1. Understanding and Implementing the CLAS Standards
Development of CLAS Standards
The Need for Culturally Competent Healthcare
Data from the 2010 US Census confirmed that the country’s nonwhite and foreign-born populations have continued to increase.[ US Census Bureau. Overview of Race and Hispanic Origin: 2010. Available at: http://2010.census.gov/2010census/data/] In fact, more than a decade ago, nonwhite population groups became the majority of the population in the state of California. The language diversity alone of the US population points to the need for, and challenges of implementing, culturally competent healthcare:
This growing diversity presents numerous challenges ranging across the whole spectrum of healthcare facilities—from small rural clinics through community-based facilities to large urban medical centers. These may range from patients who speak only a language that is not familiar to any staff members at a healthcare facility to cultural practices regarding interactions between members of the opposite sex.
Sensitivity to the needs of individuals from all ethnicities, languages, and ways of life can make a large contribution to developing a productive, respectful encounter between the staffs of healthcare organizations and patients who often enter such a relationship with significant cultural differences. However, individual efforts fall short of adequately reducing the common organizational barriers found in many healthcare organizations. These barriers can have a significant impact on how patients from diverse populations access healthcare services and how healthcare providers deliver those services.
Efforts to Define Cultural Competence
For several decades now, efforts to cultivate cultural competence have been pursued as key for healthcare providers to understand and respond effectively to the cultural and linguistic needs and practices that patients present during a clinical encounter. Many healthcare organizations across the United States have developed culturally responsive practices, and some academic institutions and community organizations have developed a variety of tools and resources to help healthcare organizations improve their services for diverse populations.
In addition, policy makers at the national, state, and local levels have undertaken efforts to address issues of making healthcare more accessible and effective for culturally diverse populations. However, many of these policy makers are at various stages of defining what constitutes cultural competence and ways to assess and enforce it. Some of these efforts aim to be comprehensive, while others address particular issues—such as mental health or HIV infection—or particular geographic areas. Consequently, there is a wide spectrum across the country and among different organizations of ideas about what constitutes culturally competent health services, including significant differences concerning target populations, scope, and quality of services.
In 1997, the Office of Minority Health initiated a project of reviewing existing cultural and linguistic competence standards and measurement tools across the United States and of preparing a draft report proposing guidelines and an agenda for further efforts. The resulting 1999 report was based on an analytical review of key laws, regulations, contracts, and standards in use by federal and state agencies and other national organizations, and it incorporated input from an advisory committee of policymakers, healthcare organizations, and researchers. After additional review and revision, that report became the initial draft of the CLAS Standards, published in the Federal Record in December 1999. After a public comment period and final revisions, National Standards for Culturally and Linguistically Appropriate Services in Health Care was published in the Federal Register in December 2000 (available at: www.federalregister.gov/articles/2000/12/22/00-32685/office-of-minority-health-national-standards-on-culturally-and-linguistically-appropriate-services).
Purpose of the Standards
The CLAS standards represent a path to correcting current inequities in the provision of healthcare services and to making those services more responsive to the needs of individuals of all cultural and linguistic backgrounds. Although the standards are meant to be inclusive of all cultures, they are designed to address in particular the needs of racial, ethnic, and linguistic population groups that may experience unequal access to healthcare services—and, ultimately, to help eliminate health disparities and improve the health of all Americans.
The standards offer a common understanding and consistent definitions of culturally and linguistically appropriate healthcare services. They offer healthcare providers a practical framework for implementing the types of services and organizational structures that can help them be responsive to the cultural and linguistic issues that come with a rapidly diversifying population.