Making CLAS Happen A Guide to Implementing Culturally and Linguistically Appropriate Services (CLAS) Hello, thank you for coming! Introduce myself Rodrigo Monterrey, Deputy Director DPH-Office of Health Equity

Why CLAS? Despite multiple public- and private-sector initiatives to address health inequities and disparities in access and health care, progress has been slow, and problems with equity and disparities persist. Among the many factors related to health inequities, CLAS has been recognized as one of the more modifiable factors, with the goal of improving the quality of care received and reducing the resulting disparities experienced by racial and ethnic minorities and other underserved populations (Saha, Beach and Cooper, 2008).

Objectives WHAT: Define CLAS WHO: Define DPH’s role in monitoring and supporting vendors’ efforts HOW: Continuous Quality Improvement (PDSA) Activities and expectations of vendors Resources and tools

What is CLAS? CLAS: Culturally and Linguistically Appropriate Services Federal service-provision guidelines Leadership/Workforce (Standards 2-4) Language/Communication (Standards 5-8) Accountability (Standards 9-15) A PMQI Tool

Handout #1 Leadership/Workforce Language Access Accountability Let’s look at the standards: None of them are new—crosswalk of ADA, JACHHO, Civil Rights, etc. Put into a framework for programs to keep track Language Access Accountability

https://www.polleverywhere.com/multiple_choice_polls/pWDnDeQMUrrggqm

Are CLAS Standards Mandatory? For DPH-contracted vendors, YES. All are expected to work throughout the life of their contract to meet the standards.

15 CLAS Standards What do these standards do? Contribute to the elimination of health disparities Make services more responsive to the individual needs of clients Support vendors to create culturally-competent organizations and systems Let’s take a look at them…HANDOUT #1 The CLAS standards were developed over a decade ago with considerable input from key stakeholders CLAS has expanded to include people with Disabilities, LGBTQ, etc.

Health Disparities / Inequities Definition: Differences between populations in: Rates of disease Access to health care Health outcomes “Health Inequities” explains that these differences are unjust and preventable

Health Disparities / Inequities Causes: Social, economic, and environmental factors Barriers to getting health care Differences in quality of health care

Health Disparities / Inequities Example: ASK: Why is it important to look at health disparities between diverse population groups? “In health matters, place matters.”

Cultural competence Culture: a shared set of values and behaviors that define a population Competence: a baseline of competence to ensure effectiveness A “baseline” set of values, policies and practices that allow organizations to be effective working with diverse populations Half the group define CULTURE Other half define COMPETENCE

DPH and CLAS: Brief History MA received Federal grant to implement CLAS Standards in health services in FY05 CLAS language added to DPH RFRs in FY07 CLAS language added to contract renewals in FY12 The PTS system requires that all contract renewals include the CLAS Self-Assessment, starting in FY16 DPH must now support and monitor vendors’ CLAS implementation efforts through contract management

DPH and CLAS: RFR Question Standard Question #8: Federal standards direct agencies to deliver effective, understandable and respectful care that is provided in a manner compatible with a client’s cultural health beliefs and practices and preferred language. Please describe your program’s strategies for delivering culturally competent and linguistically appropriate services. For assistance in developing strategies to provide culturally and linguistically appropriate standards of care, please see the Cultural and Linguistic Appropriate Services Standards and Guidelines attachment available at the Comm-PASS Specifications screen. How many of you have been involved with writing and/or reviewing an RFR?

DPH and CLAS: Contract Renewals

Procurement Tracking System (PTS)  

How is CLAS integrated? Over time… CLAS is not a checklist—it is a framework for Continuous Quality Improvement Most providers are already doing CLAS-related things, such as using interpreters, even if they don’t call it CLAS Ongoing, incremental implementation, with annual goals over the term of contract

How do we monitor CLAS? Contract Managers… Ask vendors to complete new Self-Assessment annually Designate CLAS champion Identify priorities Define goals and make a plan Support and monitor your efforts annually, during site visits and performance reviews, contract renewals

Handout #2: Self Assessment Tool The tool (HANDOUT #2), is part of the RFR and has three parts: Part 1: Agency info and CLAS Point person (this is useful for CM to assist programs who may not know what their agency is doing re: CLAS) Part 2: The questions (these cover each of the standards and are meant for programs to look at themselves, not to be scored by DPH) Part 3: The priority and workplan (this is what the program and the CM review on an ongoing / yearly basis)

Framework for CQI Plan Do Study Act: Rapid-cycle process improvement

Workplan Section Approach this section using PDSA: Goal: must address a challenge Activity: something concrete you can implement tomorrow and track for the next 6-8 weeks Measure: did it solve or improve the issue? The tool (HANDOUT #2), is part of the RFR and has three parts: Part 1: Agency info and CLAS Point person (this is useful for CM to assist programs who may not know what their agency is doing re: CLAS) Part 2: The questions (these cover each of the standards and are meant for programs to look at themselves, not to be scored by DPH) Part 3: The priority and workplan (this is what the program and the CM review on an ongoing / yearly basis) System change: keep it? tweak it? build upon it?

The Making CLAS Happen Manual Aims to guide public health agencies of all sizes as they put CLAS standards into action Can be ordered through the MA Clearinghouse Or downloaded from the DPH website www.mass.gov by searching for “CLAS”

Making CLAS Happen Six Areas for Action: Foster Cultural Competence Build Community Partnerships Collect Diversity Data Benchmark (Plan and Evaluate) Reflect and Respect Diversity Ensure Language Access 23

Making CLAS Happen Manual Manual Introduction, page 9.

Technical Assistance and Support: Rodrigo Monterrey CLAS Coordinator DPH-OHE 250 Washington St. Boston, MA 02108 rodrigo.monterrey@state.ma.us 617-994-9806 (office) 617-938-4024 (cell-phone) Hand out / Collect Workshop Evals

Questions? Thank you!