One red flag that major work needs to be done in the areas of cultural and linguistic competence is if the demographics of the clients an agency serves do not match the demographics of the local community. For example, if a local community is composed of 2.5% Asian Americans but only 0.1% of clients served by an agency are Asian American, this is a strong indicator that something is wrong. Another example is an agency reporting anecdotally that the agency serving thousands of people does not and has never had any clients who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, and other sexual orientations and gender identities). Discerning what is going wrong in these situations can take some extra work, including further assessments that will be discussed in this module. However, with both of these examples the demographic data of the client population should be sending red flags that these populations are not being properly served.
Simply offering services and hoping that they will be appropriate for all people is certainly not the best approach to ensuring that services are culturally and linguistically appropriate. The first step to making changes that will lead to health equity is to assess the current situation. This is reflected in the Office of Minority Health’s national Cultural and Linguistically Appropriate Services (CLAS) Standards. These standards, created in 2000 and modified in 2010, outline specific goals for health organizations to meet in order to display equitable services. The first standard is considered the principle standard and sets the purpose of the following fourteen:
Provide effective, equitable, understandable, respectful, and quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
This first standard is in its own category and is the core of the fourteen standards that follow. The remaining fourteen standards are then split into the following categories: Governance, Leadership, & Workforce; Communication & Language Assistance; and Engagement, Continuous Improvement, & Accountability. Because the final category of the CLAS Standards is typically used to evaluate the cultural and linguistic competence of behavioral health organizations, the remainder of this module will focus on Engagement, Continuous Improvement, and Accountability.