1. 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

2. 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).

3. 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

4. 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

5. 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

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

8. 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.

9. 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

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

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

12. 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

13. 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

14. 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?

15. DPH and CLAS: Contract Renewals

16. Procurement Tracking System (PTS)

17. 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

18. 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

19. 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)

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

21. 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?

22. 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 by searching for “CLAS”

23. 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

24. Making CLAS Happen Manual
Manual Introduction, page 9.

25. Technical Assistance and Support:
Rodrigo Monterrey
CLAS Coordinator
DPH-OHE
250 Washington St. Boston, MA 02108
(office)
(cell-phone)
Hand out / Collect Workshop Evals

26. Questions?
Thank you!