Recent tragedies such as the Haiti earthquake, Hurricanes Katrina and Rita, and September 11th have demonstrated that minorities suffer disproportionately during all stages of a disaster. Acknowledging that culturally and linguistically competent care can help mitigate health disparities, the U.S. Department of Health & Human Services Office of Minority Health (OMH) developed a free online continuing education curriculum to equip disaster personnel with the knowledge, awareness and skills needed to provide culturally and linguistically appropriate services during all phases of a disaster.
The curriculum, titled “Cultural Competency Curriculum for Disaster Preparedness and Crisis Response” (CCC-DPCR) builds upon cultural competency modules previously developed by OMH for physicians and nurses and guides participants through four interactive courses based on the National Standards for Culturally and Linguistically Appropriate Services in Health Care. The CCC-DPCR was developed with extensive input from a literature review, specially commissioned concept papers, key informant interviews, multiple focus groups across the country, subject-matter experts on the National Project Advisory Committee, and content and format contributors in the Consensus-Building Group. The curriculum was both pilot-tested and field-tested with multiple revisions made before its final launch in July 2009.
The CCC-DPCR uses the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care as a framework for the four courses. The CLAS Standards, developed in 2001 by OMH, consist of 14 guidelines organized into 3 themes – culturally competent care, language access services, organizational supports – that offer comprehensive guidance on implementing culturally and linguistically appropriate services in health care. By integrating the CLAS Standards into disaster planning, response, and recovery, affected communities will receive equitable, effective services and information in an appropriate manner, leading to reduced health disparities.
The curriculum’s four courses each have 5-6 modules containing a variety of learning formats, including text, audio clips, video clips, first-hand accounts of cultural situations encountered by disaster responders, facts related to cultural competency, cultural insight about diverse communities, ways to implement CLAS Standards in organizations, and questions to help participants reflect on their professional experiences and what they’ve learned from the curriculum. On average, field tests found that each course takes approximately one hour to complete. In addition, 2.25 continuing education credits and a certificate are given to participants who pass the post-test and complete an evaluation for each course; a total of 9 continuing education credits can be earned for completing the entire curriculum. More details on the courses are provided below:
- Course 1: Introduction to CLAS in Disaster Preparedness and Crisis Response
Course 1 introduces participants to definitions used through the curriculum, the CLAS Standards, the Five Elements of Cultural Competence, the role of an interpreter, and factors contributing to health disparities. Participants are offered the opportunity to take a self-assessment to gauge their cultural competency level. The Respond tool is also discussed as a culturally competent way to gather personal history information from individuals.
- Course 2: Implementing CLAS in the Preparation Phase of a Disaster
Course 2 provides sample checklists (e.g., needs assessment, resource inventory, gap analysis) that aid participants in identifying and incorporating aspects of cultural and linguistic competency into their disaster preparedness plans. Examples are also presented on how to build rapport with the community and use multiple strategies for distributing information.
- Course 3: Implementing CLAS in the Response Phase of a Disaster
The first half of Course 3 focuses on the importance of just-in-time training through a video vignette and identifies ways to overcome cultural missteps. The second half of the course focuses on meeting basic needs, including both physical and mental health needs. Useful tables and checklists that can be used by participants during all phases of a disaster are included on the following topics: basic human needs, their cultural implications for disaster response and the related CLAS theme that may address the need; cultural insights on diet and fluid preferences plus food taboos; cultural beliefs surrounding death and potential preferences for post-mortem care; cultural and linguistic elements for a successful mental health program.
- Course 4: Implementing CLAS in the Recovery Phase of a Disaster
Course 4 closes the curriculum by emphasizing the importance of consulting the community, conducting evaluations, and understanding disparities that occur in the recovery phase of a disaster. A table is provided that outlines a ten step process for local planning and action.
Throughout the curriculum, references are made to additional materials available in the Resource Library. Participants can access materials at any time, including the Respond tool, CLAS Standards, and relevant laws and policies as well as resources on community engagement, communicating risk, working with the media, and collaborating with other disaster agencies.
Training participants offered feedback, such as “This engaging case-based interactive program combines relevant information and effective strategies to improve the connections between emergency personnel and patients before, during, and after a disaster;” and another trainee thought the program was “informative, relevant, and engaging.” The CCC-DPCR was also named the 2010 winner of the eHealthcare Leadership Award for Best Interactive Site in the Other Healthcare Sites category.
Using an interactive interface with minimal text per page and real-life stories, this curriculum provides an in-depth education on incorporating cultural and linguistic competency knowledge, attitudes, and skills into all phases of a disaster. As the U.S. continues to increase in diversity, online training programs like the CCC-DPCR will be instrumental in ensuring that health professionals and disaster responders provide equitable and appropriate care to diverse populations in an effort to reduce health disparities before, during, and after a disaster.