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Workshops
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Workshop
A-2: Evaluating the implementation of CLAS in clinics and health plans
Practical Evaluation of Cultural
Competency in Health Care Organizations:
Community Health Center Application
The US Office of Minority Health standards for culturally and linguistically
appropriate services (CLAS) guide health organizations working to eliminate
health care disparities due to differences in culture and language. Many
health organizations are challenged to evaluate the quality and outcomes
of their CLAS in ways that meet restrictions in budget, time, and need
for real-time data. This workshop will help participants understand how
to use the CLAS standards to develop and apply multiple evaluation methods
to understand cultural competency among the staff and environment in a
community health center.
Participants will be shown how evaluation methods were developed, the
latest results, and lessons learned about applying evaluation for CLAS
in health care. The evaluation team developed and used an organizational
survey, key informant interviews, an observational checklist, and discussion
groups to evaluate the progress of staff and organizational practices
based on the CLAS standards. Staff worked with an external evaluator to
develop measurement tools and procedures, to interpret and summarize findings,
and to train staff on evaluation activities. Measurement activities were
incorporated into existing educational activities and meetings of the
organization.
The cumulative evaluation findings suggest the community health center
made good progress with most of the 14 CLAS standards. Strengths included
the use of bilingual staff to increase availability of health care interpreting
and cultural competency training for clinical and administrative staff.
Diversity trainings for staff showed statistically significant improvement
(P<.05) in four out of eight knowledge items, and three of six skill
items related to serving patients with limited English proficiency (LEP)
(e.g., assessing patients for language and assimilation level). Staff
comments from qualitative measures showed how staff critique their own
service delivery in terms of cultural competence, and provided diverse
recommendations on how to improve organizational practices and cultural
competency training. Some recommendations for improvement were to provide
feedback on interpreting performance of bilingual staff, to increase the
number and type of cultural competency trainings (e.g., HIPAA issues when
serving with limited English patients), to improve the procedures for
using of medical assistants as interpreters in relation to their other
duties, and to increase the use of medical record data to better identify
and serve the needs of patients of different cultures and levels of English
language proficiency.
In the workshop we will show examples and discuss lessons learned for
(1) how to adapt existing tools to the needs and conditions of your organization;
(2) the rationale behind different types of tools used to understand various
aspects of organizational cultural competency; (3) the implementation
of measurement to fit the daily work of staff; and (4) how to summarize,
present and use the results to guide the organization’s strategic
planning, evaluation, and programming. Health care organizations may face
difficulties in evaluating their progress with the CLAS standards. This
workshop will show how such evaluation can be guided by the CLAS standards
and how evaluation can lead to practical recommendations for practices
and policies that may enhance the ability to create more culturally competent
health care environments and services.
Dr. Roussos
is a researcher and educator for community health and health care initiatives,
specializing in behavior change at the community and organizational levels.
Dr. Roussos’s research aims to understand and improve how health
and human services organizations contribute toward eliminating health
disparities, especially among persons with limited English proficiency.
Current work includes projects to improve health care among Latinos migrating
across California and Mexico, preventive services for limited English
persons, and educational strategies to better serve the health and development
needs of culturally and linguistically diverse communities.
Stergios
Roussos, PhD, MPH
Research Assistant Professor, SDSU/GSPH
Center for Behavioral Epidemiology and Community Health
Akouo, Community Scientist
2054 Pinehurst Court
Merced, CA 95340
(209) 723.4399
steve@akouo.org
Dr. Campa,
Chief Medical Officer of Golden Valley Health Centers in Merced, CA, oversees
medical and behavioral health programs in 18 community health centers
in Merced and Stanislaus Counties. Dr. Campa helped to develop Cultural
Positivity, a cultural competency program administered jointly with
the UC Davis-affiliated Family Practice Residency Program at Mercy Medical
Center, Merced. He serves as an advisor and member of national and regional
professional associations and initiatives related to cultural competency
and health policy. For over a decade, Dr. Campa has been actively involved
in medical education, research, and community service with an emphasis
on health care for underserved communities.
David
Campa, MD, MPH
Chief Medical Officer
Golden Valley Health Centers
737 West Childs Avenue
Merced, CA 95340
(209) 383-1848, x 330
dcampa@gvhc.org
Measuring and Reporting the Quality
of Language Assistance Programs in Health Care for Limited English Proficient
Persons
Federal law as well as the laws of many states require health care providers
participating in government funded programs such as Medicaid and Medicare
to provide language assistance to persons with limited English proficiency
(LEP). Recent legislation passed in California (SB 853) will soon require
commercial plans also to provide such services. Apart from the need to
comply with such legal mandates, providing such services makes good business
sense from a customer satisfaction point of view. Therefore, health plans
in the U.S. have implemented various forms of language assistance programs.
This presentation will address two extremely important but controversial
issues relating to these language assistance programs. First of these
is the measurement of the quality of these programs. A brief survey of
methods used for measuring quality of health care programs in general,
and language assistance programs in particular, will first be presented.
These methods will include compliance audits, organizational assessments,
outcome measures, customer satisfaction surveys, balanced scorecard approaches,
complaints analysis, internal reliability analysis, focus groups, critical
incidence technique, and customer expectations-perceptions-value measurements
with SERVQUAL type surveys. Case studies of use of some of these methods
at health plan level as well as at state level, in California, will be
presented.
The second issue that will be addressed is the proper method and format
to present language assistance program capabilities of health plans and
providers to LEP beneficiaries. While many seem to support the idea that
information on availability and quality of language assistance services
is important, there is considerable disagreement on the ideal form and
format of such "report cards". This presentation will present
several forms used and proposed in California and the controversies created
by these proposals resulting in major health plans even refusing to take
part in the project. The paper will recommend a hybrid approach involving
organizational effort and customer satisfaction in generating such reports.
Dr. Gamini
Gunawardane received his MBA and Ph.D. from University of Chicago
and his JD from Western State University in California. He has worked
in the managed health care industry in California for the past eighteen
years as a consultant, IPA administrator, HMO board member and legal counsel.
Currently, he is the Director of Legal & Regulatory affairs and CLAS
Director at Care 1st Health Plan, a primarily Medicaid health plan in
California serving some 200,000 members, which became one of the first
health plans in the nation to adopt the national CLAS Standards as its
guiding policy on services to LEP beneficiaries. In addition to his work
in the USA, Dr. Gunawardane has also worked in various capacities in Thailand,
Zambia and Sri Lanka, and has many publications in reputed journals.
Gamini
Gunawardane, Ph.D., JD
Director, Legal & Regulatory Affairs and CLAS
Care 1st Health Plan
1000 S. Fremont Avenue, Alhambra, CA 91803
626-299-5244
626-458-0415
drg@care1st.com
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