As NIATx moves into its third decade, we continue to explore new terrains in improvement. NIATx has documented success as a framework for change management and for implementing evidence-based practices such as medications for opioid use disorder and behavioral approaches like motivational interviewing. It’s also showing promise as a framework for building culturally responsive care, a top priority across the full spectrum of health care.
Considering culture and service quality is a natural extension of person-centered care. Services are most effective when they are designed for the individual, which includes an understanding of that individual’s language, customs, and values. And the vehicle that has been at the forefront of culturally responsive care across America is the National Standards for Culturally and Linguistically Appropriate Services (CLAS). These 15 standards from the US Dept of Health and Human services focus on governance, leadership, workforce, communications, language, engagement, continuous improvement, and accountability.
The ATTC Network has been instrumental in building knowledge and skills for culturally responsive services using CLAS through a range of tools and trainings, including the CLAS Matters curriculum. An updated version, Culturally and Linguistically Appropriate Services (CLAS) Standards: Supporting Culturally Responsive Services in Behavioral Health Settings, builds on this foundation by incorporating NIATx tools and techniques. The goal of the updated curriculum is to not only deepen understanding of the CLAS standards but also provide practical strategies to implement them.
NIATx is driven by five principles and the number one principal is knowing and understanding the customer. Culturally responsive, person-centered care is all about the customer. Based upon this strong values alignment, the “What” of CLAS, joined with the “How” of NIATx, creates a strong implementation partnership. And just as had been the case with other NIATx / EBP collaborations, the results are powerful.
“We need to change our organization so that it responds more effectively to the cultures of the people we serve. But how do we do this? “
This question reflects the common refrain in the human service community. While most providers of human services are well aligned with the values of person centered and culturally responsive services that are reflected in the CLAS standards, few have found clear paths toward implementing these standards. A dialogue between leading thinkers about NIATx principles and CLAS standards led to a clear consensus: NIATx could be an excellent vehicle for supporting the implementation of culturally responsive care based on the CLAS standards.
The new curriculum is the product of the ATTC Network Behavioral Health Equity and Inclusion Workgroup and represents expertise from across the network. Alfredo Cerrato, Senior Cultural and Workforce Development Officer for the Great Lakes ATTC, was part of the team that developed the updated version.
“True progress begins with a profound cultural understanding of people, a requirement for good design, buy-in, effective implementation, and sustainability,” says Alfredo. “The NIATx model and the National CLAS Standards both champion cultural responsiveness, ensuring that care is effective, equitable, and meaningful. Together, they foster organic, reciprocal change and a deep understanding of our customers, creating a transformative change process that drives lasting and impactful improvements."
Providers seeking to implement CLAS standards often struggle to operationalize the values of CLAS. NIATx process improvement tools help providers to understand the customer experience through walk- throughs and flowcharting the process. Targeted walk throughs can be conducted to understand the experience of particular populations and answer key culture questions:
NIATx guides organizations in selecting an aim related to one of the CLAS Standards, and then using Nominal Group Technique to select a strategy that can result in measurable change.
Finding a key measurable indicator of progress is another central element of using NIATx to enhance cultural responsiveness. When organizations just try to be more culturally responsive without metrics, they have no way of knowing if they are improving. By tracking key metrics, the results of their efforts become clear:
In 2023, NIATx partnered with the state of Ohio and Prevention Action Alliance to develop a NIATx learning collaborative among substance use prevention services. This Collaborative brought together 10 prevention services providers from across the state for an initial training that focused on both NIATx and the CLAS standards. This training was followed by coaching, as each organization developed and implemented a change project designed to enhance the culturally responsive nature of their service delivery related to a specific CLAS standard. NIATx also developed a NIATx CLAS assessment tool to measure each organization’s alignment with the CLAS standards.
At the end of the learning collaborative, all of the providers gathered to share the results of their projects, which included:
On the heels of this successful effort, NIATx has continued to deliver and refine our CLAS and culture-based training and technical assistance offerings. The new curriculum incorporates best practices that emerged from the Ohio training and others focused on CLAS and culturally responsive service delivery.
CLAS and culture is one more place that the best practice “What” benefits from the NIATx “How,” ensuring that best practice models can be successfully implemented, sustained, and improved. Culturally and Linguistically Appropriate Services (CLAS) Standards: Supporting Culturally Responsive Services in Behavioral Health Settings exemplifies this integration, making it easier to translate CLAS standards into meaningful practices that build equitable services and a culturally responsive organizational culture.
Watch your email for more information and new training opportunities for Culturally and Linguistically Appropriate Services (CLAS) Standards: Supporting Culturally Responsive Services in Behavioral Health Settings!
Mat Roosa, LCSW-R
Mat Roosa is a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant and trainer in the areas of process improvement, evidence-based practices implementation, and organizational development and planning. Mat’s experience also includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human services agency administration.
The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.