1. An Overview: Strategies for HIV/AIDS Providers Co-Presented by: : Ms. Tawara Goode, MA, Director, National Center for Cultural Competence and Ms. Wendy Jones, Director, Children & Youth with Special Health Care Needs project of the National Center for Cultural Competence National Center for Cultural Competence, Georgetown University Medical Center

2. 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.

3. In 2001 U.S. Department of Health and Human Services, Office of Minority Health, issued a national set of standards designed to:  ensure that all people in this nation’s health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.  correct inequities that currently exist in the provision of health services.  to be inclusive of all cultures and not limited to any particular population group or sets of groups.  contribute to the elimination of racial and ethnic health disparities.

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

5. What are the CLAS Standards? While some are voluntary recommendations, Standards 4, 5, 6, and 7 are mandates under Title VI of the Civil Rights Act of 1964, Section 601, for any health care organization receiving Federal funds.

6. Cultural Competence behaviors attitudes policies structures practices requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally (adapted from Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2011 - National Center for Cultural Competence

7. Five Elements of Cultural Competence Organizational Level value diversity conduct cultural self-assessment manage the dynamics of difference institutionalize cultural knowledge adapt to diversity - policies - structures - values - services (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2011 - National Center for Cultural Competence

8. Five Elements of Cultural Competence Individual Level (Cross, Bazron, Dennis and Isaacs, 1989) acknowledge cultural differences understand your own culture engage in self-assessment acquire cultural knowledge & skills view behavior within a cultural context Slide Source:© 2011 - National Center for Cultural Competence

9. LINGUISTIC COMPETENCE POLICY PRACTICES STRUCTURESPROCEDURES DEDICATED PERSONNEL RESOURCES DEDICATED FISCAL RESOURCES Slide Source:© 2011 - National Center for Cultural Competence LINGUISTIC COMPETENCE FRAMEWORK Goode & Jones, Revised 2009, National Center for Cultural Competence

10. Values and Guiding Principles for Cultural Competence Cultural competence:  embraces the principles of equal access and non- discriminatory practices in service delivery.  is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families.  involves working in conjunction with natural, informal support and helping networks within culturally diverse communities. Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles http://nccc.georgetown.edu/foundations/frameworks.html

11. Values and Guiding Principles for Linguistic Competence  Services and supports are delivered in the preferred language and/or mode of delivery of the population served.  Written materials are translated, adapted, and/or provided in alternative formats based on the needs and preferences of the populations served.  Interpretation and translation services comply with all relevant Federal, state, and local mandates governing language access.  Consumers are engaged in evaluation of language access and other communication services to ensure for quality and satisfaction. National Center for Cultural Competence, Foundations/Guiding Values and Principles Source: National Center for Cultural Competence, Foundations/Guiding Values and Principles http://nccc.georgetown.edu/foundations/frameworks.html

12. Culture influences the way people interact with health and mental health care systems including:  Participation in health prevention and promotion programs  Access to health information and services  Choices and decisions related to health and mental health services  Understanding of and priorities related to health and illness  Help-seeking behavior and adherence to recommended treatment

13.  Systems of care poorly designed for diverse populations  Poor cross-cultural communication between providers and patients  Patient/client fears and distrust  Cultural stigma  Lack of diversity in health care leadership and workforce

14. Why should your organization implement the CLAS Standards? EVIDENCE INDICATES IMPROVEMENT Care Services Supports Outcomes EffectivenessAccessSatisfactionAcceptability Slide Source:© 2011 - National Center for Cultural Competence

15.  gain knowledge about cultural values and beliefs of the patient and apply that knowledge in a health care context.  interact effectively with people whose cultures and belief systems are different than your own.  provide quality care that is respectful and nonjudgmental.  deliver health care, services, and supports in the primary languages spoken be patients/clients and their families  identify and respond effectively to the preferences and needs of populations served.

16.  The remainder of this Webinar series will discuss each Standard and strategies organizations might pursue to implement CLAS.  We will use the case studies that we asked you to download when you registered to illustrate various points.  This Webinar series is designed to increase your awareness and knowledge of how you deliver care. Remember, how patients/clients see you may not be how you see yourself.

18. Ensure that clients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural beliefs and practices and preferred language.

19.  Acquire knowledge about the cultures and languages spoken by your patients/clients.  Collect data on cultural beliefs and practices and the language of choice of your patients/clients.  Collect data periodically on patient/client experience of care and the extent to which it addresses culture and language. Consider focus groups, short surveys, web-based applications, and feedback from patient navigators.

20.  Collaborate with patients/clients and their advocates to develop, update, or access an existing:  glossary of terms that providers are likely to encounter  directory of services offered by the agency/organization that is easy to understand and is offered in languages spoken by the patient/client population  directory of community-based services that patients/clients can access.

21. 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.

22.  Obtain patient feedback on their preference for patient- provider concordance (e.g. race, ethnicity, language, sexual orientation, gender, gender identity).  Assess the degree to which staff demographics match patient preferences.

23.  Establish staff diversity as recruitment, hiring, and retention goals for your organization.  Post notices of job announcements and vacancies in forums, venues, and in varied languages to increase the likelihood of attracting diverse applicants.  Where possible, recruit and hire qualified individuals (including past and current patients/clients) of the populations and communities impacted by the HIV epidemic.  Assist individuals from culturally and linguistically diverse groups to complete required training needed to qualify for varied positions within the health and/or mental health care setting.

24.  Provide ongoing training and mentoring to all staff, including new hires, to enhance their cultural competency and their capacity to communicate effectively cross-culturally (including but not limited to patients/clients and their families who speak languages other than English, those who have disabilities, and individuals who are deaf or hard of hearing).  Include criteria for cultural and linguistic competence in staff performance evaluations.  Provide staff with an open and safe forum and a process to raise and address issues related to individual and the organizational capacity to deliver culturally and linguistically competent services.

25. Ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.

26.  Periodically query staff about their perceived learning needs in the area of cultural and linguistic competence.  Designate interested and knowledgeable staff the responsibility of coordinating in-service training/professional development.  Provide cross- and discipline-specific training in cultural and linguistic competency that is responsive to staff’s expressed interests, needs, and learning styles.  Keep abreast of current trends and emerging evidence about culturally and linguistically competent care to include in all in- service training and professional development efforts.

27.  Staff performance evaluations should include criteria that addresses active participation in and completion of training/professional development activities.  Support professional development by offering varied modalities for learning (e.g. Web-based, self-directed and self-paced curricula, coaching and mentoring, continuing education, journal/book clubs, discussion groups).  Address cultural and linguistic competency as a routine component of staff meetings and retreats. Establish meaningful incentives and special recognition awards for cultural and linguistic competency within the organization.

28. Offer and provide language assistance services, including bilingual staff and interpreters, at no cost to each client/consumer with limited English proficiency at all points of contact in a timely manner during all hours of operation.

29.  Conduct an annual assessment of languages (other than English) spoken within the geographic locale served by the organization to ensure language access. Include data on the population of people who are deaf or hard of hearing.  Update the organization’s language access plan on an annual basis. Ensure that there are adequate resources (fiscal and personnel) for the provision of language access services.  Ensure that all staff are knowledgeable of organizational policy, procedures, and practices for language access, including individual responsibility according to job function.

30.  Ensure that language access services include sign language interpretation.  Ensure that all legally binding documents are professionally translated into the languages spoken by the patient/client population. Such documents may include, but is not limited to, consent forms, confidentiality and patient rights statements, release of information, eligibility and applications for services.  Ensure that medical orders, patient education, and health/mental health promotion resources are translated into the languages spoken by the patient/client population. Such documents should also be offered in Braille.

31. Provide to clients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

32.  Post signage in prominent locations stating patients’/clients’ rights to receive language access services (at no cost) in the health/mental health facility.  Ensure that staff provide both verbal and written notification of patients’/clients’ rights to receive language access services at no cost.

33. Case Presentation: More than Language

34. National Center for Cultural Competence, Georgetown University Medical Center Part 2 of this module will be held on: July 6, 2011 at 2:00 PM (EST)