Analysis: The Enhanced National CLAS Standards

The Enhanced National CLAS Standards – How to Deliver the Highest Level of Health Care to an Increasingly Diverse Population in the United States

“Health equity is the attainment of the highest level of health for all people”[1]. Presently in the United States individuals from diverse cultural origins cannot access the highest level of health care available just because of factors outside their control like their socioeconomic status, language, education level and the location of medical centers and availability of health services. As the majority of health care interpreters can testify, these translate among other situations into missed appointments because of the lack of transportation, miscommunications between health care providers and

patients, poor comprehension of instructions or understanding of insurance policies, and a number of situations that are unthinkable to people of a higher socioeconomic status.
Although health inequities have emerged due to discrimination in the past and continue in the present, one of the factors that can be relatively easily improved is the supply of services that are responsive to the cultural and linguistic needs of individuals. The cultural diversity among patients needs to be recognized and addressed as well as the individual understanding of particular customs such as the identification of the socioeconomic status, disabilities, sexual orientation, and gender identity.
It is critical that health disparities are at least reduced, if not eliminated, to ensure that patients do not experience negative health outcomes. The detrimental social determinants of health, which include lack of access to good jobs, unsafe neighborhoods, malnutrition and poor transportation, are significant factors that need to be addressed to enable better health care services.
According to the National Center for Cultural Competence, there are different statistics for the number of people that experience different degrees of difficulty speaking English. This number ranges from 4.2%, which translates into 11 million of people, up to 8.1%, which is 21 million people living in the United States, elevated high number that could lead to a cascade of adverse medical and legal effects.. In the health care industry, these individuals are referred to as Limited English Proficiency (LEP) patients. It is estimated that by 2050, the United States will be a “majority minority” nation, which means that more than half the population will be coming from racial or ethnic minority backgrounds; it is anticipated that the percentage of LEP patients will increase dramatically.
In a study published in the International Journal of Health Services, LaVeist, Gaskin, & Richard, (2009) stated that “health disparities and deaths due to inadequate and/or inequitable care cost the U.S. $ 1.24 trillion” in a three-year period from 2003 to 2006[2] Studies have proven that racial and ethnic minorities are more likely to suffer worse outcomes than the general population (Unequal Treatment, Institute of Medicine 2003) during emergency situations resulting from man-made or natural disasters, among other situations.
In response to this health issue, a set of standards known as CLAS, which stands for Culturally and Linguistically Appropriate Services in Health and Health Care, was developed.

The main purpose of these standards is to achieve health equality, and to help eradicate health care disparities by providing a blueprint for both the delivery of services and patient expectations. The Blueprint, was developed for individuals, health care organizations and medical providers in order to deliver medical services that are appropriate from an individual’s cultural and linguistic point of view. The Blueprint includes a list of 15 norms intended to be used as an implementation guide to help provide medical care in the language of the LEP patient and in a manner that is culturally appropriate not only at the doctor’s office but also in emergency

situations.

History
“The U.S. Department of Health and Human Services (HHS) has made a longstanding effort to promote cultural and linguistic competence among health care providers in order to eliminate health disparities”. In this way, providers and organizations not only help to improve health equity but also increase client trust and satisfaction and improve quality and safety. The organizations in turn acquire market advantage and are compliant with legislative and regulatory standards. The issueis complex, however, as many providers are committed to improving cultural and linguistic competence but are not fully knowledgeable about how to do so.
As a result of this effort, “in 2000 the Office of Minority Health published the first National Standards for Culturally and Linguistically Appropriate Services in Health Care (National CLAS Standards), which provided a framework for all health care organizations” [3] to give better services to an increasingly diverse population. These organizations include government health care systems, not-for-profit health care systems, and for-profit health care systems.
After thirteen years of successful implementation, the Office of Minority Health launched an initiative to update the standards to reflect the tremendous growth in the field of cultural and linguistic competency and the increasing diversity of the nation, as well as the previous decade’s advancements. These enhanced standards review issues beyond the traditional definitions of race and ethnicity, in the sense that they are respectful to individual and varied religious beliefs and cultural practices, spiritual needs, traditional family roles and diets. The improved standards take mental health issues into account as well, and they provide guidance for the recognition and treatment of various disorders.
Effective communication is the first step in providing the highest quality of care and services, and it improves health equity at every point of patient contact.

The CLCCHC is a part of the HHS Office of Minority Health and its mission is to work with federal agencies and other public and private organizations to provide the highest quality of services at every point of patient contact. Language Access Services (LAS) are designed to ensure effective communication between LEP patients and English speakers. LAS primarily include translation and interpreting services at the different points of contact that a patient and his/her family goes through when they look for health care services:
1. The initial contact between patient and provider, and appointment scheduling
2. Entering the health care organization and navigating the system
3. Registration or admission upon arrival or via phone
4. Preparation for the visit and filling out various forms
5. Waiting in the lobby and the availability of brochures in different languages
6. Billing
7. Procedures, radiology and lab work
8. Diagnosis and explanation of treatment and discharge plan
9. Assessment and the clinical encounter, including the physical exam
10. Discussion of

referrals
11. Pharmacy
12. Reminders and follow-up communications
13. Patient complaints incident reporting and requesting medical records.
The CLCCHC also promotes competent health care by establishing free online educational programs for physicians, physician’s assistants, nurses, social workers, disaster mental health workers, first responders, including EMTs (Emergency Medical Technicians) and firefighters, oral health physicians, emergency managers, etc. Providers can learn to think differently , leading to changed beliefs and attitudes that over time translate into better treatment for the increasingly diverse US population and to better health outcomes.
Although adherence to CLAS is voluntary, many organizations have committed to some or all of the fifteen standards. It is hoped that providers will come to realize the economic benefit of adhering to the standards, and that the ethical mandate will become imperative as well.