Skip to main content

Advertisement

SpringerLink
Log in

Literature Review of the National CLAS Standards: Policy and Practical Implications in Reducing Health Disparities

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care are a practical tool for health and health care organizations to improve their provision of culturally and linguistically appropriate services (CLAS). Published by the Office of Minority Health at the U.S. Department of Health and Human Services, the National CLAS Standards provide health and health care organizations with a set of action steps for better meeting the needs of individuals from culturally and linguistically diverse backgrounds. Few studies have examined the concept of CLAS or the National CLAS Standards, and they have rarely been extensively studied or reviewed. The authors conducted three literature searches between February 2014 and May 2015, examining the organizational challenges, applicability, and policy implications related to the National CLAS Standards or CLAS, and selected 55 articles for inclusion in the review. The literature highlights a number of challenges in implementing the National CLAS Standards and/or providing CLAS, including issues related to the communication within health care organizations and the inconsistency of accountability measures. This literature review contributes to the growing knowledge base of the National CLAS Standards and CLAS in health and health care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. U.S. Department of Health and Human Services, Office of Minority Health. National standards for culturally and linguistically appropriate services in health and health care: a blueprint for advancing and sustaining CLAS policy and practice; 2013. Available from https://www.thinkculturalhealth.hhs.gov/Content/clas.asp

  2. Koh HK, Gracia JN, Alvarez ME. Culturally and linguistically appropriate services—advancing health with CLAS. N Engl J Med. 2014;371(3):198–201.

    Article  CAS  PubMed  Google Scholar 

  3. Passel JS, Cohn D. U.S. population projections: 2005–2050; 2008. Available from: http://pewsocialtrends.org/files/2010/10/85.pdf

  4. U.S. Department of Commerce, Census Bureau. American community survey; 2010. Available from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_DP02&prodType=table

  5. Betancourt JR, Corbett J, Bondark MR. Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation. Chest. 2014;145(1):143–8. doi:10.1378/chest.13-0634.

    Article  PubMed  Google Scholar 

  6. Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57:181–217.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Diallo AF, McGrath JM. A glance at the future of cultural competency in healthcare. Newborn Infant Nurs Rev. 2013;13(3):121–3.

    Article  Google Scholar 

  8. Like RC. Educating clinicians about cultural competence and disparities in health and health care. J Contin Educ Health Prof. 2011;31:196–206.

    Article  PubMed  Google Scholar 

  9. Diamond LC, Wilson-Stronks A, Jacobs EA. Do hospitals measure up to the national culturally and linguistically appropriate services standards? Med Care. 2010;48(12):1080–7.

    Article  PubMed  Google Scholar 

  10. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Fixsen DL, Naoom SF, Blasé KA, Friedman RM, Wallace F. Implementation research: A synthesis of the literature. (FMHI Publication No. 231). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network; 2005. Available from http://ctndisseminationlibrary.org/PDF/nirnmonograph.pdf.

    Google Scholar 

  12. Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.

    Google Scholar 

  13. Nilsen P. Making sense of implementation theories, models, and frameworks. Implement Sci. 2015. doi:10.1186/s13012-015-0242-0.

    PubMed  PubMed Central  Google Scholar 

  14. Cooper HM. Synthesizing Research: A Guide for Literature Reviews. 3rd ed. Thousand Oaks, Calif: Sage Publications; 1998.

    Google Scholar 

  15. Thomas JM. Diffusion of innovation in systematic review methodology: why is study selection not yet assisted by automation? OA Evid Based Med. 2013;1(2):12.

    Article  Google Scholar 

  16. Barksdale CL, Kenyon J, Graves DL, Jacobs CG. Addressing disparities in mental health agencies: strategies to implement the National CLAS Standards in mental health. Psychol Serv. 2014;11(4):369–76.

    Article  PubMed  Google Scholar 

  17. Barr DA, Wanat SF. Listening to patients: cultural and linguistic barriers to health care access. Fam Med. 2005;37(3):199–204.

    PubMed  Google Scholar 

  18. Bender DE, Clawson M, Harlan C, Lopez R. Improving access for Latino immigrants: evaluation of language training adapted to the needs of health professionals. J Immigr Health. 2004;6(4):197–209.

    Article  PubMed  Google Scholar 

  19. Carrillo-Zuñiga G, Dadig B, Guion KW, Rice VI. Awareness of the national standards for culturally and linguistically appropriate services at an academic health center. Health Care Manag. 2008;27(1):45–53.

    Google Scholar 

  20. Carrillo-Zuñiga G, Seol Y, Dadig B, Guion K, Rice V. Progression in understanding and implementing the cultural and linguistic appropriate services standards: Five-year follow-up at an academic center. Health Care Manag. 2013;32(2):167–72.

    Google Scholar 

  21. Cassey MZ. Using technology to support the CLAS standards. Nurs Econ. 2008;26(2):133–5.

    PubMed  Google Scholar 

  22. Chong N. A model for the Nation’s health care industry: Kaiser Permanente’s Institute for culturally competent care. Perm J. 2002;6(3):47–50.

    Google Scholar 

  23. Davis JA, Whitman MV. Organizational characteristics associated with cultural and linguistic service provision within Alabama hospitals. Health Care Manag. 2008;27(1):79–88.

    Google Scholar 

  24. Doornbos M, Zandee GL, Degroot J. Attending to communication and patterns of interaction: culturally sensitive mental health care for groups of urban, ethnically diverse, impoverished, and underserved women. J Am Psychiatr Nurses Assoc. 2014;20(4):239–49.

    Article  Google Scholar 

  25. Droese P, Peterson N. Utilization of the medical librarian in a state Medicaid program to provide information services geared to health policy and health disparities. J Med Libr Assoc. 2006;94(2):174–9.

    PubMed  PubMed Central  Google Scholar 

  26. Gaydos L, Blake S, Gazmararian J, Woodruff W, Thompson W, Dalmida S. Revisiting safe sleep recommendations for African-American infants: why current counseling is insufficient. Matern Child Health J. 2014;19:496–503.

    Article  Google Scholar 

  27. Graham G, Heurtin-Roberts S. Addressing disparities in clinical trials: culturally and linguistically appropriate standards in clinical trials (CLAS-ACT) and the EDICT backpack initiative. J Cancer Educ. 2009;24 Suppl 2:S54–5.

    Article  PubMed  Google Scholar 

  28. Hoffman NA. The requirements for culturally and linguistically appropriate services in health care. J Nurs Law. 2011;14(2):49–57.

    Article  Google Scholar 

  29. Solutions IQ. National standards for culturally and linguistically appropriate services in health care: final report. Washington, DC: Office of Minority Health; 2001. Available from http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf.

    Google Scholar 

  30. Jackson CS, Gracia JN. Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health. Public Health Rep. 2014;129 Suppl 2:57–61.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Jacobs EA, Chen AH, Karliner L, Fortier JP, Mutha S. Legal and regulatory obligations to provide culturally and linguistically appropriate emergency department services. Clin Pediat Emerg Med. 2004;5(2):85–92.

    Article  Google Scholar 

  32. Jacobs CG, Graves DL, Kenyon J, Pacheco G. Advancing culturally and linguistically appropriate services at all phases of a disaster. Washington Lee J Civil Rights Soc Justice. 2012;19(1):3–17.

    Google Scholar 

  33. Jenkins LB. Cultural competency and optometric education. Optom Educ. 2006;31(3):79–83.

    Google Scholar 

  34. Jodache S, Howe T, Siyambalapitiya S. Assessment of a Samoan–English speaker with bilingual aphasia: “It’s hard.”. Aphasiology. 2014;29(7):872–88.

    Article  Google Scholar 

  35. Kairys J, Like RC. Caring for diverse populations: do academic family medicine practices have CLAS? Fam Med. 2006;38(3):196–205.

    PubMed  Google Scholar 

  36. Khanna SK, Cheyney M, Engle M. Cultural competency in health care: evaluating the outcomes of cultural competency training among health care professionals. J Natl Med Assoc. 2009;101(9):886–92.

    Article  PubMed  Google Scholar 

  37. Lawson EH, Carreon R, Veselovskiy G, Escarce JJ. Collection of language data and services provided by health plans. Am J Manag Care. 2011;17(12):e479–87.

    PubMed  Google Scholar 

  38. Lindsay J. Achieving compliance with Title VI of the Civil Rights Act of 1964: a comprehensive approach to ensuring meaningful access to services for limited-English-proficient individuals. J Nurs Law. 2005;10(1):47–55.

    Google Scholar 

  39. Luquis RR, Pérez MA. Achieving cultural competence: the challenges for health educators. Am J Health Educ. 2003;34(3):131–8.

    Article  Google Scholar 

  40. ORC MACRO. CLAS in health care: Implementation of the national standards for culturally and linguistically appropriate services in health care at the Alameda Alliance for Health (Executive Summary No. 282-98-0013). Calverton, MD: ORC Macro; 2004. Available from http://minorityhealth.hhs.gov/assets/pdf/checked/CLAS_healthcare.pdf.

    Google Scholar 

  41. Martinez KM, Green CE, Sañudo FM. The CLAS challenge: promoting culturally and linguistically appropriate services in health care. Int J Pub Admin. 2004;27(1/2):39–61.

    Article  Google Scholar 

  42. McLean S, Riley-Eddins E. Editorial: recommended standards for culturally and linguistically appropriate health services. J Multicult Nurs Health. 2000;6(2):5–6.

    Google Scholar 

  43. Messias DKH. What nurses need to know about the national standards for culturally and linguistically appropriate services [CLAS] in health care. S C Nurs. 2003;10(3):23–4.

    Google Scholar 

  44. Moxley A, Mahendra N, Vega-Barachowitz C. Cultural competence in health care. ASHA Leader. 2004;9(7):6–21.

    Google Scholar 

  45. Narayan MC. The national standards for culturally and linguistically appropriate services in health care. Care Manag J. 2002;3(2):77–83.

    CAS  Google Scholar 

  46. Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Iezzoni LI, et al. Linguistic and cultural barriers to care: perspectives of Chinese and Vietnamese immigrants. J Gen Intern Med. 2003;18(1):44–52.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Orozco E. Understanding the culturally and linguistically appropriate services [CLAS] standards. Migrant Health Newsl. 2012;1:2–3.

    Google Scholar 

  48. Pacquiao DF. President’s message: CLAS standards for culturally and linguistically appropriate services. J Transcult Nurs. 2004;15(4):338.

    Article  Google Scholar 

  49. Parker VA. The importance of cultural competence in caring for and working in a diverse America. Part of a Special Issue: Building a Workforce to Care for an Aging Society: Challenges and Opportunities. 2010;34(4):97–102.

    Google Scholar 

  50. Payne P. National culturally and linguistically appropriate services standards—mandates or not? J Health Care Poor Underserved. 2012;23(3):968–71.

    Article  PubMed  Google Scholar 

  51. Peltier S. Providing culturally sensitive and linguistically appropriate services: an insider construct. Can J Speech Lang Pathol Audiol. 2011;35(2):126–34.

    Google Scholar 

  52. Putsch B, SenGupta I, Sampson A, Tervalon M. Reflections on the CLAS standards: best practices, innovations, and horizons. Cross Cultural Health Care Program: Seattle, WA; 2003. Available from http://minorityhealth.hhs.gov/assets/pdf/checked/reflections.pdf.

    Google Scholar 

  53. Russell C. What you need to know about culturally and linguistically appropriate services. Conn Med. 2010;74(4):241–2.

    PubMed  Google Scholar 

  54. Salimbene S. CLAS A-Z: A practical guide for implementing the national standards for culturally and linguistically appropriate services (CLAS) in health care. Inter-Face Intl. 2001. Available online at http://www.minorityhealth.hhs.gov/assets/pdf/checked/CLAS_a2z.pdf.

  55. Scott BS. Managed care to the head of the CLAS: implementing culturally and linguistically appropriate services. Closing the Gap. 2003. Available online at http://minorityhealth.hhs.gov/assets/pdf/checked/Managed%20Care%20Moves%20to%20the%20Head%20of%20the%20CLAS--Implementing%20Culturally%20and%20Linguistically%20Appropriate%20Services.pdf.

  56. Semansky RM, Altschul D, Sommerfeld D, Hough R, Willging CE. Capacity for delivering culturally competent mental health services in New Mexico: results of a statewide agency survey. Adm Policy Ment Health. 2009;36(5):289–307.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.

    Google Scholar 

  58. Starr S, Wallace DC. Self-reported cultural competence public health nurses in a southeastern U.S. public health department. Public Health Nurs. 2009;26(1):48–57.

    Article  PubMed  Google Scholar 

  59. Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it? non-conscious bias in medical decision making. Med Educ. 2011;45(8):768–76.

    Article  PubMed  Google Scholar 

  60. Taveras EM, Flores G. Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department. Clin Pediat Emerg Med. 2004;5(2):76–84. doi:10.1016/j.cpem.2004.01.004.

    Article  Google Scholar 

  61. Thobaben M. Culturally competent health care: the national standards on culturally and linguistically appropriate services. Home Health Care Manag Pract. 2003;15(5):454–5.

    Article  Google Scholar 

  62. UQIOSC. CLAS standards implementation tips (Cultural Competency QIO Regional Training). UQIOSC. 2005. Available online at http://ww2.nasbhc.org/RoadMap/PracticeCompliance/CLAS%20Standards%20Implementation%20Tips.pdf.

  63. Vandervort EB, Melkus GD. Linguistic services in ambulatory clinics. J Transcult Nurs. 2003;14(4):358–66.

    Article  PubMed  Google Scholar 

  64. Weech-Maldonado R, Dreachslin JL, Brown J, Pradhan R, Rubin KL, Schiller C, et al. Cultural competency assessment tool for hospitals: evaluating hospitals’ adherence to the culturally and linguistically appropriate services standards. Health Care Manag Rev. 2012;37(1):54–66.

    Article  Google Scholar 

  65. Whitman M, Valpuesta D. Examining human resources’ efforts to develop a culturally competent workforce. Health Care Manag. 2010;29(2):117–25.

    Google Scholar 

  66. Wilson-Stronks A, Galvez E. Hospitals, language, and culture: A snapshot of the nation. Exploring cultural and linguistic services in the nation’s hospitals: a report of findings.; 2007. Available from http://www.jointcommission.org/assets/1/6/hlc_paper.pdf

  67. Xu Y. National standards for providing culturally and linguistically appropriate health care: policy implications for nursing. Nurs Econ. 2001;19(5):240–1.

    Google Scholar 

  68. Yearby R. When Is a change going to come?: Separate and unequal treatment in health care fifty years after Title VI of the Civil Rights Act of 1964. Diversity, the University, and the World Outside. 2014;67:287–289.

  69. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competency: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118:293–302.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67:478–86.

    Article  PubMed  Google Scholar 

  71. LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44:2093–105.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Logan DM. Culturally and linguistically appropriate services: an overview of policy and safe acute care nursing practice in the United States. Gastroenterol Nurs. 2007;30(1):29–36.

    Article  PubMed  Google Scholar 

  73. U.S. Department of Health and Human Services, Office of Minority Health. Tracking CLAS; 2016. Available from https://www.thinkculturalhealth.hhs.gov/Content/LegislatingCLAS.asp

Download references

Acknowledgments

The authors wish to acknowledge the support of and partnership with the staff at the HHS Office of Minority Health, particularly, Christine Montgomery, the Project Officer for this contract, and Juan Arroyo, Yendelela Cuffee, Anna DiColli, and Ticona N. Fillah for their assistance.

Author information

Authors and Affiliations

  1. Health Determinants & Disparities Practice, CSRA Inc, 6003 Executive Blvd. Suite 400, Rockville, MD, 20852, USA

    Crystal L. Barksdale, Jennifer Kenyon, Kimberly Green & C. Godfrey Jacobs

  2. Division of Educational Psychology, Research Methods, & Education Policy, College of Education and Human Development, George Mason University, Fairfax, USA

    William H. Rodick III & Rodney Hopson

Authors
  1. Crystal L. Barksdale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William H. Rodick III
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodney Hopson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Kenyon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimberly Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Godfrey Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Crystal L. Barksdale.

Ethics declarations

Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Funding

This work was funded by contract #HHSN2639999000291 to CSRA Inc. (formerly SRA International, Inc.) from the Office of Minority Health at the U.S. Department of Health and Human Services.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barksdale, C.L., Rodick, W.H., Hopson, R. et al. Literature Review of the National CLAS Standards: Policy and Practical Implications in Reducing Health Disparities. J. Racial and Ethnic Health Disparities 4, 632–647 (2017). https://doi.org/10.1007/s40615-016-0267-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-016-0267-3

Keywords

Search

Navigation