In 1986, the U.S. Department of Health and Human Services (HHS) established the Office of Minority Health (OMH), with the goal of providing complete access to health care for all patients at hospitals and clinics that receive federal funds. In 1997, OHM developed a set of standards for Culturally and Linguistically Appropriate Services (CLAS) for federally funded hospitals and clinics. For private facilities not federally funded, CLAS compliance supports accreditation through the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
Minorities
Between 2006 and 2008, 2.4 million new U.S. citizens were naturalized. Recent significant immigration from India and Arab nations has enriched American culture, and the United States enjoys established minority populations of Native American, Pacific Island and African-Americans. Hispanics are the fastest growing minority, increasing from 22.4 million among a total 249 million population in 1990 to 35.3 million among 281 million in 2000. CLAS mandates protect the health care rights of minorities, including hearing-impaired patients, whose health care access rights are also protected under the Americans with Disabilities Act.
Access Mandates
Health care facilities receiving federal funds are mandated by federal law to provide treatment information in the patient's preferred language at all times. Patients who are not proficient in English must be advised of their right to have an interpreter. The advisement may be verbal or written, but it must be in their preferred language. The interpreter must be competent to translate medical information. Written health care materials and signage must be distributed in the patient's preferred language. Patients receiving these services cannot be billed for them.
Competence Guidelines
The OMH publishes the following guidelines for health care staff diversity competence. Health care facilities should provide patients with staff members who respect cultural diversity and will give treatment that is compatible with the patient's cultural health beliefs and preferred language. Health facilities should have diverse staff and administrative leadership that reflect the demographics of their communities. Health care providers should plan and implement ongoing diversity education for all staff at all levels to train them in cultural awareness and linguistic appropriateness in health care.
Support Guidelines
CLAS guidelines describe internal organizational supports. Health care organizations should develop strategic plans for achieving linguistically appropriate service goals, including oversight. The facility's program of self-assessment and internal audits should include "outcomes-based" evaluations for cultural and language activities. At the patient level, care management data systems should include ethnicity, race and language preference. At the community level, local involvement in designing CLAS compliance should be sought. Demographic and epidemiological (disease profile) information should be included in plans, and grievance systems must be accessible.
Special Ed
Federal interest in access to health programs includes funding for the Early Childhood Research Institute on Culturally and Linguistically Appropriate Services. The institute is at the University of Illinois at Urbana-Champaign and collaborates with other universities and education groups. The institute studies and promotes awareness for the role of diversity sensitivity in identifying special needs students, particularly those with health disabilities, and meeting their needs with CLAS-compliant programs.
Tags: preferred language, Appropriate Services, Culturally Linguistically, Culturally Linguistically Appropriate, health care, Linguistically Appropriate Services
