Cultural and Linguistic Competence
The National Center for Cultural Competence link suggests the following conceptual framework and definitions for cultural and linguistic competence, respectively:
Cultural competence requires that organizations have a defined set of values and principles, and demonstrate behaviors, attitudes, policies and structures that enable them to work effectively cross-culturally; have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve; incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.
Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum (adapted from Cross et al., 1989).
Linguistic competence is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competency requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity (Goode & Jones (modified 2009). National Center for Cultural Competence, Georgetown University Center for Child & Human Development.)
There are many variations on conceptual frameworks and definitions, and these links provide far more than the basics. We encourage users to begin enhancing their knowledge, awareness and skills by spending some time exploring these well-established and highly regarded resources.
There are many, many excellent resources to turn to for learning about cultural and linguistic competence. A few favorites are annotated below. Some of these sites are resource portals and others focus on providing training or other services. Please see the JEMF GCCCT annotated bibliography in the Teaching Tools section for an extensive list of additional cultural competence resources, including toolkits, cultural and spiritual assessment tools, and references/links to many other resources.
National Center for Cultural Competence - “Provides national leadership and contributes to the body of knowledge on cultural and linguistic competency within systems and organizations. Major emphasis is placed on translating evidence into policy and practice for programs and personnel concerned with health and mental health care delivery, administration, education and advocacy.” The site provides many links and scholarly documents for learning about and implementing cultural competence initiatives at any level in the health care system. The “curricula enhancement series centers on four key content areas: cultural awareness, cultural self-assessment, process of inquiry-communicating in a multicultural environment, and public health in a multicultural environment.”
A great place to access reputable resources is the Culturally Competent Services Resource Brief at http://mchb.hrsa.gov/training/cultural-competence.asp. Of special interest to genetic counselors is “Achieving Cultural and Linguistic Competence in Systems Serving Children and Youth with Special Health Care Needs and their Families,” accessible at http://www.gucchdgeorgetown.net/NCCC/journey/ and "The Cultural and Linguistic Competence Assessment for Disability Organizations (CLCADO): Assessment and Guide", accessible at http://www.gucchdgeorgetown.net/NCCC/CLCADO/
DiversityRx - This comprehensive resource portal promotes language and cultural competence to improve the quality of health care for minority, immigrant, ethnically diverse communities, and all patients. In addition to featuring excellent materials and links, DiversityRx sponsors the CLAS listserv. This listserv is a wonderful resource and it is free to join. DiversityRx also offers regular webinars, which are posted on the website after the program has been recorded. Mining the Web: Useful Internet Resources on Health, Culture and Diversity
National Cancer Institute: Center to Reduce Cancer Health Disparities - this site focuses on research and training regarding cancer health disparities. Of particular interest are brochures, reports, fact sheets on programs and research in specific minority populations and evaluating interventions such as using patient navigators.
UMDNJ Center for Cultural Competency - The University of Medicine and Dentistry of New Jersey developed a comprehensive center for online information and education of health care providers on cultural competency. The site offers definitions, links, training courses, health disparities demographics, and legislation information.
Think Cultural Health - Sponsored by the Office of Minority Health, “this site offers the latest resources and tools to promote cultural competency in health care. You may access free online courses accredited for continuing education credit as well as supplementary tools to help you and your organization promote respectful, understandable, and effective care to your increasingly diverse patients.” Information about cultural competency, the complete CLAS standards, and legislation and policy information can be found on this site. In addition, genetic counselors may want to explore these comprehensive online educational programs:
A Physician's Practical Guide to Culturally Competent Care is a free online educational program accredited for physicians, physician assistants, and nurse practitioners.
Culturally Competent Nursing Care: A Cornerstone of Caring is a free online educational program designed specifically for nurses and is accredited by the American Nurses Credentialing Center and the National Association of Social Workers.
Health Care Language Services Implementation Guide is a web-based interactive tool that can assist health care organizations in planning, implementing, and evaluating language access services to better serve their limited English proficiency patient population and decrease disparities in access to health care.
Transcultural C.A.R.E. Associates -This is “a private organization of Dr. Josepha Campinha-Bacote [a leading voice in the field] providing key note presentations, workshops, seminars, consultations, and training focusing on clinical, administrative, research, and educational issues related to cultural competence, transcultural health, and mental health.” The website features models of cultural competence and an extensive list of assessment tools.
Program for Multicultural Health, University of Michigan Health Systems -This resource portal includes basic concepts and definitions, clinical assessment tools, demographics, clinical tips, and case studies. There are tools and resources for improving interactions with multi-cultural clients. The site also includes an excellent compilation of resources on general health beliefs for a variety of cultural and religious groups.
HRSA - Cultural Competency and Health Literacy Resources for Health Care Providers -This government site provides links to several free online courses in health literacy and other cross cultural communication topics, as well as links to numerous culture/language specific resources. Dimensions of Culture-This site is by Colorado-based Marcia Carteret, M.Ed. It includes useful newsletters on a variety of cultural topics and an excellent cross cultural health care curriculum.
The Cross Cultural Health Care Program -This Seattle-based organization serves as a bridge between communities and health care institutions to ensure full access to quality health care that is culturally and linguistically appropriate. It provides a combination of cultural competency trainings, interpreter trainings, research projects, and community coalition building.
Community Health Association of Mountain/Plains States (CHAMPS) -The mission of CHAMPS is to provide opportunities for education and training, networking, and workforce development to Region VIII (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming) community health centers to better serve patients and communities. This site provides basic cross cultural health information, links to government-sponsored sites, and clinical resources that focus on primary care.
Cultural Competence Resources on Medscape - Cultural Competence Resources on Medscape-This website provides links to several dozen programs, articles, slide sets, cases, videos and other resources, some of which have been CME approved.
Dimensions of Culture - This site is by Colorado-based Marcia Carteret, MEd. Cross-Cultural Communications for Health Care Professionals.
US Dept HHS Outreach Activities and Resources Multi-Cultural Resources for Health Information - This comprehensive resource portal includes links on cultural competency, dictionaries, health literacy, multilingual resources, interpreting in health care, legislation and national standards, limited English proficiency, refugee health, and other topics.
American Academy of Pediatrics Culturally Effective Care Toolkit - The American Academy of Pediatrics (AAP) defines culturally effective care as “the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of cultural distinctions leading to optimal health outcomes.” Such understanding should take into account the beliefs, values, actions, customs, and unique health care needs of distinct population groups. This toolkit is a practical, hands-on resource to help practicing pediatricians and their office staff provide culturally effective care to their patients and families.