Glossary and List of Acronyms
Access: The degree to which services are readily obtainable – determined by the extent to which needed services are available and information about these services is provided, the responsiveness of the system to individual cultural and linguistic needs, and the convenience and timeliness with which services are obtained.
Assessment: The process of documenting, usually in measurable terms, knowledge, skills, attitudes and beliefs. Cultural competence assessments often include a set of specific indicators (measures) that are used as tools to examine, demonstrate and document cultural competence in organizations.
Bilingual staff: Individuals who have some degree of proficiency in more than one language. Bilingual staff includes those who serve in a dual role, providing interpreter services in addition to their primary position.
Community-based participatory research (CBPR): In CBPR, community-based organizations help researchers recruit subjects and play a direct role in designing and conducting research studies. Community members then share the research findings directly with the community.
Community health workers: Health professionals that offer informal counseling and social support, health education, advocacy, referral and follow-up services to clients. Research studies show that community health workers improve health outcomes among racially, ethnically and linguistically diverse populations. By serving as the bridge between clients and health services, they improve access to primary health care, reduce costs of care, improve quality of care and reduce health disparities.
Competence: Having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by people and their communities.
Cultural broker: An individual who bridges, links, or mediates between groups or persons of differing cultural backgrounds for the purpose of reducing conflicts, producing change, or advocating on behalf of a cultural group or person. Cultural brokers can also be medical professionals who draw upon cultural and health science knowledge and skills to negotiate with the patient and health system toward an effective outcome.
Cultural competence: a set of behaviors, attitudes, and policies that come together in a system that enables effective work in cross-cultural situations to effectively address the needs of clients and communities, all of which involves:
- The capacity to value diversity, self-assess personal biases, manage the dynamics of difference, institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of the communities served
- Incorporating the requirements above in all aspects of policy development, administration, practice/service delivery and involving consumers in a systemic way (as part of common practice).
Culturally and linguistically appropriate services: Health services that are respectful of and responsive to cultural and language needs.
Culture: Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
Disparities: Differences in health care that are closely linked with social, economic, and/or environmental disadvantages. Health disparities adversely affect persons who have experienced obstacles to health based on their ethnic or racial group, religion, socioeconomic status, gender, age, mental health, ability status, sexual orientation or gender identity, geographic location or other characteristics historically linked to discrimination or exclusion.
Effective communication: Ensuring clients’ understanding of the informed consent process, participation in their own care, understanding of all information provided and ability to fulfill the responsibilities related to their care. Information provided must be complete, accurate, timely, unambiguous, and understood by the patient.
Ethnicity: A person’s background, heritage, culture, ancestry, or sometimes the country where persons or their families were born.
Health equity: 1) Distribution of disease, disability and death in such a way as to not create a disproportionate burden on one population. 2) The absence of persistent health differences over time between racial and ethnic groups.
Health literacy: The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.
Interpretation: The oral restating in one language of what has been said in another language.
Language services: Mechanisms used to facilitate communication with individuals who do not speak English and those who are deaf or hard-of-hearing. These services can include in-person interpretation using a professional interpreter, bilingual staff, or remote interpreting systems such as telephone or video medical interpreting. Language services also refer to processes in place to provide translation of written materials or signage.
Linguistic competence: The capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with visual and hearing impairments.
Limited English Proficient (LEP): An LEP individual is a person who is unable to speak, read, write or understand the English language at a level that permits him or her to interact effectively with health and social service agencies and providers.
Mutual Assistance Association (MAA): Self-help organizations that assist newcomer communities in the process of adjusting to a new country. Through education, social and other support services, MAAs are closely linked with communities of diverse cultures.
National Standards on Culturally and Linguistically Appropriate Services (CLAS standards): The set of culturally and linguistically appropriate services (CLAS) mandates, guidelines, and recommendations issued by the United States Department of Health and Human Services Office of Minority Health intended to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate health services.
Patient-centered care: Health care that establishes a working partnership with patients and their families to ensure decisions are made that respect and honor patients’ wants, needs, and preferences and to ensure that patients have the education and support they need to act as a central resource in their own health and/or the health of their family.
Plain language: Clear, straightforward expression, using only as many words as necessary. It is language that avoids obscurity, inflated vocabulary and convoluted sentence construction. It is not baby talk, nor is it a simplified version of the language. Writers of plain language let their audience concentrate on the message instead of being distracted by complicated language.
Planning: The organizational process of creating and maintaining a strategy or approach and establishing goals, activities and expected outcomes.
Professional health care interpreter: An individual who has the appropriate training/certification and experience to provide accurate and effective verbal language translation, and adheres to a set code of professional ethics.
Race: The various social groups that individuals identify with as having similar physical characteristics, usually sharing similar phenotype or geographic origins.
Racial bias: A preformed negative opinion or attitude toward a group of persons who have common physical, cultural or linguistic characteristics.
Telephone interpreting: Interpreting carried out remotely, with the interpreter connected by telephone to the principal parties, typically provided through speakerphones or headsets. In health care settings, the principal parties (e.g., doctor and patient) are normally in the same room, but telephone interpreting can be used to serve individuals who are also connected to each other only by telephone.
Threshold population/language: A linguistic group that makes up 15% or more of a program’s clients and who share a common language other than English as a primary language. For example, if program XYZ serves 200 clients and at least 30 of them speak Haitian-Creole as a primary language, this would be considered a threshold population and language for that program. Some programs may have multiple threshold populations/languages; some programs may have no threshold populations and languages.
Translation: Written conversion of written materials from one language to another.
Video medical interpreting: Interpreting that is carried out remotely using a video camera that enables an interpreter in a remote location to both see and hear the parties for whom he or she is interpreting via a television monitor. The interpretation is relayed to the principal parties by speakerphone or through headsets. Two-way interactive television can also be used so that the other parties can interact with the interpreter as though face-to-face.
Vital documents: Information critical or essential for ensuring a client’s well-being or continuity of care. For the purposes of ensuring language access, examples include signage, directions and notices about the availability of interpreter services and legal documents (consent forms, client rights and responsibilities, privacy notices, complaint forms, grievance policies) and client intake forms.
Voluntary Organizations (VOLAGs): Agencies that, through their local affiliates, help resettle newcomer communities.
Portions adapted from: Wilson-Stronks, A. et al. 2008. One Size Does Not Fit All. Meeting the Health Care Needs of Diverse Populations. Oakbrook Terrace, IL: The Joint Commission.
Acronyms Used in this Manual
AHEC – Area Health Education Center
AMP – Affirmative Market Program
CPBR – Community-Based Participatory Research
CHC- Caring Health Center
CHNA – Community Health Network Area
DOJ – U.S. Department of Justice
GNBCHC – Greater New Bedford Community Health Center
HIPAA – Health Insurance Portability and Accountability Act of 1996
HHS – U.S. Department of Health and Human Services
JCAHO – Joint Commission on Accreditation of Healthcare Organizations
LEP – (Persons with) Limited English Proficiency
LGBT – Lesbian, gay, bisexual and transgender
MassCHIP – Massachusetts Community Health Information Profile
MAA – Mutual Assistance Associations
MCAD – Massachusetts Commission Against Discrimination
MDPH – Massachusetts Department of Public Health
MOD – Massachusetts Office on Disability
MWBE – Minority and Women-owned Business Enterprises
NCQA – National Committee for Quality Assurance
NBWIC – New Bedford Women, Infants and Children
OCR – U.S. Department of Health and Human Services’ Office for Civil Rights
ODEO – Massachusetts Office of Disability and Equal Opportunity
OHE – Office of Health Equity (for purposes of this manual, the OHE is the Office of Health Equity at the Massachusetts Department of Public Health)
OSD – Operational Services Division
PHSC -Office of Public Health Strategies and Communications at the Massachusetts Department of Public Health
SOMWBA – State Office of Minority and Women Businesses Assistance
WIC – Women Infants and Children
VOLAG -National Voluntary Agencies
APPENDIX A:
CLAS Self-Assessment Tool
APPENDIX B
Overview of Laws
Appendix B: Overview of Laws Supporting Culturally and Linguistically Appropriate Services
Title VI and Derived Guidelines:
- S. Department of Justice (DOJ) Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000 et seq.)
http://www.justice.gov/crt/about/cor/coord/titlevi.php - S. Department of Health and Human Services (HHS) Office of Civil Rights Title VI regulations (45 C.F.R. Section 80.3 (b) (2) and Title VI LEP Guidance (68 Fed. Reg. 50121)
http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep - Presidential Executive Order 13166: Improving access to services for persons with limited English proficiency (65 Fed. Reg. 50121)
http://www.lep.gov/13166/eo13166.html
Overview
Title VI and related guidance and guidelines require agencies receiving federal financial assistance to:
- Prohibit discrimination on the basis of race, color, and national origin in programs and activities
- Examine the services they provide, identify any need for services for Limited English Proficiency (LEP) populations, and develop and implement a system to provide identified services
- Offer recommendations on identifying LEP populations, interpreting and translation, training, and elements of effective language plans
To Whom They Apply
- Any organization receiving federal financial assistance, directly or indirectly
- Grantees, subgrantees, contractors
- Almost all health care providers (Medicaid, SCHIP, and block grants to health and welfare agencies all receive federal financial assistance)
Other Federal Laws Governing Culturally and Linguistically Appropriate Services
- Hill-Burton Act “Hospital Survey and Construction Act” (42 U.S.C. 291 et seq.)
- Medicaid, State Children’s Health Insurance Program (SCHIP) and Medicare statutes and regulations
Massachusetts’ Commitment to Reducing Disparities
Executive Order no. 478: Order Regarding Non-Discrimination, Diversity, Equal Opportunity and Affirmative Action (2007)
Overview
Issued as a state priority in 2007, this order details measures to ensure non-discrimination and diversity in state agencies, state-funded programs and service providers.
To Whom it Applies
State agencies, grantees, state-licensed programs, state-funded programs, contracted service providers and subcontractors
Requirements
- Adapt programs and services to prevent discrimination and meet needs of diverse groups (section 2)
n Increase workforce diversity (section 3):
n Develop affirmative action, diversity plans
n Recruit and promote employees from under-represented groups
n Adopt equal opportunity employment policies
n Contractors must commit to non-discrimination practices (section 5):
n Comply with fair labor and employment laws
n Commit to purchasing services from minority, women-owned and small businesses
n Offer mandatory diversity training (section 10)
n Establish a complaint resolution process for non-compliance with anti-discrimination laws
Massachusetts’ Commitment to Immigrants and Refugees
Executive Order 503: Integrating Immigrants and Refugees into the Commonwealth (2008)
Overview
Issued as a state priority on July 30, 2008, this order introduces the “New Americans Agenda” uniting resources from various state and nonprofit agencies to ease the transition of immigrants and refugees.
To Whom it Applies
State departments, offices, divisions and agencies
Requirements
- Follow recommendations from the Massachusetts Office of Refugees and Immigrants (MORI) to develop New Americans plans that incorporate:
n Effective training and resources;
n Culturally and linguistically competent and appropriate services; and
n Administrative practices that address the needs of immigrants and refugees (Sec. 5).
n Plans must be in accordance with recommendations from MORI.
n Plans must be submitted within a year of receipt of MORI recommendations.
State and Federal Policies that Emphasize the Collection of Race, Ethnicity and Language (REL) Data
- Massachusetts Executive Order No. 478: Order Regarding Non-Discrimination, Diversity, Equal Opportunity and Affirmative Action
- Office of Management and Budget (OMB) revised standards (1997)
http://www.whitehouse.gov/omb/fedreg_1997standards - Health Insurance Portability and Accountability Act of 1996
- Initiative to Eliminate Racial and Ethnic Disparities in Health (1998)
- Consumer Bill of Rights and Responsibilities (1997)
- Benefits Improvement and Protection Act (2000)
- Report of U.S. Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equity (1999)
- Executive Order No. 13166 “Improving Access to Services for Persons with Limited English Proficiency” and Executive Order No. 13125 “Improving the Quality of Life of Asian Americans and Pacific Islanders” (2000)
- Minority and Health Disparities Research and Education Act of 2000
- Department of Health and Human Services Title VI Regulations (1964)
- Department of Health and Human Services Inclusion Policy (1997)
- Title VII of the Civil Rights Act of 1964
- Healthy People 2010 (2000)
- Culturally and Linguistically Appropriate Services Standards (2001)
- HHS Data Council Activities (ongoing)
- National Committee on Vital Health Statistics (ongoing)
- The Joint Commission standard to collect client’s primary language information (2006)
- G.L.A. 272, Section 98, Public Accommodations Law
Laws Governing Culturally Competent Grievance Processes
Massachusetts Executive Order No. 478, section 11
Section 11 of Executive Order No. 478i grants power to the Massachusetts Office of Diversity and Equal Opportunity (ODEO) and the Massachusetts Office on Disability (MOD) to develop guidelines establishing a complaint resolution process for individuals who allege discrimination.
In cases where this process does not resolve the complaint, ODEO and MOD can submit complaints to the Massachusetts Commission Against Discrimination (MCAD). The MCAD can initiate investigations and, where necessary, file complaints against agencies or persons in violation of anti-discrimination laws.
According to Massachusetts Health Insurance Consumer Protection Law 105 CMR 128.000, clients must be offered:
- A clear, concise and complete written description of the internal grievance process;
- Toll-free telephone numbers for assistance; and
- Notification regarding availability of these resources.
Laws and Policies Regarding the Provision of Language Access Services for Limited English Proficient (LEP) Populations
Hill-Burton Community Service notice, U.S. Department of Health and Human Services, provisions of 42 C.F.R. 124.604(a), requires that clients be notified of the availability of interpreter services at all points of contact.
U.S. Health and Human Services Office of Civil Rights (OCR) Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Individuals
http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html
OCR “Safe Harbor Laws”
The “Safe Harbor Laws” establish that organizations can offer sufficient proof that they are making an effort to meet the needs of LEP groups by providing written translations for at least:
- Ten percent of the eligible population or 3,000 clients, whichever is less, for all documents
- Five percent of the eligible population or 1,000 clients for the most vital documentsii
Massachusetts Department of Public Health Best Practice Recommendations for Hospital-Based Interpreter Services
Massachusetts Department of Public Health (MDPH) best practice recommendations for hospital-based interpreter services suggest that written translations should be provided for LEP populations that make up 15% of a program’s clients.iii
i See Massachusetts Executive Order No. 478, Section 11.
ii U.S. Department of Health and Human Services, Office for Civil Rights. Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Individuals. http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html
iii Torres, Brunilda. 2001. Best Practice Recommendations for Hospital-Based Interpreter Services. Massachusetts Department of Public Health. Office of Health Equity.
Laws Mandating Equal Access for Persons with Disabilities
Laws mandating equal access for persons with disabilities include:
- Section 504 of the Rehabilitation Act of 1973, which applies to federal health care services and facilities, and recipients of federal financial assistance (including those receiving Medicaid funds or federal research grants) requires all hospital programs and services to provide effective means of communication for patients, family members and hospital visitors who have a disability.
- Title II of the Americans with Disabilities Act, which applies to all public (state and local) health care providers.
- Title III of the Americans with Disabilities Act, which applies to all private health care providers.[i]
Laws and Ethical Rules Prohibiting Discrimination of LGBT Persons
Ethical Rules and Regulations
Almost every major American medical association has ethical rules that prohibit discrimination of LGBT people in the practice of medicine, recognizing that such discrimination is harmful to patients’ health. In July 2011, the Joint Commission released their Comprehensive Accreditation Manual for Hospitals. The Code of Federal Regulations for hospitals includes similar non-discrimination rules.[ii]
Conditions of Participation from The Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services updated their Conditions of Participation in January 2011 for hospitals and critical access hospitals to require equal visitation for same-sex partners.[iii]
U.S. Department of Health and Human Services Guidance to State Medicaid Agencies
The U.S. Department of Health and Human Services has issued guidance to state Medicaid agencies on financial protections for same-sex couples. New rules require hospitals to protect patients’ rights to choose their own visitors during a hospital stay, including a visitor who is a same-sex domestic partner.[iv]
Updated Data Collection Requirements
Data Collection Requirements from the Affordable Care Act of 2010
Section 4302 of the Affordable Care Act of 2010 contains provisions requiring the collection of information on race, ethnicity, sex, primary language and disability status.[v]
In 2011, the Office of Minority Health at the U.S. Department of Health and Human Services added standards for the collection of data on disability status, and recommended integrating questions on sexual orientation and gender identity into national data collection efforts.
[i] National Association of the Deaf: ADA Questions and Answers for Health Care Providers: Auxiliary Aids and Services. Silver Spring, MD: National Association of the Deaf. (http://www.nad.org/issues/health-care/providers/questions-and-answers)
[ii] The Joint Commission. 2011. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL.
[iii] U.S. Department of Health and Human Services. Medicare steps up enforcement of equal visitation and representation rights in hospitals. September 7, 2011. http://www.hhs.gov/news/press/2011pres/09/20110907a.html
[iv] Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press, 2011.
[v] U.S. Department of Health and Human Services. Final data collection standards for race, ethnicity, primary language, sex, and disability status required by Section 4302 of the Affordable Care Act. Rockville, MD: U.S. Department of Human Services, 2011.
Clas Appendices Glossary and List of Acronyms – Download [Optimized PDF]
Clas Appendices Glossary and List of Acronyms – Download