1. DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Staff Member Name
Title
Equity and Language Access
Initiatives in Virginia Behavioral
Health & Developmental
Services

2. Page 2
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Overview
• Getting on the same page- common
understanding of terms
• Why should we plan for cultural &
linguistic competence?.
• What does it look like?
• Lessons learned
• Possible strategies for other agencies

3. Page 3
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
WHAT IS CULTURAL COMPETENCE?
Adapt to the cultural
Contexts of your
community
Acquire and
institutionalize
cultural knowledge
Manage the
Dynamics of
difference
Conduct Self
Assessment
Value
Diversity
Cultural
Competence
And incorporate the above in all aspects of policy making, administration, practice, service
delivery and involve systematically consumers, key stakeholders and communities.
National Center for Cultural Competence

4. Page 4
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Levels of Cultural Competency
System’s Levels
Laws and regulations in place and
an infrastructure that supports
diverse communities

5. Page 5
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services What is 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 disabilities.
National Center for Cultural Competence

6. Page 6
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Why Plan for CLC?
* Alignment with Secretary Initiatives
* Legal requirements related to language
access
* Growing Population diversity
* Limited staff with CLC expertise
* Lack of organizational and systemic focus
on CLC Efforts

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Secretariat Initiatives
• Virginia Health Reform
Initiative
• Systems
Transformation
• Organizational and
Program Effectiveness

8. Page 8
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Systems Transformation
“In 2006, Virginia embarked on a bold mission: to
bring about a true systems transformation that will
afford individuals across all ages and disability
populations personal choice and easier access to
needed long-term supports that are integrated,
individualized and simple to use. This is occurring
by improving services access, enhancing person-
centered practices and self direction, and
transforming information technology to support
systems change.”
http://www.hhr.virginia.gov/Initiatives/SystemsTransformation/

9. Page 9
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Healthcare Reform
Virginia Health Reform Initiative
“Ensure that meaningful reform is achieved
throughout the Commonwealth. There is a desire
to see that the health care delivery system as a
whole is positively impacted as a result of the
work accomplished through the initiative.”
Health and Well-Being
Improve the health and well-being of the population.
HHR Human Resources: Spotlight on Collaborative HR Strategies, Sept. 27, 2011.

10. Page 10
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Organizational and Program Effectiveness
Organizational Effectiveness
Provide services in the most effective and
efficient possible manner
Program Effectiveness
Programmatically deliver services which will
strengthen the family, take care of children,
aid the impaired, aged, and disabled.
HHR Human Resources: Spotlight on Collaborative HR Strategies, Sept. 27, 2011.

11. Page 11
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Why Plan for CLC?
FEDERAL LAW
Civil Rights Act of 1964
The Civil Rights Act of 1964 says that no
person shall be excluded from participation
in, be denied the benefits of, or be
subjected to discrimination based on race,
gender, ethnicity or national origin under
any program or activity receiving Federal
financial assistance."

12. Page 12
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Why Plan for CLC
Presidential Executive Order 13166
Sec. 3 – Federally Assisted Programs
“Each agency providing federal financial
assistance shall draft title VI guidance
specifically tailored to its recipients that is
consistent with the LEP Guidance issued by
the Dept. of Justice”
Executive Order on Limited English Proficiency, August 11, 2000

13. Page 13
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Title VI - “Meaningful Access”
Organizations are required to take reasonable
steps to ensure meaningful access to their
programs and activities by LEP persons. The
Guidance explains that the obligation to
provide meaningful access is fact-dependent
and starts with an individualized assessment
that balances four factors:
1. Number or Proportion of LEP Individuals
2. Frequency of Contact With the Program
3. Nature and Importance of the Program
4. Resources Available

14. Page 14
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Americans with Disabilities Act
The ADA prohibits
discrimination on the
basis of disability in
employment, State and
local government, public
accommodations,
commercial facilities,
transportation, and
telecommunications. It
also applies to the United
States Congress.

15. Page 15
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
Other Federal Laws Prohibiting
Discrimination in Human Services
The Social Security Act prohibits
discrimination in the Maternal and Child
Health Services Block Grant.
The Public Health Service Act prohibits
discrimination in the Community Mental
Health Services Block Grant and Substance
Abuse Prevention and Treatment Block
Grants.
The Public Health Service Act prohibits
discrimination in the Preventative Health
and Health Services Block Grants

16. Page 16
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Consequences
• Inova Health System has agreed to a $145,000 settlement
after the U.S. Department of Justice filed a complaint on
behalf of a hearing-impaired couple who claimed they were
not properly provided with a sign-language interpreter after
their newborn son developed medical complications while in
Inova Fairfax Hospital.
• Maryland Department of Health and Mental Hygiene DOJ
review required county health departments have agreed to
conduct periodic language needs assessments of their
service areas and to incorporate a variety of data sources in
the process.
• DBHDS investigation into allegations of discrimination based
on national origin. As a result, language policy and
procedures were developed.

17. Page 17
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Why Plan for CLC?
Over 350 languages are spoken in the
U.S.
There are more than 47 million people in
the nation who speak a language
other than English, and over 30 million
who were born outside the United
States
During the past decade, the number of
Spanish and Asian-language speakers
grew by 50%
Over 17% of the nation’s population
speak a language other than English
at home.
Virginia is one of the top 15 states for
refugee resettlement

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services

19. Page 19
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
CLC in Practice
Cultural
Competence
Do our
practices
Inhibit or
prohibit
engagement?
Do we seek
meaningful
inclusion of cultural
considerations
throughout the
planning process?
Do we get
regular
feedback
from
employees?
Do we have
ONGOING
training that
develops
a workforce able to
work cross
culturally?

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
CLC in Practice
Cultural
Competence
Do we utilize
outreach
strategies and
engage
cultural
brokers?
Do we explore
new methods
for recruitment
and
retention of
culturally
competent staff
Do we provide
safe
venues for people
to discuss
their
communication
differences?
Do we maintain
demographic,
cultural, and
epidemiological
profiles?
Provide training
on addressing
bias,
discrimination,
and racism in
health, mental
health, and social
service systems.
Standardize ways
to assess a
candidate’s
ability to deliver
culturally
competent
services

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
CLC in Practice
Linguistic
Competence
Hire bilingual/
bicultural staff
Use varied
approaches
to communicate
With individuals
who experience
cognitive
disabilities
Require the
use
of qualified
interpreters
Pre-test the reader-
friendliness of
enrollment
and education
materials
with focus groups
Offer multilingual
Tele-communication
systems

22. Page 22
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
CLC in Practice
Linguistic
Competence
Offer TTY
and other
assistive
technology
devices
Offer materials
in Alternative
formats (e.g.,
audiotape,
Braille, enlarged
print )
Use qualified
translation
Services
especially for
legally binding
documents
Print materials in
Easy to read,
low literacy,
picture and
symbol formats
Utilize ethnic media
in languages
for outreach to
diverse
communities

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
OCLC- Critical Foundations
• Conferences that built
awareness and
enthusiasm prior to
developing specific
initiatives.
• Formal Statewide
Committee
• Visible Leadership
• Documents that provided a
foundation to our work –
charter, position statement
• Having roots in community
work and community
partners

24. Page 24
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services OCLC- Focus Areas
OCLC
Language
Services
Planning at
Secretariat,
Agency, and
Local level
Workforce
Diversity, and
Inclusion
(Recruitment,
Retention, and
Succession)
Organizational
CLC Training
and
Consultation
CLC Resource
Development

25. Page 25
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services
OCLC- Keys for Success
• Broad support from leadership
• Active and passionate
statewide advisory committee
• Emphasis on outreach,
building partnerships, and
networking
• Commitment to supporting
existing work and initiatives
• Focus on language services
• LOTS of free training!
• Utilization of interns
• GRIT!!

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DBDHS
Virginia Department of
Behavioral Health and
Developmental Services OCLC Challenges for the future
• Lifting the discussion to the macro level
• Keeping up momentum- Engaging all
services in our purview and integrating CLC
principles in existing and new initiatives
• Finding support and funding for more
complex issues
• Developing indicators for progress
• Expanding the number of engaged providers
• Keeping CLC as a priority

27. Page 27
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Possible Agency Approaches
Agencies with an existing
CLC/disparity effort (POC)
• Include CLC staff in planning,
consultation, staff orientation,
policy work, and training efforts
• Leverage CLC office staff for
readiness and assessment
activities, training, community
engagement efforts, social
marketing and program strategies
• Include CLC plans and goals as
agency plans and goals and vice
versa to avoid duplication of
efforts

28. Page 28
DBDHS
Virginia Department of
Behavioral Health and
Developmental Services Possible Agency Approaches
Agencies without an existing CLC/disparity efforts
(POC)
• Have leadership articulate a message of the
importance of CLC/disparity efforts
• Designate someone to coordinate efforts
• Convene a CLC/Multicultural/Disparity Advisory
Council
• Commit to a diversity of all advisory groups
• Carry out a readiness assessment
• Develop a CLC plan
• Incorporate CLC training at all levels of the work
• Don’t isolate CLC/disparity efforts