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of Health and Human Services has developed the National Standards for Culturally and Linguistically Appropriate Services in
Health and Health Care (the National CLAS Standards) to assist
health-care providers in delivering culturally and linguistically
appropriate services. The standards are intended to promote
health equity and quality and aid in the elimination of disparities
as systems of care implement them (see figure 3).
11 These standards should be utilized by dentistry, as well as medicine as we
seek to become a culturally competent workforce.
A number of models and prototypes have also been developed to assist health-care providers in achieving cultural
competence. Training programs utilize the cultural competence
continuum, the LEARN model, the Purnell model for cultural
competence, individual assessments of cultural competence
among others, to educate providers in the cultural competence
3, 6 Copious resources exist for training programs for all
types of health-care providers and can be easily accessed for
training purposes. Possibly most significant is an understanding by the provider of his or her own culture. Afterall, how can
one understand other cultures if one does not have a good grasp
on one’s own cultural identity? Self-assessments and the models
referred to previously are available throughout the medical and
dental literature for providers to access and become comfortable with their own culture, enabling them to understand and
appreciate the cultural parameters of others.
Cultural Competence in Dentistry
In an integrative medicine journal, Dahiya and colleagues reminded readers of the proverb: “If the eyes are a window to the soul,
then the mouth is the doorway to the body.”
12 The Commission
on Dental Accreditation requires cultural competence training for
dental and dental hygiene students as part of the standard curriculum; schools are taking steps to increase the cultural competence
of students through various educational methods.
13, 14, 15, 16 It is an
ongoing process and additional research is warranted to determine
the effectiveness of cultural competence training in US dental
programs. Attaining cultural competence is a dynamic, ongoing process that is difficult to achieve; however, dental providers
should be cognizant of the significance of cultural parameters
when delivering services and make every effort to function within
those parameters. The “one-size-fits-all” mentality is no truer in
dentistry than in medicine, and dental providers must seek the
knowledge and skills to treat patients from a variety of cultures.
One of the primary considerations in cultural competence
training is that of communicating with patients of diverse
cultures. The dimensions of individualism and collectivism are
major aspects of how a person communicates with others.
People of individualistic cultures tend to focus on the “I,”
with each person having a personal responsibility for themselves. Independence, uniqueness, and competition are valued,
with the needs and preferences of the individual coming before
those of the group. This is the common thread in mainstream
6, 7 Collectivistic cultures tend to focus on the “we,”
with the dependence and connections of the group being most
valued and its needs and interests taking priority over a single
member. This is often the view held by emerging majority
groups in the US.
6, 7 These contrasting concepts become very
significant when making decisions regarding health-care services and treatments requiring sensitivity of the health-care
provider to both conceptual frameworks.
Figure 3: National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care.
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health
and health-care organizations to:
1. Provide effective, equitable, understandable, and respectful quality care and
services that are responsive to diverse cultural health beliefs and practices,
Governance, leadership, and workforce:
2. Advance and sustain organizational governance and leadership that promotes
CLAS and health equity through policy, practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the
4. Educate and train governance, leadership, and workforce in culturally and
linguistically appropriate policies and practices on an ongoing basis.
Communication and language assistance:
5. Offer language assistance to individuals who have limited English proficiency
and/or other communication needs, at no cost to them, to facilitate timely
access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly
and in their preferred language, verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should
8. Provide easy-to-understand print and multimedia materials and signage in the
languages commonly used by the populations in the service area.
Engagement, continuous improvement, and accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning
10. Conduct ongoing assessments of the organization’s CLAS-related activities and
integrate CLAS-related measures into measurement and continuous quality
11. Collect and maintain accurate and reliable demographic data to monitor and
evaluate the impact of CLAS on health equity and outcomes and to inform
12. Conduct regular assessments of community health assets and needs and use
the results to plan and implement services that respond to the cultural and
linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies,
practices, and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization’s progress in implementing and sustaining
CLAS to all stakeholders, constituents, and the general public.