 Ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.  Culturally and Linguistically Appropriate Services (CLAS) standards are:  Developed as a means to correct inequities  Intended to be inclusive of all cultures  Aimed to contribute to the elimination of racial and ethnic health disparities

 Developed by the US Department of Health & Human Services’ Office of Minority Health in 1997  Published standards in 1999 for comment  Final form published in 2000

 Culturally Competent Care (Standards 1-3)  Language Access Services (Standards 4-7)  Organizational Supports for Cultural Competence (Standards 8-14)

 CLAS Mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7)  CLAS Guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13)  CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14)

 Standard 4 – Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at not cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.  Standard 5 – Health care organizations must provide to patients/ consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

 Standard 6 – Health care organizations must assure the competence of language assistance provided to limited English proficient (LEP) patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).  Standard 7 – Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.

 Standard 1 – Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language  Standard 2 – Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.

 Standard 3 – Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.  Standard 8 – Health care organizations should 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.

 Standard 9 – Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.  Standard 10 – Health care organizations should ensure that data on the individual patient’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.

 Standard 11 – Health care organizations should maintain a current demographic cultural, and epidemiological 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.  Standard 12 – Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.

 Standard 13 – Health care organizations should 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 patients/consumers.

 Standard 14 – Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.

 Role of scheduler  Role of office staff  Role of nurses  Role of providers

 Identify patients with limited English proficiency during appointment scheduling and document the language needed in the Special Needs field  Determine if an interpreter is needed to schedule the appointment, i.e., a three-way call with a telephone interpreter  Schedule an interpreter for the appointment and make note of it in the appointment.

 Identify patients with limited English proficiency during greeting.  If patient asks for a family member to interpret, a trained medical interpreter should be present as well to ensure accuracy.  Address yourself to the patient, not the interpreter.  Speak slowly, with an even pace, and pause often.  Be prepared to repeat yourself in different words if your message is not understood.  Ask only one question at a time.

 Have a brief pre-interview meeting with the interpreter to clarify goals and roles of the office visit.  Allow introductions of all parties.  Address yourself to the patient, not the interpreter.  Speak slowly, with an even pace, and pause often.  Be prepared to repeat yourself in different words if your message is not understood.  Ask only one question at a time.  All patients respond positively to a calm tone of voice and respectful body language.

 Includes CAM, SLCH, Storz, HealthKey, 4444 Forest Park, Montclair, Chase Park Plaza  Call  Provide scheduler with requested information, including patient name, date of birth, language needed, appointment date, appointment time, scheduling provider, appointment location, and reason for appointment  Covered by Barnes-Jewish Hospital Interpreter Services  Provides Language and American Sign Language interpretation  Interpreters may be available by phone or in person

 LANGUAGE INTERPRETATION  Call  Service provided by the Language Access Metro Project (LAMP)  Identify yourself as a Washington University physician office  Provide scheduler with requested information, including patient name, date of birth, language needed, appointment date, appointment time, scheduling provider, appointment location, and reason for appointment  Interpreters may be available by phone or in person  Regular business hours are: 8am-5pm  Language interpreters are also available after hours at a higher hourly rate

 SIGN LANGUAGE INTERPRETATION  Call  Service provided by Deaf-Interlink  Identify yourself as a Washington University physician office  Provide scheduler with requested information, including patient name, date of birth, language needed, appointment date, appointment time, scheduling provider, appointment location, and reason for appointment  Regular business hours are: 7am-5pm  Sign Language interpreters are also available after hours at a higher hourly rate

 BJH Interpreter Services costs per patient  $27.57/encounter – Language interpretation  $47-$87/hr – Sign Language

 LAMP (Language interpretation only)  Costs per patient  Rates (minimum onsite charge of 1 hour, minimum telephone charge of 30 minutes, then charged per quarter hour)  $38/hr: Mon-Fri (8am-5pm)  $46/hr: Weekend (8am-5pm)  $46/hr: 6am-8am and 5pm-11pm  $54/hr: 11pm-6am  No-show/Late Cancellation Fee is based on a one hour rate as described above  Mileage of $0.48/mile will also be charged

 Deaf Inter-Link (Sign Language Interpretation only)  Costs per patient  Rates* (minimum charge of 2 hours)  $57.50-$65/hr: Mon-Fri (7am-5pm)  $80-$90/hr: 5pm-11pm and Weekends (7am-11pm)  $105-$120/hr: 11pm-7am and holidays from 5pm eve to 7am the morning after  No-show/Late Cancellation Fee is based on a two hour rate as described above  Late scheduling fee of $40 for requests with less than 48 hours notice

 Level 4 or 5 required for medical/mental health office visits per Missouri law (5 CSR )  Level 4 – Advanced Skills  Routine medical office visits  Routine mental health visits  Level 5 – Comprehensive Skills  Serious medical situations (complicated medical procedures or surgeries, life-threatening health problems, Obstetrics)  Serious mental health visits