Keynote presentation delivered May 6th at the 6th annual conference for Health Care Access and Quality at the University of Massachusetts

1. Paving the Way: CLAS & Policy Darci L. Graves, MA, MA Senior Health Education and Policy Specialist, SRA International, Inc.

3. Overview Paving the Way… Legislation, Policy and Health Disparities Cultural Competency Legislation Impact of Cultural Competency Legislation

4. What do we mean by culture? Graves, 2001 (revised 2011)

5. Cultural and Linguistic Competence in Health A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

6. Fiorello H. LaGuardia

7. Policy & Publication Timeline

9. HHS Office of Minority Health: National CLAS Standards The CLAS Standards were developed by OMH in December 2000 as a means to improve access to health care for minorities, reduce disparities, and improve quality of care. There are currently 14 standards which are divided into 3 themes. The National CLAS Standards Enhancement Initiative launched in fall of 2010 and the second iteration of the Standards are due for release in Fall 2011.

10. Statewide Plans to Reduce Health Disparities National Conference of State Legislatures

11. Summary of State Law Requirements Addressing Language Needs in Health Care National Health Law Program

12. Legislation regarding Cultural Competency Training Dark Blue denotes legislation requiring (WA, CA, NJ, NM) or strongly recommending (MD) cultural competence training, which was signed into law. Purple denotes legislation which has been referred to committee and is currently under consideration. Royal Blue denotes legislation which died in committee or was vetoed.

14. HHS Plans for AddressingHealth Disparities & Health Equity

15. Released in Spring 2011 THE HHS ACTION PLAN TO REDUCE RACIAL AND ETHNIC HEALTH DISPARITIES NATIONAL STAKEHOLDER STRATEGY FOR ACHIEVING HEALTH EQUITY

16. First Examples of Mandated Legislation New Jersey, California and Washington

17. New Jersey – 2005 (#Bill S144) The State Board of Medical Examiners shall prescribe the following requirements for physician training, by regulation, in consultation with the Commission on Higher Education: (e) A physician licensed to practice medicine in this State shall be required, as a condition of relicensure, to document completion of cultural competency training [] to the satisfaction of the board no later than three years after the effective date of this act.

19. Implications of Cultural Competency Legislation: A Case Study New Jersey

20. Mandatory cultural competency education garners some criticism; however, many feel that it will improve patient-provider interactions, compliance, and patient satisfaction. New Jersey: A case study on the implications of legislation for cultural competency curricula Legislative Mandates on Cultural Competency Training

21. Think Cultural Health from the HHS Office of Minority Health Continuing education programs that equip health professionals with awareness, knowledge, and skills to treat diverse patients Up-to-date information on issues related to cultural competency and health disparities Tracking of cultural competency legislation around the country

22. A Physician’s Practical Guide to Culturally Competent Care Free, online program accredited for physicians, physician assistants, and nurse practitioners Designed to equip physicians with the awareness, knowledge and skills to treat diverse patients and improve quality of care

23. A Physician’s Practical Guide to Culturally Competent Care Two-year evaluation results: Curriculum participation results in development of knowledge, awareness and skills related to cultural competency. The curriculum shows the potential for improving health outcomes and ultimately mitigating racial and ethnic health disparities.

24. Assessing the Impact of Cultural Competency Mandates Mandatory training may be an ideal way to promote cultural competency as an effective strategy to eliminate health disparities: Higher exposure to cultural competency due to legislative requirements Higher exposure to cultural competency creates a workforce equipped to provide quality care to diverse patients

25. Assessing the Impact of Cultural Competency Mandates New Jersey mandated 6 hours of cultural competency continuing education for physician relicensure. Examination of differences in attitudes about cultural competency between individuals who self-select to take the program and those who take it to fulfill a mandate.

26. Assessing the Impact of Cultural Competency Mandates Self-reflection components of the curriculum were compared among mandated and non-mandated individuals. Physicians’ attitudes related to cultural competency were similar for mandated and non-mandated participants.

27. Assessing the Impact of Cultural Competency Mandates Large increases in New Jersey physician participation in the cultural competency curriculum New Jersey physician participants

28. Cultural Competency Mandates Mandatory cultural competency education garners some criticism, including the idea that forced training will create negative reactions to cultural differences or cross-cultural efficacy. However, these concerns seem to be unfounded based on these results.

29. Implications – Potential for Cultural Competency Mandates Completion of the physicians’ curriculum, whether mandated or not, increases cultural competency knowledge and may improve practice behavior.

30. Implications – Potential for Cultural Competency Mandates This negates criticism that mandatory cultural competency training is ineffective because mandated providers will show reluctance in grasping cultural competency concepts. Mandates may be an ideal way to help improve care and ultimately help eliminate health disparities.

31. Summary Cultural competency education has the potential to improve patient-provider interactions, compliance, and patient satisfaction. Through cultural competency education mandates, policy can play a vital role in eliminating health disparities.

33. For questions or additional information, contact: Darci L. Graves, MA, MA Darci_Graves@sra.com www.ThinkCulturalHealth.hhs.gov