A patient bill of rights or documentation which outlines Site A: ___ A Site B: ___ client’s rights and responsibilities. Site C: ___ 9.2 Link to QFP: Cultural Competency and Client Dignity A core premise of Recommendations for Providing Quality Family Planning Services is that quality services are client-centered, which includes providing services in a respectful and culturally competent manner. Reviewer Evidence of Quality Quality Indicator Comments Code Indicator in Place? The grantee needs assessments or other documentation Yes No A (including those of the sub-recipients) describe populations that may be in need of culturally competent care. The grantee has written policies and procedures that require Yes No their sites and sub-recipients to receive training in culturally A competent care. This should include how to meet the needs of the following key populations: LGBTQ, adolescents, individuals with limited English-proficiency, and the disabled. Yes No Documentation (e.g., training records) that demonstrates staff A have received training in providing culturally competent care to populations identified in the needs assessment. Observation of the clinic environment demonstrates that it is Yes No welcoming (i.e., Privacy, cleanliness of exam rooms, ease of A access to service, fair and equitable charges for services including waiver of fees for cause,” language “good assistance). Yes No Client surveys document that clients perceive providers and A other clinic staff to be respectful. Yes No + Additional quality indicators, best practices, or highly innovative If Yes, describe: A approaches Exceptional (All 5 Quality Indicators Evident + Best Practices In Place) Good (3 5 Quality Indicators Evident) – 9.2 Quality Assessment Score: Fair (1 2 Quality Indicators Evident) – 0 Quality Indicators Evident 9.2 Additional Comments: 9.3: Non-Discriminatory Services
A Site A: ___ Site B: ___ Site C: ___ A patient bill of rights or documentation which outlines client’s rights and responsibilities. 9.2 Link to QFP: Cultural Competency and Client Dignity A core premise of Recommendations for Providing Quality Family Planning Services is that quality services are client-centered, which includes providing services in a respectful and culturally competent manner. Reviewer Code Evidence of Quality Indicator in Place? Quality Indicator Comments A Yes No The grantee needs assessments or other documentation (including those of the sub-recipients) describe populations that may be in need of culturally competent care. A Yes No The grantee has written policies and procedures that require their sites and sub-recipients to receive training in culturally competent care. This should include how to meet the needs of the following key populations: LGBTQ, adolescents, individuals with limited English-proficiency, and the disabled. A Yes No Documentation (e.g., training records) that demonstrates staff have received training in providing culturally competent care to populations identified in the needs assessment. A Yes No Observation of the clinic environment demonstrates that it is welcoming (i.e., Privacy, cleanliness of exam rooms, ease of access to service, fair and equitable charges for services including waiver of fees for “good cause,” language assistance). A Yes No Client surveys document that clients perceive providers and other clinic staff to be respectful. A Yes No + Additional quality indicators, best practices, or highly innovative approaches If Yes, describe: 9.2 Quality Assessment Score: Exceptional (All 5 Quality Indicators Evident + Best Practices In Place) Good (3 – 5 Quality Indicators Evident) Fair (1 – 2 Quality Indicators Evident) 0 Quality Indicators Evident 9.2 Additional Comments: 9.3: Non-Discriminatory Services
opa_program_rev_tool_2017_0.docx