Cultural Competency

Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, 1989)

Providing culturally- and linguistically-appropriate emergency medical care that is respectful of and responsive to the cultural and linguistic needs of pediatric patients and their families offers the potential to improve access to care, quality of care, and ultimately, health care outcomes.

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center

• Effective Communication and Cultural Competence in Emergency Care of the Adolescent. Developed through Children’s National Medical Center on behalf of the EMSC Program, this adolescent training curriculum provides guidance on cultural competency as it relates to managing the emergency medical care needs of adolescents. (1997)

• 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 Academy’s website provides data and statistics, project information, and other cultural competency-related resources.

• 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. (2004)

American College of Emergency Physicians

• Policy Statement: Cultural Competence and Emergency Care. This policy statement affirms the College’s support for culturally and linguistically appropriate resource utilization in the emergency department and by emergency physicians. (2001)

Association of State and Territorial Health Officials

• Health Departments Take Action: A Compendium of State and Local Models Addressing Racial and Ethnic Disparities in Health. This publication features case studies of state and local public health programs addressing racial and ethnic health disparities. (2000)

The Center for Health Professions at the University of California, San Francisco

• Emergency Medical Services Workforce for the 21st Century Project. Developed and maintained by the Center on behalf of the Health Resources and Services Administration and the National Highway Traffic Safety Administration, this website includes an EMS professionals discussion blog on cultural competency.

• Toward Culturally Competent Care: A Toolbox for Teaching Communications Strategies. This curriculum seeks to teach clinicians to recognize cultural differences in patient interactions and demonstrates the use of specific communication skills to improve patient care. (2007)

The Commonwealth Fund

• Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective. This report studies culturally competent care from the patient’s perspective, investigates methods for assessing culturally competent care, and identifies areas for further research. (2006)

• Racial and Ethnic Disparities in U.S. Health Care: A Chartbook. This chartbook serves as a straightforward resource on health care disparities for policy makers, researchers, practitioners, and others. (2008)

• Providing Language Interpretation Services in Health Care Settings: Examples From the Field. A joint publication of The Commonwealth Fund and the National Health Law Program, this report offers promising practices in the implementation of cultural and linguistic competency approaches in health care services and financing. (2002)

Emergency Nurses Association

• Position Statement: Diversity in Emergency Care. This positions statement affirms the Association’s commitment to the integration of cultural competency in the provision of emergency medical care. (2003)

Hablamos Juntos (not U.S. government website)

• Universal Symbols in Healthcare: Best Practices for Sign Systems. Supported by the Robert Wood Johnson Foundation, this best practices manual provides concise instructions for implementing culturally and linguistically appropriate health care signage systems. (2005)

Henry J. Kaiser Family Foundation

• Compendium of Cultural Competence Initiatives in Health Care. The Compendium identifies public and private entities focused on cultural competency, minority health, health disparities, and Limited English Proficiency (LEP) issues; provides organizational descriptions of various initiatives; and includes of list of experts. (2003)

National Academies Press

• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. This Institute of Medicine (IOM) report found that, “many sources including those related to characteristics of patients, of health systems, and the clinical encounter may contribute to racial and ethnic disparities in health care.” (2003)

• Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare. This guide addresses health care provider issues brought forth as a result of the findings of the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. (2002)

• Unequal Treatment: What Health Care System Administrators Need to Know about Racial and Ethnic Disparities in Health Care. This publication looks at health care system issues brought to light from the findings of the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. (2002)

National Center for Cultural Competence

• Cultural Competency Health Practitioner Assessment. This health care provider 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.

• 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. (2007)

• NHSC Link Appalachian Communities and Care. This fact sheet demonstrates implementation of successful cultural and linguistic competency strategies in addressing children’s access to mental health services by sharing how and why the actions of health care providers worked. (2003)

National Conference of State Legislatures

• Language Access: Helping Non-English Speakers Navigate Health and Human Services. This report provides snapshots of positive state efforts to integrate culturally and linguistically appropriate strategies in health care financing and services for diverse populations. (2003)

National Initiative for Children’s Healthcare Quality

• Improving Cultural Competency in Children’s Healthcare. With support from The California Endowment, this report shares findings from a pilot project looking at racial and ethnic disparities in health care, specifically as related to children’s health care. (2005)

Public Health Foundation: TRAIN

• Cultural Competency Training Courses. Developed by the Public Health Foundation, this website provides links to on-line cultural and linguistic continuing education courses for a variety of health care providers and supports the Health Resources and Services Administration’s Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency course.

ScienceDirect

• Clinical Pediatric Emergency Medicine. Volume 5, Issue 2 (June 2004) includes journal articles focused on pediatric emergency care and emergency medicine as they relate to cultural and linguistic competency issues.

State University of New York Institute of Technology

• CultureMed. This project includes web-based bibliographies and links to on-line resources that illustrate health beliefs or ethnographic information about various ethnic groups.

Think Cultural Health

• Cultural Competency Curriculum for Emergency Responders. Supported by the Office of Minority Health, this case-based curriculum is designed to help emergency responders better meet the cultural and linguistic needs of those for whom they provide care.

• Culturally Competent Nursing Care: A Cornerstone of Caring. A free, on-line educational program created for the Office of Minority Health, the curriculum provides nurses with essential awareness, knowledge, and skills to better care for their increasingly diverse patient population.

• Health Care Language Services Implementation Guide. With support from the Office of Minority Health, this electronic guide is available to assist health care organizations in developing effective language access services for their patients with Limited English Proficiency.

• Physician’s Practical Guide to Culturally Competent Care. Developed for the Office of Minority Health, this accredited on-line cultural competency curriculum equips physicians, physician assistants, nurse practitioners, and others with awareness, knowledge, and skills to better treat the increasingly diverse population they serve.

University of Illinois at Urbana-Champaign

• Culturally and Linguistically Appropriate Services (CLAS) Early Childhood Research Institute. The Institute identifies, compiles, and analyzes resources and practices developed for children and families from culturally and linguistically diverse backgrounds.

University of South Carolina Rural Health Research Center

• Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency. This study reviews how rural hospitals are meeting the needs of their Limited English Proficiency patients in relations to the federal government’s Culturally and Linguistically Appropriate Services (CLAS) requirements. (2005)

University of Washington Medical Center and Harborview Medical Center

• Culture Clues. This website offers multi-cultural tip sheets for health care providers to increase their awareness of different cultures and ethnicities.

• EthnoMed. EthnoMed’s website provides information about cultural beliefs and how these values relate to the provision of health care services.

Utah Bureau of Emergency Medical Services

• Cultural Competence Needs Assessment Fact Sheet. This fact sheet, developed by the Utah Emergency Medical Services for Children (EMSC) program, profiles the results of the 2006 national EMSC Needs Assessment, revealing the need for the development and integration of emergency medical services provider-focused cultural and linguistic appropriate resources. (2007)

Yale Center for Public Health Preparedness

• Cultural and Linguistic Competence in Public Health Preparedness. This publication highlights the need for the development and implementation of culturally and linguistically competent resources relating to disasters and public health preparedness.

U.S. Department of Health and Human Services

• The Office of Minority Health has a wealth of resources available on the topic of linguistic and cultural competence, including, but not limited to: Center for Linguistic and Cultural Competence in Health Care; National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care; Setting the Agenda for Research on Cultural Competence in Health Care; State Offices of Minority and Multicultural Health Liaison Map; and Teaching Cultural Competence in Health Care: A Review of Current Concepts, Policies and Practices.

• The Agency for Healthcare Research and Quality offers the following resources: Health Literacy and Cultural Competency and Minority Health Research.

• The Centers for Disease Control and Prevention recommends its Minority Health Resources.

• The Centers for Medicare and Medicaid Services developed Providing Oral Linguistic Services, A Guide for Managed Care Plans: Summary. This guide provides methods for defining the needs of those with Limited English Proficiency (LEP) and for developing strategies to meet their communication needs. (2003)

• The Health Resources and Services Administration offers the following resources: Cultural Competency Resources for Health Care Providers; Council on Graduate Medical Education Minorities in Medicine: An Ethnic and Cultural Challenge for Physician Training; Indicators of Cultural Competence in Health Care Delivery Organizations: An Organizational Cultural Competence Assessment Profile; Bridging Cultures & Enhancing Care: Approaches to Cultural & Linguistic Competency in Managed Care; Cultural Competence Works; and Quality Health Services for Hispanics: The Cultural Competency Component

• The National Institutes of Health recommends its: Multi-Cultural Resources for Health Information and National Center on Minority Health and Health Disparities.

EXAMPLE PRACTICES

EMSC Resource Center of Minnesota (not U.S. government website).

This Emergency Medical Services for Children project seeks to address cultural competency as it relates to pediatric emergency care by co-sponsoring emergency medical services provider diversity workshops, developing cultural competency-focused articles for emergency medical services newsletters, and disseminating surveys to local ambulance services on cultural competency and diversity.

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, 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 Limited English Proficiency (LEP) patients and includes detailed profiles of promising practices. (2004)

FAMILY AND CAREGIVER RESOURCES

EMSC National Resource Center

• 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)

Families USA

• Making Public Programs Work for Communities of Color: An Action Kit for Community Leaders. This on-line action kit provides community leaders with the information, tools, and resources needed for advocacy efforts to overcome racial and ethnic health disparities.

Family Caregiver Alliance

• Cultural Competency In Working With Latino Family Caregivers. Encompassing case studies, cultural competency guidelines, and a resource list, this publication serves as an instructional manual for both health care providers and families. (2004)

Family Voices

• Diversity and Cultural Competence. This area of Family Voices’ website includes information on diversity, population-specific links, and other culturally-focused resources.

Institute for Family-Centered Care

• Advancing the Practice of Patient- and Family-Centered Ambulatory Care: How to Get Started. This publication includes checklists that address patient and family-centered care topics, including cultural and linguistic competency issues. (2008)

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

• 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, this network promotes tools, programs, and information for consumers, caregivers, and health providers.