)~ Information specialists~ Local community leaders and liaisons involved with community health issues and networks~ Faith-based organizations representing local communities~ Civic organizations representing local communities~ Consumer or advocacy groups~ Other, please specify _____________________________________________~ Don’t know~ None of the above~ Declined5. Does your agency conduct periodic needs assessments of community and/or clients’ needs?~ Yes ! go to 5a~ No ! go to 6~ Don’t know ! go to 6~ Declined ! go to 65a. Do these assessments include a component that specifically measures the need for culturallyand linguistically appropriate services?~ Yes~ No ! go to 6 ~ Don’t know~ Declined5b. Which of the following sources does your agency use to assess the need for culturally andlinguistically appropriate services (for clients or service area)?MARK ALL THAT APPLY~ U.S. Census data~ Client utilization data~ Data from school systems and community organizations~ Focus groups research~ Other, please specify _____________________________________________~ Don’t know~ DeclinedCOSMOS Corporation, December 2003 5