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Component 1.3

Special Populations/Diversity


Special populations: 

in this document, refers to those who are vulnerable, experience
unequal access to health care and/or who experience the burden or risk of health disparities due in part to race, ethnicity, culture, socioeconomic status, geography, gender, age, disability status, risk status related to sex and gender, and other factors. (The CDC, Office of Minority Health and Health Equity: http://www.cdc.gov/minorityhealth/populations/atrisk.html.)

Transgender or Trans:

umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. (Note: Transgender is correctly used as an adjective, not a noun, thus “transgender people” is appropriate but “transgenders” is often viewed as disrespectful.)


term used by some individuals who identify as neither entirely male nor entirely female. Also termed gender-queer.


The impact of culture on access to and quality of care is particularly important to address in health care. As Oregon’s population of diverse racial and ethnic communities and linguistic groups continues to increase, patients and providers bring with them individual, learned patterns of language and culture. All of these patterns affect the health care experience.

  • Develop a plan to implement the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care.1
  • Provide ADA training for all clinic staff; assess clinic facility and services for ADA compliance; ensure physical access to medical care for people with mobility disabilities, and ensure effective communication for people who are deaf or have hearing loss.2
  • Use images, written materials and signs that can be easily understood by the diversity of patients served by the clinic and are reflective of the patient population.1
  • Provide ongoing in-service training on ways to meet the unique needs of the populations served.3
  • Ensure that all clinicians are aware that individuals with same-sex partners may not identify as gay/lesbian, particularly teenagers and young adults. Avoid making assumptions based on identity.5
  • Training on transgender health issues and availability of clinical resources should be provided to all clinic staff and providers, including front desk staff, and should be integrated into the standard hiring and on-boarding process for all employees.6-9
  • Ensure intake forms include a way to document patient’s preferred name and gender pronoun.
    • Institute procedures to ensure that patients preferred name is used by all clinic staff at every visit, regardless of whether the patient’s preferred name is identical to the patient’s name as listed in the electronic health record system.6, 9
  • Assess the limitations of the clinic’s electronic health record system in providing trans care and ensure the patient is advised in advance of potential obstacles. Examples include:
    • Challenges that may arise with any gendered forms of care (such as Pap smears, mammograms, prostate exams, Plan B, etc.)
    • Rejection of coding if the gender associated with the service is incongruent with the gender on record.
  • Policies should either define all bathrooms as gender-neutral or specifically state that patients may choose the women’s or men’s rooms according to their own preference.6, 9
  • Prioritize the recruitment of staff who reflect the patient population and possess skills to effectively interact with diverse patients.
    • Specify key characteristics such as training in cultural competency, experience providing services to diverse and underserved populations, and demographics similar to patients served.3
  • Hire individuals for entry-level positions (community health workers, medical assistants) with backgrounds closely matching those of patients, close community ties, firsthand knowledge of cultural practices relevant to sexual health, and the ability to speak more than one language.3
  • Conduct a community needs assessment or partner with the local Public Health Authority and/or CCO to do so. Gather input from an advisory board, including CCO Community Advisory Committee. Create and/or strengthen relationships with the community, patients and their families.3 Create new partnerships and programming as needed in response to these findings.
  • Conduct outreach activities to underserved communities such as holding town hall meetings and community health fairs, and establishing community advisory panels.
  • Use a system to collect distinct racial categories in demographic data, such as REAL+D race, ethnicity and language (REAL) and disability (+D).4


  1. The National Standards for Culturally and Linguistic Appropriate Services (CLAS) in Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice issued by the HHS Office of Minority Health: https://www.thinkculturalhealth.hhs.gov
  2. Information and Technical Assistance on the Americans with Disabilities Act: http://www.ada.gov/ada_intro.htm
  3. Assuring Healthcare Equity, A Healthcare Equity Blueprint: http://www.ihi.org/resources/Pages/Tools/HealthcareEquityBlueprint.aspx
  4. Oregon Health Authority, Office of Equity and Inclusion, Division
    70, Race, Ethnicity, Language, and Disability Demographic Data Collection Standards: http://www.oregon.gov/oha/oei/policyprocedures/Race%20Ethnicity%20Language%20Disability%20 Data%20Collection%20Standards.pdf
  5. Reproductive Health Access Project: Contraceptive Care for LGBT Patients: http://www.reproductiveaccess.org/resource/contraceptive-pearl-contraceptive-care-for-lgbt-patients
  6. Center of Excellence for Transgender Health: http://www.transhealth.ucsf.edu
  7. OHSU Transgender Health Program: http://www.ohsu.edu/xd/health/services/transgender-health
  8. Gay, Lesbian, Bisexual, and Transgender Health Access Project, Community Standards of Practice for Provision of Quality Health Care Services for Gay, Lesbian, Bisexual and Transgendered Clients: http://www.glbthealth.org/documents/SOP.pdf
  9. Gay and Lesbian Medical Association, Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients: http://www.glma.org/_data/n_0001/resources/live/Welcoming%20Environment.pdf