Cultural Competency

Cultural and linguistic competence is the ability to interact effectively with people of different cultures. Culture refers to the integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups (U.S. Department. of Health and Human Services, Office of Minority Health Affairs). 

In terms of Emergency Medical Services for Children (EMSC), providing culturally and linguistically appropriate emergency medical care that is both respectful of and responsive to the cultural and linguistic needs of pediatric patients and their families offers the potential to improve healthcare access, quality, and, ultimately, outcomes.

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center

• On the Same Team. Funded by the EMSC Program, this CD-ROM was created by the National Association of Emergency Medical Technicians to address issues concerning inclusion of families in the prehospital care setting, including cultural competency. (2002)

American Academy of Pediatrics

• Community Pediatrics: Culturally Effective Pediatric Care. This section of the American Academy of Pediatrics’ (AAP) website articulates the Academy’s position on culturally competent care by stating that “the needs of pediatric population are influenced by factors relating to culture and ethnicity.  Pediatricians must acquire the knowledge and practice skills that will allow them to: recognize and address culture and ethnicity, make valid assessments of clinical findings, and provide effective patient management.” (Accessed January 2010)

• Policy Statement: Ensuring Culturally Effective Pediatric Care: Implications for Education and Health Policy. This policy statement defines culturally effective health care and describes its importance for pediatrics and the health of children.  The statement also addresses the importance of cultural effectiveness, sensitivity, and competence, especially as related to medical training and education. (2004)

American College of Emergency Physicians

• Policy Statement: Cultural Competence and Emergency Care. This policy statement affirms the American College of Emergency Physician’s support for culturally and linguistically appropriate resource utilization in the emergency department as well as cultural awareness amongst emergency care providers. (Revised April 2008)

American Medical Association, Institute of Ethics

• An Ethical Force Program Consensus Report: Improving Communication – Improving Care. Developed by the Ethical Force Program, a collaborative project led by the American Medical Association’s Institute of Ethics, this report focuses on patient-centered communication, highlighting how healthcare organizations can communicate effectively with patient populations of diverse backgrounds. (2006)

Association of State and Territorial Health Officials 

• 2008 Snapshots: State Activities to Promote Health Equity (Interactive Map). With support from the U.S. Department of Health and Human Services’ Office of Minority Health, the Association of State and Territorial Health Officials surveyed state and territorial health agencies on racial/ethnic minority health and health disparities. This map of the United States portrays each individual state response. (2008)

The Commonwealth Fund 

• Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective. This research, conducted with support from the Commonwealth Fund, identifies five domains of culturally competent care that can be best assessed from the patient’s perspective, including: (1) patient-provider communication, (2) respect for patient preferences and shared decision making, (3) experiences leading to trust or distrust, (4) experiences of discrimination, and (5) linguistic competency.  The report also makes recommendations regarding the implications of cultural competence for healthcare providers and health systems, and identifies areas for further research. (October 2006)

• Racial and Ethnic Disparities in U.S. Health Care: A Chartbook. This chartbook serves as a detailed resource on health care disparities for policy makers, researchers, practitioners, and others, addressing disparities in health status and mortality, healthcare access, health insurance coverage, and quality of care – as well as strategies for closing the gaps. (March 2008)

CulturedMed

• This online project incorporates a number of links to web resources that are designed to facilitate the provision of culturally competent healthcare to refugees and immigrants worldwide, including:
  • Bibliographies by Ethnic Group (2010)
  • List of Health and Culture Websites (2010)
  • Cross Cultural Training Resources for healthcare providers and the general public (2010)
  • Multilingual Health Materials (2010)

Hablamos Juntos 

• Universal Symbols in Healthcare: Best Practices for Sign Systems. Developed by Hablamos Juntos – a project designed to improve communications amongst providers and patients with LEP with support from the Robert Wood Johnson Foundation – this best practices manual provides instructions for implementing culturally and linguistically appropriate health care signage systems to increase healthcare access for patients with limited English language skills. (2005)

National Academies Press

• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In this Institute of Medicine (IOM) report, available online through the National Academies Press, a panel of experts explores the healthcare environment from the perspective of racial minorities and examines disparities on both systems and clinical levels.  The attitudes, expectations, and behavior of patients and providers are taken into account, and the report ultimately provides recommendations for improvements in healthcare financing, care allocation, translation resources, and community-based care. (2003)

• Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare. This IOM report addresses health care disparities from healthcare providers’ standpoint, discussing topics such as the sources of such disparities and mechanisms for mitigating their effects. (March 2002)

National Center for Cultural Competence 

• Cultural Competency Health Practitioner Assessment. This health care provider self-assessment was developed for the Health Resources and Services Administration’s Bureau of Primary Care to encourage cultural and linguistic competence in efforts to support the elimination of health disparities among racial and ethnic groups.  (Accessed January 2010)

• And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children and Youth with Special Health Care Needs and their Families. Designed to offer insight and lessons learned over a decade, this publication shares the efforts of state and territorial programs in implementing culturally and linguistically competent policies, structures, and practices. (Fall 2007)

National Initiative for Children’s Healthcare Quality 

• Improving Cultural Competency in Children’s Healthcare: Expanding Perspectives. With support from The California Endowment, this report from the National Initiative for Children’s Healthcare Quality shares findings from a pilot project looking at racial and ethnic disparities in health care, specifically as they relate to children’s health. (July 2005)

National Quality Forum

• A Comprehensive Framework and Preferred Policies for Measuring and Reporting Cultural Competency: A Consensus Report. This publication aims to promote culturally competent care, to reduce health disparities, and to make care more patient-centered. It does so by endorsing a comprehensive framework or “road map” for measuring and reporting cultural competency.  The report also endorses 45 preferred practices for the provision of culturally competent care. (2009)

University of South Carolina Rural Health Research Center 

• Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency. Funded by the U.S. Department of Health and Human Services, Office of Rural Health Policy, this Rural Health Research Center study reviews how rural hospitals are meeting the needs of their LEP patients with regards to the federal government’s Culturally and Linguistically Appropriate Services (CLAS) requirements. (October 2005)

U.S. Department of Health and Human Services

• Office of Minority Health (OMH). The OMH website links to a variety of programs and online resources addressing the topics of linguistic and cultural competence.  These include the following:
  • The Center for Linguistic and Cultural Competence in Health Care. The mission of this congressionally mandated center within OMH is to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase limited English-speaking individuals' access to health care. (April 2007)
  • National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. This OMH final report focuses on developing recommendations for national CLAS standards to support a more consistent and integrated approach to cultural competency. (March 2001)
  • Setting the Agenda for Research on Cultural Competence in Health Care. This final report of the Cultural Competence Research Agenda project sponsored by OMH and the Agency for Healthcare Research and Quality,  examines how cultural competency affects healthcare and outcomes. (August 2004)
  • State Offices of Minority and Multicultural Health Liaison Map. This interactive map provides users the opportunity to view a list of minority and multicultural health liaisons by state or territory.
  • Think Cultural Health. This OMH resource links to a variety of cultural competency continuing education programs for healthcare providers and organizations. (Accessed January 2010)

• Agency for Healthcare Research and Quality (AHRQ). AHRQ, whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, offers the following online resources:
  • Health Literacy and Cultural Competency. This webpage links to relevant AHRQ cultural competency resources, including funding opportunities, articles of interest, consumer and patient resources, assessment tools, and explications of AHRQ activities to reduce racial and ethnic disparities in healthcare. (Accessed January 2010)
  • Minority Health Research. This section of the AHRQ website links to program briefs and evidence reports on agency initiatives addressing timely issues in minority health. (Accessed January 2010)

• Centers for Disease Control and Prevention (CDC). The CDC includes an Office of Minority Health and Health Disparities dedicated to working with governmental and nonprofit stakeholder groups to improve health status and eliminate disparities among racial and ethnic groups.
  • Minority Health Resources. The webpage of the CDC Office of Minority Health and Health Disparities links to minority health resources, including cooperative agreements, regional and state minority health consultants, and stakeholder groups. (January 2009)

• Health Resources and Services Administration (HRSA). Cultural competency resources available online through the HRSA website include:
  • Cultural Competency Resources for Health Care Providers. This page incorporates relevant provider resources from assessment tools and language/culture or disease/condition specific clinical care guides to training curricula and technical assistance information. (Accessed January 2010) 
  • Quality Health Services for Hispanics: The Cultural Competency Component. This primer is designed to help health care professionals better understand, and more effectively respond to the growing needs of Hispanics in the United States. It should facilitate greater access to, and utilization of, health and human services for this patient population, as well as provide suggestions for improving one-to-one provider-patient interactions. (Accessed January 2010)

• National Institutes of Health (NIH). The NIH, which houses a National Center on Minority and Health and Health Disparities to promote minority health and efforts to reduce health disparities across NIH Institutes, also provides the following resource through the National Library of Medicine:
  • Multi-Cultural Resources for Health Information. This comprehensive compendium includes information on cultural competency dictionaries, glossaries, online translation tools, and health resources in multiple languages from professional societies and organizations, governmental entities, state medical centers and university medical schools, and other stakeholder groups. (October 2009).

Yale Center for Public Health Preparedness

• Cultural and Linguistic Competence in Public Health Preparedness. This publication highlights the importance of incorporating cultural and linguistic competency within the developing fields of public health preparedness and disaster response. (November 2007)

EXAMPLE PRACTICES

Utah Emergency Medical Services for Children. In 2006, the Utah EMSC Program conducted a needs assessment survey of 668 EMS providers to determine how EMSC could help meet their needs.  Survey results were then used to compile the Cultural Competence Needs Assessment Fact Sheet, a document that summarizes the survey results, revealing the need and recommended strategies for the development and integration of culturally and linguistically appropriate resources for EMS healthcare providers. (Revised February 2007)

California Primary Care Association. Founded in 1994, the California Primary Care Association (CPCA), together with the more than 500 community clinics and health centers it represents, has helped to ensure affordable, quality health care to California’s uninsured, low-income, and minority communities. CPCA’s mission is to promote and facilitate equal access to quality health care for individuals and families through organized primary care clinics and clinic networks that, among other things, seek to maintain cost-effective, affordable medical services, as well as meet the linguistic and cultural needs of California’s diverse population.

As part of its efforts to improve language access for LEP patients, CPCA conducted a survey of community clinics and health centers throughout California on policies and procedures for providing care to LEP patients. Based on this information and subsequent surveys and interviews, CPCA produced Providing Health Care to Limited English Proficiency (LEP) Patients: A Manual of Promising Practices. This study report demonstrates how health centers address the needs of their LEP patients and includes detailed profiles of promising practices. (2004)

Southern Ohio Health Services Network. The Southern Ohio Health Services Network – a network founded in 1976 and consisting of 11 primary health care centers in poor Appalachian communities – implemented a “cultural brokering” program designed to integrate mental health services for children into the overall medical system by improving the lines of communication between healthcare providers and local communities.  The resultant fact sheet, NHSC Link Appalachian Communities and Care, demonstrates the implementation of successful cultural and linguistic competency strategies in addressing children’s access to mental health care by sharing how and why provider strategies worked in a Southern Ohio Health Services Network. (2003)

FAMILY AND CAREGIVER RESOURCES

• Working with Families to Enhance Emergency Medical Services for Children. Developed by emergency care professionals and families who have experienced emergency care first hand, this guide is intended to help state and local emergency medical services agencies, EMSC grantees, hospitals, and family advocates explore the concept of family-centered care, including culturally competent care, and apply it to pediatric emergency medical services. (2001)
  
• Non-English Language Resources. Through the Publications and Resources section of its website, the NRC also distributes a number of resources in Spanish and/or English, including the following downloadable documents:
  • Common Emergencies for Children with Special Health Care Needs (2007)
  • Disaster Preparedness Planning for Children and Youth with Special Healthcare Needs (2007)
  • ¡Urgente! (A fact sheet for Spanish speaking parents and caregivers, 2000.)
  • What to do Until Help Arrives for a Child Medical Emergency (2006)

Family Caregiver Alliance

• Cultural Competency in Working With Latino Family Caregivers. Developed by the Family Caregiver Alliance’s National Center on Caregiving, this publication encompasses case studies, cultural competency guidelines, and a resource list, and serves as an instructional manual for both health care providers and families working within the context of Latino communities. (March 2004)

Family Voices

• Diversity and Cultural Competence. This Family Voices webpage includes a variety of culturally focused resources that address building relationships with community liaisons and cultural brokers to reach families of children and youth with special healthcare needs – particularly those from underserved population groups. (Accessed January 2010) 

Institute for Family-Centered Care

• Advancing the Practice of Patient- and Family-Centered Ambulatory Care: How to Get Started. This Institute for Family-Centered Care publication includes checklists that address patient and family-centered care topics, including issues relevant to cultural and linguistic competency. (September 2009)

U.S. Department of Health and Human Services, Office of Minority Health

• National Partnership for Action to End Health Disparities. With a mission to mobilize and connect individuals and organizations across the country to end health disparities, the Office of Minority Health’s National Partnership for Action to End Health Disparities provides opportunities for interested parties to explore a network of relevant tools, programs, and information for consumers, caregivers, and health providers. (October 2007)