DBHDSVirginia Department of

Behavioral Health andDevelopmental Services

Staff Member NameTitle

Equity and Language Access Initiatives in Virginia Behavioral

Health & Developmental Services

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DBDHSVirginia 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

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesWHAT IS 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

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Levels of Cultural Competency

Individual Level

Right skills,

knowledge, and

attitude to work for a

diverse population

Organizational SystemsPolicies and procedures in place and an infrastructure that supports diverse communitiesSystem’s Levels

Laws and regulations in place and an infrastructure that supports

diverse communities

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DBDHSVirginia 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

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DBDHSVirginia 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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DBDHSVirginia Department of Behavioral Health and

Developmental Services Secretariat Initiatives

• Virginia Health Reform Initiative

• Systems Transformation

• Organizational and Program Effectiveness

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DBDHSVirginia 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/

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DBDHSVirginia 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.

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesOrganizational 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.

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Why Plan for CLC?

FEDERAL LAW

Civil Rights Act of 1964The 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."

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DBDHSVirginia 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

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DBDHSVirginia 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

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DBDHSVirginia 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.

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DBDHSVirginia 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

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DBDHSVirginia 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.

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DBDHSVirginia 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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DBDHSVirginia Department of Behavioral Health and

Developmental Services

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC in Practice

CulturalCompetence

Do our practicesInhibit or prohibit

engagement?

Do we seek meaningfulinclusion of cultural

considerationsthroughout 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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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC in Practice

CulturalCompetence

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 safevenues 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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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC in Practice

LinguisticCompetence

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

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesCLC 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 mediain languages

for outreach to diverse communities

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesOCLC- 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

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DBDHSVirginia 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

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DBDHSVirginia Department of Behavioral Health and

Developmental ServicesOCLC- 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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DBDHSVirginia 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

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Possible Agency ApproachesAgencies 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

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DBDHSVirginia Department of Behavioral Health and

Developmental Services Possible Agency ApproachesAgencies 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