Culturally and Linguistic Appropriate Services in Healthcare (CLAS)

Culturally and Linguistic Appropriate Services in Healthcare (CLAS)

When I first came across CLAS, my first reaction was an initiative to enhance equity within the healthcare setting and reduce discrimination and disparities when providing services to individuals. This way, patients who were initially unable or could not access quality care because of disparity barriers can now access care, resulting in improved health outcomes. According to Nieto & Zoller Booth (2010), the word competent is often used among professionals. This means that the ability of a professional to interact with patients and colleagues in another culture or country would be an aspect of cultural competence. But, when an individual is able to interact with people of a different country, it does not make them culturally competent by itself.

In this case, the word competent was substituted for appropriate because the word culturally competent implies that culture can be seen as a technical skill for which healthcare professionals can be trained to enhance their expertise. Appropriate was used instead because, for instance, when a health care professional uses an interacting style such as covert racism, they are aware of their fears of a particular cultural group. However, they know that open expression of their attitudes would be inappropriate (Campinha-Bacote et al., 2005). They would, therefore, attempt to cover up their true feelings. This would not require professional competence to treat the patient but suitable communication and sensitivity in that circumstance, hence the word appropriate. Besides, circumstances are different for every patient or cultural group and would not require constant professional skill alone to handle every patient. CLAS aligns with my expectation of appropriate care because it is clear that a healthcare professional would not really need the competence to take the suitable medical history of a patient with heart failure to lead to enhanced outcomes for the patient with heart failure. This way, I am confident that the health professional would handle any issue I have as a patient based on my circumstances at that very moment.

Implicit bias, an unconscious belief about a particular social group, may lead people to attribute particular characteristics to certain group members (Cherry, 2020). Implicit bias may influence decision-making and clinical judgment and affect outcomes of treatment in a healthcare setting by affecting clinical interactions and the adherence of the patient to treatment (Blair, Steiner & Havranek, 2011). This effect is clearly reflected in the model below in the figure. In a research study, physicians who scored high in implicit bias tests were found to dominate conversations with African American patients. This led to patients having less trust and confidence in the health provider and rating the care quality as low (Cherry, 2020). This means that the implicit bias has created a barrier for the provider to give CLAS to the patient because the patient has already made a negative conclusion about the health provider based on the implicit bias.

Model reflecting the influence of implicit bias on control of hypertension (Blair, Steiner & Havranek, 2011)

References

Blair, I. V., Steiner, J. F., & Havranek, E. P. (2011). Unconscious (implicit) bias and health disparities: where do we go from here?. The Permanente Journal, 15(2), 71.
Campinha-Bacote, J., Claymore-Cuny, D., Cora-Bramble, D., Gilbert, J., Husbands, R. M., Like, R. C., … & Tang, G. (2005). Transforming the face of health professions through cultural and linguistic competence education: The role of the HRSA Centers of Excellence.
Cherry, K. (2020). How does Implicit Bias Influence Behavior? https://www.verywellmind.com/implicit-bias-overview-4178401
Nieto, C., & Zoller Booth, M. (2010). Cultural competence: Its influence on the teaching and learning of international students. Journal of Studies in International Education, 14(4), 406-425.

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this is the question to react to
Part II: In the second part of this week’s discussion, you will be required to meaningfully integrate your assigned module readings and videos to answer the series of questions below.

• What was your reaction when you first read or heard the phrase culturally and linguistically appropriate services (CLAS)? Why do you think the word appropriate has been substituted for the previously used word, competent? As you discuss this question, consider your own beliefs about what it means to provide culturally and linguistically appropriate services. Also, share how well CLAS does or doesn’t align with your expectations of appropriate care.
• As a result of completing one or more Implicit Attitudes Tests (IAT), how has your understanding of implicit bias changed? You are not required to share any personal information, like which test you took or your actual test results. Instead, you are being asked to reflect on the experience itself. Describe how implicit bias might impact behaviors and relationships with people you perceive as different from yourself. Then, taking this from the personal to the professional, how might implicit bias create barriers to CLAS for individuals and families?