Transcript Slide 1

An Overview: Strategies for HIV/AIDS Providers
Co-Presented by: Tawara D. Goode, MA, Director, National Center for Cultural Competence (NCCC)
Wendy Jones, M.Ed.,. MSW, Director, NCCC, Children and Youth with Special Health Care Needs Project
Georgetown University Center for Child and Human Development
National Center for Cultural Competence,
Georgetown University Medical Center
At the completion of this webinar each
participant will:
 state the importance of the 14 CLAS Standards
and their relevance to HIV/AIDS care and
treatment.
 identify at least one implementation strategy
relative to HIV/AIDS care and treatment for each
of the 14 Standards.
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Part 2 of this Webinar series discusses Standards 6-14 and
strategies organizations and their personnel might pursue
to implement CLAS.
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We will use a case study to illustrate various points.
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This Webinar series is designed to increase your
awareness and knowledge of how you deliver care that is
responsive to the cultural and linguistic characteristics of
populations impacted by HIV/AIDS.
Ensure the competence of
language assistance
provided to limited English
proficient clients/consumers
by interpreters and bilingual
staff.
Family and friends should
not be used to provide
interpretation services
(except on request by the
client/consumer).
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Use professional medical interpreters or
trained and qualified bilingual/multilingual
staff or volunteers.
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Use telephone or video interpreting
technology as an alternative to on-site
interpretation, especially for low incidence
languages.
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The organization should critically review and keep
abreast of the evidence against using family,
friends, minors, and untrained interpreters in the
provision of health and mental health care and
related services and supports.
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Use this evidence to inform policy and procedures
as to whom can provide interpretation services for
the health/mental health care organization.
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The organization must have established policy and specific
procedures to assess the competency of staff, contractors,
and volunteers providing language access services. This
may include assessment of:
 English and foreign language proficiency.
 Knowledge of health and mental health terminology and key
terms specific to HIV/AIDS (e.g. terms for sexual practices and
behaviors, substance abuse, medical procedures, medications).
 Awareness of colloquialisms used by cultural groups (e.g.
slang, street terms).
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The organization must have established policy and specific
procedures to assess the quality of language access services.
 Assess patient/client and provider satisfaction with the
accuracy and quality of interpretation services received.
 Analyze patient/client and provider satisfaction data to inform
quality improvement efforts.
 Inform patients/clients and staff how data will be used to
improve services and supports.
 Ensure that the organization’s contracts for interpreters and
translators have quality provisions.
Make available easily
understood, client-related
materials, and post signage
in the languages of the
commonly encountered
groups and/or groups
represented within the
service area.
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Develop and/or adapt patient/client materials and resources
that address the literacy and health literacy of the patient
populations served.
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Design alternative approaches to provide information to
those patients/clients who may neither be literate in English
nor their language of origin.
 Provide training to staff in the use of literacy and health
literacy tools and strategies (e.g. REALM-SF, SAHLSA-50,
“Teach Back,” “Ask Me 3,” & “Plain Language”) to assess and
respond to patient needs.
Develop, implement, and promote a written strategic plan
that outlines clear goals, policies, operational plans, and
management accountability/oversight mechanisms to
provide culturally and linguistically appropriate services.
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Integrate the delivery of culturally and linguistically competent
HIV/AIDS care, treatment, and related services into the
organization’s strategic plan. The strategic plan should include
implementation of all CLAS standards.
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Involve people living with HIV/AIDS across demographic groups,
their families, and advocates in the development of the strategic
plan (e.g. race, ethnicity, culture, age, gender, gender identity,
sexual orientation, socio-economic status, education).
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Ensure that the plan includes establishment of a work group or
team responsible for the provision of culturally and linguistically
competent, care, treatment, and related services to all
patients/clients, including those with HIV/AIDS and their families.
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Set SMART goals and objectives for the delivery of HIV/AIDS
care, treatment and related services.
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Report to the organization’s board, staff and patients/clients
on progress towards meeting these goals and objectives.
Conduct initial and ongoing organizational
self-assessments of CLAS-related activities.
(Organizations) are encouraged to integrate
cultural and linguistic competence-related
measures into their internal audits,
performance improvement programs,
patient satisfaction assessments, and
outcomes-based evaluations.
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Establish a structure and dedicate resources (personnel and fiscal)
to plan and conduct CLAS-related self-assessment activities.
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Identify and select instruments, tools, data sources, and processes
for self-assessment of CLAS-related activities. Embed measures
for cultural and linguistic competence in the organizations internal
auditing, evaluation, and quality improvement processes.
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Collect and analyze data from multiple sources. Develop
reports and data summaries. Share findings with staff,
patients/clients, board members, and contractors. Discuss
their implications for policy, practice, and community
engagement.
Ensure that data sharing processes and reports are accessible to
patients/clients (in plain language) and are provided in multiple
formats (translation, oral presentations, large print/Braille).
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Monitor data that demonstrate the degree to which the
organization as a whole, and individual
departments/programs, are progressing toward the goals
and objectives of the strategic plan for cultural and linguistic
competence.
Ensure that data on the
individual client's/consumer's
race, ethnicity, and spoken
and written language are
collected in health records,
integrated into the
organization's management
information systems, and
periodically updated.
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The organization’s information systems should have the
capacity to collect data on race, ethnicity, and language.
Capacity should include, but is not limited to:
 Patients’ or clients’ primary language (written, spoken, &
sign) , and preferred language for service delivery.
 Need for an interpreter.
 English language ability (i.e. ability to speak, read, and
understand English).
 Literacy and health literacy levels.
Communicate (in writing and verbally) the organization’s policy and
practices for confidentiality to all patients.
Inform patients/clients that they have the option to share or not
share racial, ethnic, and language data, and that their choice will
not in any way affect their ability to receive services.
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Advise patients/clients that data collected will be used
to improves services and reduce disparities in health
and health care based on race, ethnicity, and language.
Determine the extent to which the collection of granular data
will enhance service delivery to patient populations. Granular
data based on cultural factors may include sexual orientation,
gender, gender identity or expression, country of origin, cultural
identity.
Maintain a current demographic, cultural,
and epidemiologic profile of the community
as well as a needs assessment to accurately
plan for and implement services that
respond to the cultural and linguistic
characteristics of the service area.
Ensure that policy, procedures, and practices are in place to monitor:
 current and emerging demographic trends in the geographic area
served (e.g. race, ethnicity, languages spoken, age, immigrant and
refugee data).
 incidence, prevalence, and future projections for HIV/AIDS in the
service area. (e.g. age, gender, gender identify, sexual orientation,
race, ethnicity, country of origin).
Analyze these data to determine their implications for planning,
delivering, and evaluating culturally and linguistically competent
services and supports. Update periodically.
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Conduct asset and need assessments of the geographic area to
determine the range of community resources that provide services
and supports to people living with HIV/AIDS. Attend to the
capacity of the community based resources to address culture,
language, sexual orientation, gender identity or expression, and
other characteristics of the population of people living with
HIV/AIDS.
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Consult the National Minority Quality Forum (www.nmqf.org)
website for current epidemiological data based on zip code.
Develop participatory, collaborative
partnerships with communities, and utilize a
variety of formal and informal mechanisms
to facilitate community and client/consumer
involvement in designing and implementing
CLAS-related activities.
Ensure that the organization’s:
 mission values communities as essential allies in achieving
its overall goals.
 policy, procedures, and practices delineate community and
consumer and participation in planning, implementing, and
evaluating services and supports for people living with
HIV/AIDS.
 policy and procedures allow the provision of fiscal resources
and in-kind contributions to community partners, agencies
or organizations.
 policy, procedures, and practices support community
engagement in languages other than English.
Data Source: Goode, T. (2001). Policy Brief 4 – Engaging Diverse Communities: Culturally Competent Approaches. National
Center for Cultural Competence. Retrieved from http://nccc.georgetown.edu/documents/ncccpolicy4.pdf
Suggested community and patient/client engagement strategies include but are not limited to:
 Determine areas of mutual interest, benefit, and collaboration for partner organizations
and agencies.
 Legitimize formal partnerships with memoranda or agreements.
 Collaborate with partners, where appropriate, to achieve goals, objectives, and desired
outcomes in the provision of culturally and linguistically competent care to people living
with HIV/AIDs and the communities in which they live.
 Establish a structure for collaborative activities and resource sharing specifically for the
provision of services and supports to people living with HIV/AIDS (e.g. referral network,
exchange of best practices and lessons learned, joint grant proposals, shared patient
education and related materials, joint training/professional development).
 Issue joint reports on the outcomes of collaboration to partnering organizations, their
boards, staff and patients/clients, and to the community at large.
 Assess satisfaction with partnerships and revise partnering agreements as appropriate.
 Identify and collaborate with informal, natural networks of support within culturally diverse
communities to enhance services and supports to people living with HIV/AIDS.
 Ensure patient/client voice and choice to plan, implement, and evaluate collaborative
efforts (e.g. community engagement, public education, health fairs, representation on
boards, media campaigns, training/professional development, HIV clinical trials and
participation in research).
Ensure that conflict and grievance resolution
processes are culturally and linguistically
sensitive and capable of identifying,
preventing, and resolving cross-cultural
conflicts or complaints by
clients/consumers.
Suggested approaches for conflict and grievance resolution include, but are not
limited to:
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Obtain patient/client and staff input to craft grievance policy and process.
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Create a policy and process that is responsive, inclusive, and equitable and that
leads to prompt resolution of grievances in a culturally and linguistically
responsive manner. At a minimum, the process must address literacy, English
ability, individuals with disabilities, and unfamiliarity or reluctance of some
cultural groups to make formal complaints.
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Ensure that the organization’s data system has the capacity to document and
track complaints, their status, and resolution for both patients/clients and staff.
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Provide training to all new staff on the grievance policy and process. Ensure all
staff, volunteers, patients/consumers are informed of the policy and process.
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Update the grievance policy and process as appropriate.
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Consider using an ombudsperson in the resolution of grievances where
appropriate. The ombudsperson should be knowledgeable of the cultural
and linguistic contexts in which services are delivered and the population
served. Additionally, the ombudsperson should be experienced in
working with interpreters (sign and foreign language).
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Provide notice to patients/clients in a prominent location on how to file a
grievance. Include assurances that patients/clients have the right to file
grievances without fear of recriminations. Notices should be written in
the languages of the populations served.
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Monitor adherence to the grievance procedures, including tracking
resolution rates, as part of the overall quality improvement process.
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Assess patients’ or clients’ satisfaction with grievance processes as part
of the overall periodic patient satisfaction query efforts.
Regularly make available to the public
information about their progress and successful
innovations in implementing the CLAS
standards, and provide public notice in (the
organization's) communities about the
availability of this information.
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Disseminate progress toward implementing CLAS to diverse
constituents on at least an annual basis. Dissemination may include a
variety of formats and audiences including:
(1) reports tailored for staff, patients/clients, board members, or
community partners
(2) presentations for community meetings/forums;
(3) multimedia displays in waiting areas;
(4) website postings, and
(5) use of ethnic media such as radio and newspapers.
Case Study
Appropriateness of Family Members Serving as Interpreters
Matilde, a 42 year old Latina, reported for the results of her HIV test
three months after being tested. She has limited ability to speak and
understand English, so she brought her two teenage sons, Miguel
and Javier along to interpret for her. The clinic neither has bilingual
staff nor contract interpreters. The counselor feels uncomfortable
about sharing the results of Matilde’s HIV test with her two sons but
has no other way to communicate the results. As the counselor
begins to inform the sons that their mother has tested positive for
HIV, Miguel begins to cry. Javier, interprets the results to his mother,
and accuses her of sexual promiscuity. What are some of the issues
that are reflected in this case study? Which of the CLAS Standards
could provide guidance in addressing this situation?
As a culturally competent
I am capable of interacting positively with
people who do NOT
look like,
talk like,
move like,
think like,
believe like,
act like,
live like...
ME!!!
Data Source Multnomah County Department of Health.
Slide Source: National Center for Cultural Competence, 2011
Modification from Mike Magy,
Massachusetts Department of Mental Health, November 2005 .
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AETC NMC at Howard
University
Office of Minority Health
National Center for Cultural
Competence
Center for Multicultural Mental
Health
National Minority Quality
Forum
The Cross Cultural Healthcare
Program
DiversityRx
Ethnomed
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www.aetcnmc.org
www.omhrc.gov
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http://nccc.georgetown.edu/
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www.cmmh-cmtp.com/index.php
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www.nmqf.org/
www.xculture.org/
www.diversityrx.org
www.ethnomed.org
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National Center for Cultural Competence,
Georgetown University Medical Center