At the height of the COVID 19 pandemic, when community-serving organizations were suffering from personnel shortages, among other challenges, Cochise County Health & Human Services, received a grant from the state of Arizona to address COVID and promote health equity and healthcare access. Partners collaborated together developing strategies to use of community health workers as agents of change in local communities AND to address barriers to care, through development of capacity of local agencies to provide culturally and linguistically appropriate services. Partners included: Cochise County Health and Social Services, the Arizona Community Health Worker Association (AzCHOW) – which provided CHW core competency training, Pinal Hispanic Council, the University of Arizona Prevention Research Center (UAPRC) – which provided evaluation and technical assistance, Winchester Heights Health Organization (WHHO), Chiricahua Community Health Centers the local FQHC, and several local agencies working with the unhoused. The project initiated in November, 2021 and ended in late 2023.
With most partners training and deploying CHWs, SEAHECs specific role in this effort was to work with local health and social service agencies, and directly with health providers, to increase their capacity to provide CLAS services.
Project Summary:
The Southeast Arizona Health Education Center (SEAHEC) was subcontracted to provide essential training and capacity-building opportunities for local organizations to improve their ability to provide culturally and linguistically appropriate services (CLAS) standards.
Project Objectives:
Decrease Health Disparities: The project's overarching goal was to reduce health disparities among Cochise County's diverse communities, ensuring that everyone has equitable access to healthcare services and experience improved health outcomes.
Implement CLAS Standards: The project worked to implement the National Culturally and Linguistically Appropriate Services (CLAS) Standards within health organizations throughout Cochise County. This includes promoting culturally sensitive care and improving language access for non-English speakers.
Methodology:
SEAHEC first conducted an assessment of existing trainings and resources regarding CLAS and found that most trainings took a “deficit approach” to the topic and were not engaging or personalized. After discussing their findings with colleagues, conducting a literature review, SEAHEC decided to develop its own approach to CLAS standards.
SEAHEC identified organizations that provided health and social services and asked their leadership/management about their interest in providing culturally and linguistically appropriate services and their willingness to participate in training to improve their capacity in this topic. Overwhelmingly local organizations responded positively, with 8 organizations agreeing to participate. We then provided a presentation with an easy-to-understand, culturally and linguistically appropriate approach. Once, an organization agreed to participate, they conducted an “organizational assessment”, before receiving any further training. The assessment aimed to identify the Culturally and Linguistically Appropriate Services (CLAS) standards that were already being implemented and to pinpoint areas for improvement, as well as to identify existing health disparities, cultural barriers, and linguistic challenges within the organization. Then individual employees participated in assessments, to help the organization improve how it delivers services and interacts with clients.
SEAHEC designed and delivered training sessions and workshops for healthcare providers, administrators, and staff to increase their understanding and implementation of CLAS standards within their work scope. These trainings were available in English and Spanish as well as different modalities including in-person, hybrid or online. SEAHEC offered ongoing technical assistance and guidance to health organizations as they worked to integrate CLAS standards into their policies and practices and their daily work scope.
While the scope of our project, did not allow for measurement of long term impact, the anticipated outcomes, resulting from CLAS standards training and capacity building include:
Improved access to healthcare services for underserved populations in Cochise County.
Increased cultural competence among healthcare providers and organizations.
Enhanced language access for non-English-speaking individuals.
Reduction in health disparities and improved health outcomes.
Stronger collaboration between local health organizations and communities.
Successes:
Through this project, SEAHEC trained 69 individuals within 8 organizations. The CLAS training, led by our dedicated program coordinators, Pablo Albelais and Mariana Gonzales, demonstrated remarkable success. The training contained various engaging activities that fostered an interactive learning experience.
Remarkably, individuals from outside our organization, as well as Arizona Department of Health Services (ADHS) staff who had previously completed CLAS training offered by other agencies, consistently expressed that our training was notably more accessible and comprehensible than other programs. This positive feedback underscores the effectiveness and quality of our training program.
The training program achieved a significant national milestone by presenting our work on CLAS standards at the National Rural Health Conference in San Diego, CA in 2023. This presentation garnered notable interest from numerous organizations across the nation, expressing a strong desire to make this training available within their own organizations. This recognition underscores the widespread relevance and impact of our program on a national scale.
Following the presentation at the National Rural Health Association (NRHA) conference in San Diego, the Centers for Medicaid & Medicare Services (CMS) Office of Minority Health (OMH) reached out to Mariana Gonzalez, SEAHEC program coordinator, requesting an interview. The primary objective of this interview was to delve deeper into the practices and strategies employed by organizations and healthcare providers to deliver culturally and linguistically appropriate services in rural, geographically isolated, and frontier communities.
The SEAHEC CLAS standards initiative is poised to advance the collective understanding of best practices in the provision of culturally and linguistically appropriate healthcare services in underserved regions. Our experience in implementing its CLAS standards capacity building are set to be incorporated into the CMS's CLAS standards toolkit, to be disseminated on a national scale. These local, state and national-level recognitions underscore the credibility and significance of our CLAS training within the field.
Lessons learned include the lack of enough literature on CLAS standards or experience in implementing training on the standards, and a lack of engaging and literacy level appropriate training materials on CLAS as well. Recognizing the need for accessible material, SEAHEC developed content that was easy to understand, using short sentences, pictures, and attention-grabbing colors to ensure that everyone could comprehend the material effortlessly.
As well, SEAHEC observed that there are very few resources for nonprofits to effectively learn about and adapt the CLAS standards. SEAHEC used examples of how the standards could work together or separately, ensuring flexibility in the training approach according to each organization's capacity.
Conclusion:
SEAHEC successfully achieved its goal of providing essential training and capacity-building, on culturally and linguistically appropriate services (CLAS) standards. The primary objective was to eliminate health disparities and enhance health equity in Cochise County's diverse populations, improving the capacity of health and social service agencies to serve their community members effectively. SEAHEC used different modalities, including online, hybrid, and in-person formats, ensuring accessibility for clinicians. The training involved eight organizations in Cochise County, including locations in Bisbee, Douglas, Winchester, Benson, and Sierra Vista. The impact of these efforts is evident in the increased awareness and implementation of CLAS standards within local health organizations, ultimately contributing to the reduction of health disparities and improved health outcomes. Looking ahead, SEAHEC aims to extend this training to any organization demonstrating a need and interest in CLAS standards, provided funding is available, thereby continuing our commitment to promoting health equity in rural communities. SEAHEC expresses gratitude for the opportunity to make a positive impact on healthcare accessibility and quality in Cochise County.