Cultural Competence Continuing Education (CCCE)

Renewal Application

Our Oregon Story

Since at least the 1990s to today, communities of color experiencing racial/ethnic health care disparities in Oregon have continued to advocate for culturally competent health care. In 1999, the community’s efforts resulted in former Governor Kitzhaber’s Executive Order, which established the Governor’s Racial and Ethnic Health Taskforce within Office of Equity and Inclusion (OEI), formerly known as the Office of Multicultural Health. At the time, OEI, and other health divisions were housed within the Oregon Department of Human Services (ODHS). However, in 2009, legislation was passed which split the health divisions from ODHS, and moved them into the Oregon Health Authority (OHA)— a new state agency responsible for streamlining and aligning state health purchasers and programs to maximize efficiency, organize state health policy and health services, and implement health reform policies and programs. With the creation of OHA, the state was better situated to “ensure Oregonians have access to affordable, sustainable, high-quality health care, and to ensure health equity for all.”

Oregon Health Authority’s First Cultural Competence Continuing Education Committee

The state’s subsequent efforts with Senate Bill 97 to require cultural competence continuing education (CCCE) standards and trainings for health care professionals fell short during the 2011 legislative session. But for many communities of color experiencing racial/ethnic health care disparities, it was the first time they had engaged with their state government, by sharing their stories. In 2012, many continued to engage with their state government, as OHA-OEI established its first Cultural Competence Continuing Education Committee (CCCEC) of diverse stakeholders including: health care licensing boards and professional associations, health systems organizations, academia, health care professionals, culturally-specific community-based organizations, and small businesses. Guided by Oregon Health Policy Board’s 2010 report, Oregon’s Action Plan for Health, which identified cultural competence as a critical method for eliminating health disparities, CCCEC worked with OHA-OEI, and more than 160 health care professionals statewide, to produce the agency’s groundbreaking CCCE report. With CCCEC’s leadership, this was our state’s first collective attempt to provide a common definition and framework for determining both essential and advanced CCCE training standards. The Committee also explored existing local and national CCCE training options for health care professionals and provided recommendations to advance cultural competence continuing education for: OHA, Oregon’s health care professional boards, Coordinated Care Organizations (CCOs), and trainers and developers of continuing education for health care professionals.

HB 2611 (2013)

Building upon this work, culturally-specific community based organizations, representing people experiencing health care disparities: Unite Oregon (formerly known as Oregon Action and Center for Intercultural Organizing), Asian Pacific American Network of Oregon, Urban League of Portland, Basic Rights Oregon, Oregon Student Association, and health care professional organizations, asked Representative Alissa Keny-Guyer and Senator Jackie Winters to co-sponsor and re-introduce the 2011 bill requiring cultural competence continuing education of health care professionals.  Instead, health care professional groups proposed to create a voluntary framework, with a requirement that health care professional boards track and report the boards’ CCCE requirements and their respective licensees’/members’ CCCE participation levels to OHA. The framework also established an OHA advisory committee focused on developing criteria for approving high quality cultural competence continuing education trainings, approving trainings, and establishing an online registry of OHA-approved trainings.  This time, the amended version of the bill, still focused on helping to improve the cultural competence of regulated health care professionals in Oregon, successfully passed into law, with an operative date of January 1, 2015. [Stat. Auth.: ORS 413.450, 2013 Oregon Law.] Later operational dates allowed boards of varying size, resource, and staffing capacity, enough time to create a reporting system to facilitate the submission of CCCE data to OHA.  Subsequent HB 2611(2013) rules (OAR 943-090-0000 through 943-090-0020) defined cultural competency as:

A lifelong process of examining the values and beliefs and developing and applying an inclusive approach to health practice in a manner that recognizes the content and complexities of provider-patient communication and interaction and preserves the dignity of individuals, families, and communities.

Since 2015, the CCCE Advisory and Review Committee members have worked closely together with OHA-OEI to inform the development of criteria and process for OHA to approve a growing registry of cultural competence continuing education trainings for the following health care professional boards, impacted by this legislation:

• Oregon Board of Chiropractic Examiners
• Oregon Board of Dentistry
• Oregon Board of Denture Technology
• Oregon Board of Direct Entry Midwifery
• Oregon Board of Examiners for Speech-Language Pathology and Audiology
• Oregon Board of Licensed Dietitians
• Oregon Board of Licensed Social Workers
• Oregon Board of Licensed Professional Counselors and Therapists
• Oregon Board of Massage Therapists
• Oregon Board of Medical Imaging
• Oregon Board of Naturopathic Medicine
• Oregon Board of Optometry
• Oregon Board of Pharmacy 
• Oregon Board of Physical Therapy
  
• Oregon Board of Psychologist Examiners
• Oregon Health Authority, to the extent that the authority licenses emergency medical service providers
• Oregon Home Care Commission
• Oregon Lactation Consultants Program
• Oregon Medical Board
• Oregon Nursing Home Administrators Board
• Oregon Occupational Therapy Licensing Board
• Oregon Respiratory Therapist and Polysomnographic Technologist Licensing Board
  
• Oregon State Board of Nursing

The first report to the Legislature was received in August 2018, which showed varying levels of CCCE completion. For example, 4 of 23 health care professional boards (includes OHA for emergency medical service providers) voluntarily required CCCE (from 4 to 6 credits per license renewal period), while 13 boards allowed CCCE to satisfy general CE requirements (with no specified number of credits). Also, according to board reports received by OHA-OEI during the first six-month period of data collection, Oregon Board of Psychology and Oregon State Board of Nursing reported the highest percentages of their licensees participating in CCCE (over 40%). Specifically, 134 out of 310 health care professionals for Oregon Board of Psychology, and 8,288 out of 18,861 health care professionals for Oregon State Board of Nursing.

HB 2011 (2019)

During the 2019 legislative session, in response to the continued, and in some cases, worsening health disparities for Oregonians, Representative Keny-Guyer, Representative Tina Kotek, Senator Lew Frederick, Representative Alonso Leon, and Senator Monnes Anderson, introduced HB 2011, an updated version of Oregon’s CCCE law, HB 2611 (2013), as chief sponsors of the bill.  With this action, the state legislature continued to build upon over 20 years of the state’s cooperative CCCE work with culturally-specific community-based organizations representing people experiencing racial/ethnic health care disparities, health care professional boards, and other diverse stakeholders with shared goals of eliminating health care disparities and advancing health equity for historically and contemporarily marginalized communities.

According to Speaker of the House Tina Kotek’s testimony on April 2, 2019, in support of the bill to the House Committee on Health Care,

• African Americans, Asian Americans, Pacific Islanders, and Latinos all reported worse access to care than their white peers in 2015, 2016 and 2017
• Non-white patients are less likely to be prescribed pain medication, less likely to have their pain taken seriously, and less likely to feel heard by their clinician
• In Oregon, 22 percent of transgender Oregonians reported being refused medical care
• In 2017, 8 of 16 CCOs regressed on their satisfaction with care metric.

HB 2011 (2019), which has now become law, directs (instead of voluntarily allows) specified health care professional boards to require people authorized to practice the profession regulated by the board to complete cultural competency continuing education. OHA-OEI’s role specific to approving high quality CCCE training that meets agency criteria for approval will continue. These criteria are reflective of four domains of culturally competent practice and training:

• Self-awareness & self-assessment of provider’s beliefs, attitudes, emotions, & values
• Acquisition of provider knowledge
• Acquisition of provider skills
• Specific educational approaches for acquisition of provider knowledge and skills 

Per Section 1(2)(d) of the updated law, OEI will continue to share, through the online registry above, agency-approved high quality CCCE trainings as a resource for Oregon’s health care professional boards and their respective licensees/members. The new CCCE requirements will become operative on July 1, 2021. Thus, fulfilling the state’s original intent years ago, of requiring CCCE for health care professionals, as a means of improving provider-patient interactions and subsequently, health outcomes— not just for people experiencing racial/ethnic health disparities, but for all historically and contemporarily marginalized people in Oregon.