When considering the process of developing organizational standards for culturally and linguistically appropriate services (CLAS) in our health care environment, it will be helpful to utilize John Kingdon’s model for agenda setting and policy formation. In Kingdon’s model, there are three streams operating relatively independent of each other. First, the problem stream consists of the set of issues that the government or agency may be dealing with (Tepper, 2009). The second stream is the policy stream. This involves possible alternatives or solutions. Lastly the political stream involves opportunity or the extent to which decision maker are receptive to a new idea (Tepper, 2009). Kingdon’s model emphasizes that a window of opportunity opens when there is a confluence of these streams (Longest, 2010).
The problem stream with regards to CLAS has been illustrated in the Census data. The Census Bureau began collecting data on the foreign born in 1994. Until recently, the overall immigration trend since 1994 was clearly upward (Camarota & Zeigler, 2009). The diversity of the community is well-illustrated in our clinics and hospital. Concerns have been brought forward on multiple levels, staff, patients, community groups, and community leaders, including providing proper treatment and follow-up.
The policy stream was put in play when the Office of Minority Affairs was mandated by the United States Congress (P.L. 101-527) in 1994 to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase access to health care for limited English-proficient people. The United States Congress, House Committee on Appropriations, 103rd Congress 2d Session, Report 103-553, June 21, 1994, also recognized the need to address language barriers faced by limited English-speaking populations in the health care delivery system (U.S. Department of Health & Human Services, 2007).
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