Cultural Responsiveness: Exploring the CLAS Standards


In recent years NIATx has focused on a “What-How” strategy:

  • A range of evidence-based practices and improvement agendas have provided the “What” (i.e., what we want to implement or improve).
  • The NIATx improvement model has provided the “How” (i.e., how we can effectively implement or improve it).

Using this model, NIATx has found success in supporting states, provider systems, and organizations in effectively implementing and improving a range of practices. These have included motivational interviewing, substance use screening, peer services, contingency management, regulatory compliance, family engagement, clinic services, and other practices across a spectrum of health and human services.

Focus on Cultural Responsiveness

A powerful “What-How” that has recently emerged involves organizational and systemic efforts to improve Cultural Responsiveness (CR). CR includes efforts to understand and engage the wide array of cultural attributes that individuals and groups bring to the service environment. This includes both service staff and customers, such as service recipients, and other community partners.  These cultural features can include language, behaviors, beliefs, values, and customs. A focus on culture tends to create a broader dialogue beyond race and ethnicity, including cultural differences found in different regions, generations, urban and rural locations, gender and sexual orientation, faith communities, etc. 

Much energy is being focused on CR right now as SAMHSA promotes the Culturally and Linguistically Appropriate Services (CLAS) Standards framework in health and healthcare.  The 15 action steps of CLAS focus on advancing health equity, eliminating disparities, and improving service quality.

In support of the CLAS Standards, the NIATx Foundation has developed the NIATx CLAS Assessment Tool (NCAT). The assessment features multiple subscales and can be delivered to a team or a broader system to determine the organization’s perspectives and needs related to CLAS. Participant responses to the web-based survey result in scores that represent the four quadrants below, including low or high scores related to the organization’s “world view” and low or high scores related to the organization’s “actions” as they pertain to CLAS.

Case Study: Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa


Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa in Burlington, Iowa has a clear understanding of the cultural diversity present in the community and the need to address this diversity to effectively provide services. “ADDS’s challenge is everyone’s challenge,” explained NIATx Foundation’s Mat Roosa, “but because they are progressive and have self-awareness, they see it and the opportunities it can bring.”


ADDS partnered with the NIATx Foundation to complete a CLAS assessment and facilitate a day-long CR training. The objective of this project was to leverage ADDS’s progressive ideals to identify ways to more thoughtfully engage with the community’s culturally diverse groups.

The ADDS team actively participated in an initial meeting to explore their experience on a range of cultural variables that impact—and sometimes challenge—their care delivery. The staff team then completed the CLAS assessment using NCAT to develop an operational baseline for the organization.

Upon completion of the assessment, ADDS staff came together with two NIATx Foundation subject matter experts in CLAS/Culture and Process Improvement. This day-long work session supported the ADDS team in:

  1. Understanding the multiple ways that cultural differences impact how they deliver care, and
  2. Developing implementation and change strategies to enhance their ability to engage service recipients.


While the population of Burlington, Iowa is 86% white (U.S. Census), the ADDS team was readily able to identify a number of cultural diversity issues that could be the focus of future service enhancement projects. Potential targets include:

  • Improving access for Spanish speaking populations.
  • Engaging youth/college students and senior residents.
  • Conducting outreach to rural and agricultural communities.

The ADDS team left the CR work session with a clear understanding of their current world view related to culture and associated action plans to improve service access. The team also refined their awareness of the tremendous amount of cultural diversity that exists in the Burlington community, much like any other community.