Promoting Health Literacy through the Office of Minority Health CLAS Standards Guadalupe Pacheco, MSW Project Officer, Think Cultural Health HHS Office of Minority Health

Overview Introduction Health Literacy and the HHS OMH CLAS Standards Health Literacy and the HHS Office of Minority Health

HHS Office of Minority Health Mission: To improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities Develops policies and programs to eliminate health disparities, including the CLAS Standards and the National Partnership for Action to End Health Disparities

HHS Office of Minority Health National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) National Partnership for Action to End Health Disparities The CLAS Standards were developed by OMH in December 2000 as a means to improve access to health care for minorities, reduce disparities, and improve quality of care. There are three themes: Culturally Competent Care, Language Access Services, Organizational Supports The National Partnership: OMH initiative that includes strategies to improve health literacy as a key component of eliminating racial and ethnic health disparities – aims to mobilize and connect individuals and organizations across the country to create a Nation free of health disparities, with quality health outcomes for all people

Health Literacy Determinants of limited health literacy Populations most likely to have limited health literacy Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Who and Why?  Who has low health literacy? And what factors influence health literacy levels? Determinants (Why?): Health care providers who use words that patients don’t understand; Low educational skills; Cultural barriers to health care; Limited English Proficiency (LEP); Age Who?: Older adults; Racial and ethnic minority populations; Those who have low socioeconomic status; Medically underserved people; LEP populations Source: HHS 2010

Health Literacy Health literacy affects quality of care Disproportionate impact on Limited English Proficient individuals and racial and ethnic minorities Grave implications for health outcomes for diverse communities Health literacy is a critical determinant of a person's ability to navigate the health care system, fill out forms, share personal information and health history, locate providers and services, and engage in self-care and chronic disease management. In these ways, health literacy fundamentally impacts patient-provider interactions and quality of care. Limited health literacy is linked to poor health outcomes, such as lower use of preventive services and higher rates of hospitalization. As this burden disproportionately affects racial and ethnic minorities, it is a major contributor to the prevalent racial and ethnic health disparities faced by our nation’s diverse communities. Source: HHS 2010

Health Literacy and the HHS OMH CLAS Standards National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) Culturally Competent Care Language Access Services Organizational Supports The CLAS Standards are a set of recommendations, guidelines and mandates for the healthcare workforce to help improve access to health care for minorities, reduce disparities, and improve quality of care.

Health Literacy and the HHS OMH CLAS Standards Culturally Competent Care Patient-centered care Fact-centered vs. attitude/skill-centered approach Disease vs. illness Language Access Services Interpersonal communication best practices Strategies to provide language access services Interpretation and translation Organizational Supports Training staff in cultural competency Collecting patient data Community partnerships There are currently 14 standards which are divided into 3 themes. Culturally Competent Care – Standards 1-3 – refers primarily to the relationship between providers and patients/clients, and the delivery of culturally competent care to patients and their families by individual or collective health professionals. Language Access Services (LAS) – Standards 4-7 – focus on facilitating communication during all points of contact during a patient’s health encounter/experience. LAS also refers to educating community members about their rights and services Organizational Supports – Standards 8-14 – focus on policies and procedures to help health providers and staff provide effective services to the community at every point of patient contact.

Health Literacy and the HHS OMH CLAS Standards Enhancement Initiative: Fall 2011 Revisiting the CLAS Standards to broaden their scope and advance the field for the next decade. In December 2001, a group of dedicated advocates, policy makers and health practitioners published one of the first concrete documents to provide strategy on how to best serve our diverse populations. Since that time, the National Standards for Culturally and Linguistically Appropriate Services in Health Care have become the cornerstone for many initiatives in both the public and private sectors. Ten years later, there has been a proliferation of standards, recommendations, research and case studies in the area of CLAS and patient care. In an era of health care reform, greater diversity than ever and evidence based best practices – it is time to revisit the National Standards to broaden their scope, tighten their influence and advance the field for the next decade. The Enhancement Initiative will involve extensive stakeholder dialogue, subject matter expert input, and public comment opportunities, as well as a comprehensive “State of the Field” report. The revised CLAS Standards will have a broader scope to reach the myriad of health professionals that serve diverse communities and to address the many determinants of health, such as health literacy. These enhancements will advance the field for the next decade of research and discussions regarding culturally and linguistically appropriate services in health care. A session on Enhancing the CLAS Standards was held on Monday evening. Our first public comment meeting will be held on Friday, October 22 at the Baltimore Renaissance Hotel.

Health Literacy and the HHS OMH CLAS Standards Understandable communication to individuals who have low literacy skills is part of culturally and linguistically competent services. Cultural and linguistic competency of health professionals can mitigate the effects of low health literacy. Cultural competency is effectively providing services to people of all cultures, races, ethnic backgrounds and religions in a manner that respects the worth of the individual and preserves their dignity. Cultural and linguistic competency includes communicating effectively with diverse populations that have varying cultural needs, levels of health literacy, or English proficiency In particular, the Language Access Services standards focus on how healthcare providers can help Limited English Proficient individuals increase their health literacy skills in order to give the best care possible Cultural and linguistic competency of health professionals can mitigate the effects of low health literacy

Health Literacy and the HHS Office of Minority Health National Partnership for Action to End Health Disparities Mobilize and connect individuals and organizations across the country to create a Nation free of health disparities, with quality health outcomes for all people A collaborative initiated by the HHS Office of Minority Health

Health Literacy and the HHS Office of Minority Health National Partnership for Action to End Health Disparities Stated strategies to eliminate health disparities include a discussion of improving health literacy and communication The National Plan for Action identifies low health literacy as a risk factor for adverse health outcomes that disproportionately affects racial and ethnic minority populations. In addition, it asserts the value of language access services/cultural competency for those with low literacy skills. It states: “There is a strong need to develop, implement, and evaluate culturally appropriate patient education programs that address the literacy and language needs of racial and ethnic minority populations.” Strategy 9: “Health Communication -- Enhance and improve health service experience through improved health literacy, communications, and interactions”

Health Literacy and the HHS Office of Minority Health National Action Plan to Improve Health Literacy’s goals include: Promote changes in the health care system that improve health information, communication, informed decision making, and access to health services Support and expand local efforts to provide culturally and linguistically appropriate health information services in the community The HHS Office of Minority Health plays an integral role in advancing the goals of the National Action Plan to Improve Health Literacy.

Health Literacy and the HHS Office of Minority Health OMH supports these goals through: CLAS Standards Think Cultural Health: a cultural competency clearinghouse OMH supports these goals through: The 14 CLAS Standards, particularly those that pertain to Language Access Services, complement the national action plan’s strategies to address low health literacy and promote culturally and linguistically competent care Think Cultural Health, an HHS Office of Minority Health initiative, educates health professionals nationwide in cultural and linguistic competency through online continuing education courses and other resources

Health Literacy and the HHS Office of Minority Health Think Cultural Health Continuing education programs that equip health professionals with awareness, knowledge, and skills to treat diverse patients Up-to-date information on issues related to cultural competency and health disparities Tracking of cultural competency legislation around the country The DHHS Office of Minority Health (OMH) has been at the forefront of cultural competency education as a strategy to combat health disparities, developing a suite of cultural competency continuing education programs for health care providers. Think Cultural Health is a cultural competency resource center that houses several continuing education programs and a variety of tools and resources, including the latest State cultural competency legislation. The continuing education programs include curriculum for Physicians (A Physician’s Practical Guide to Culturally Competent Care), Nurses (Culturally Competent Nursing Care), and Disaster Personnel (Cultural Competency Curriculum for Disaster Preparedness and Crisis Response), as well as a health care language services implementation guide. Benefits of OMH CE programs -- Online: can be completed at home, in the office, or any other location with internet access Interactive: self-assessment exercises, pre- and post-tests, analytical responses to real life scenarios Convenient: No need to travel for a class; Courses can be completed 24 hours a day, 7 days a week when users’ schedules permit Free: no cost to any user Accredited: a requirement for licensure and relicensure in some states Learning tailored to the individual: users can proceed through the courses at their own pace, spending more time on areas of individual interest

Summary Health literacy fundamentally impacts quality of care, and limited health literacy among racial and ethnic minorities have grave implications for health outcomes for diverse communities. Cultural and linguistic competency of health professionals can mitigate the effects of low health literacy The HHS Office of Minority Health plays an integral role in advancing the goals of the National Action Plan to Improve Health Literacy.

Office of Minority Health, HHS For More Information www.ThinkCulturalHealth.hhs.gov Guadalupe Pacheco, MSW Project Officer Office of Minority Health, HHS Guadalupe.Pacheco@hhs.gov