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Health systems - North American perspectives - The CLAS Standards

See for source.

Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda.

Recommended Standards for Culturally and Linguistically Appropriate Health Care Services (Office of Minority Health, Public Health Service, & U.S.Department of Health and Human Services 2002).

 Based on an analytical review of key laws, regulations, contracts, and standards currently in use by federal and state agencies and other national organizations, these proposed standards were developed with input from a national advisory committee of policymakers, providers, and researchers. In the [full report], each standard is accompanied by commentary that addresses its relationship to existing laws and standards, and offers recommendations for implementation and oversight to providers, policymakers, and advocates.

The mindmap is derived from the CLAS Standards

CLAS Standards 

Culturally competent health care organizations

The following is derived from   

Researchers at Georgetown University Child Development Center have defined a continuum of cultural competency for health care institutions that ranges from cultural destructiveness to cultural proficiency. This six-part continuum is a progression from cultural destructiveness to cultural incapacity, cultural blindness, pre-competence, competence, and finally, cultural proficiency. Understanding this continuum may help administrators and staff, as well as the individual provider, to assess and improve the organization.

Each phase on the continuum is described below.

  • Culturally destructive organizations actively participate in purposeful attacks on another culture, and dehumanize their clients from different racial and ethnic groups. The attitudes, policies and practices of these agencies are destructive to cultures and the individuals within these cultures. An example of this is the long-term syphilis study in Tennessee, which deprived poor black men of treatment so that scientists and doctors could study the progression of the disease. The study even prevented the subjects from receiving treatment elsewhere.

  • Cultural incapacity occurs when organizations do not intentionally seek to be culturally destructive but have no capacity to help clients from other cultures. The system remains extremely biased, believes in the superiority of the dominant group, and assumes a paternal posture towards "lesser" groups. An example is a private hospital that would turn away a sick or injured Hispanic person from the emergency room and direct him to the nearest public hospital.

  • Culturally blind organizations believe that color or culture makes no difference and that if the system works as it should, all people—regardless of race or culture— will be served with equal effectiveness. A simple example of cultural blindness was the light tan bandage that for years was sold as "flesh-colored." It was, but only if you were a fair-skinned white person.

  • Culturally pre-competent organizations acknowledge their weaknesses in serving some communities and attempt to improve some aspect of their services to specific populations.

  • Culturally competent organizations accept and respect differences among and within different groups; continually assess their policies and practices regarding culture and expand cultural knowledge and resources; and adapt service models in order to better meet the needs of different racial and/or ethnic groups. These organizations work to hire staff who are unbiased and those who represent the racial and ethnic communities being served; and seek the advice and counsel from their clients. They are committed to policies that enhance services to a diverse clientele.

  • Culturally proficient organizations conduct original research, develop new therapeutic approaches based on culture and publish and disseminate their results to add to the knowledge base of culturally-competent practices. Culturally proficient agencies hire staff who are specialists in culturally competent practice. Such agencies are expansive, advocating for cultural competence throughout the health care system and for improved relations between cultures.

(Cross et. al. 1989)