The U.S. Department of Health and Human Services Office of Minority Health (OMH) has released its long-awaited “enhanced” National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. The original CLAS standards were issued by OMH in 2000 and the effort to revise, or “enhance” the standards was begun in 2010.
The enhanced standards are reorganized into a “principal standard”, and then three themes: Governance, Leadership, and Workforce; Communication and Language Assistance; and Engagement, Continuous Improvement, and Accountability:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce
2. Advance and sustain governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally, and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.
10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of the populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.
OMH has issued an extensive background document called the Blueprint for Advancing and Sustaining CLAS Policy and Practice to explain and provide more details on the enhanced standards. Unfortunately, the U.S. Department of Health and Human Services does not take any action to implement the enhanced CLAS standards by incorporating the standards into its own requirements for federally funded health care and services, grants, contracts, and other activities.
The enhanced CLAS standards broaden the OMH’s definition of culture as “the integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics.” This is a more inclusive definition that now incorporates DHHS’ activities to address disparities in health and health care based on income, geography, disability, sexual orientation, gender identity, and other factors.
Similarly, the enhanced CLAS standards broaden the OMH’s definition of communication and language assistance to highlight the communication needs of Limited English Proficient individuals, persons with disabilities, and persons with lower health literacy.
The enhanced standards, blueprint, and other materials are available on the OMH’s Think Cultural Health website after a free registration process. Note that the one sentence shorthand descriptions of the standards on the website and in the documents do not include the full detail of the wording of the actual standards.
Ignatius Bau 