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Cultural and Linguistic Competence

Find information on why culturally and linguistically competent care is critical to the provision of quality health care.

 

To include a relevant study or report from your organization, please complete the Studies Submission Form.

Also find FACTS & CHARTS on cultural and linguistic competence.

The Language Access Advocacy Project has compiled four template presentations on the issue of language access in health care. We hope they are helpful for your own education and advocacy needs.

Importance of Language Services
When You Can't Talk to Your Doctor
Promising Practices in Healthcare
State and Federal Requirements for Language Access

The Language Access Advocacy Project partners include the Asian Pacific American Legal Center, the Asian Pacifici Islander American Health Forum, the California Primary Care Assocation, the California Pan-Ethnic Health Network, the Fresno Health Consumer Center, the Latino Coalition for a Healthy California, and the National Health Law Program and is funded by The California Endowment.

Achieving Equity by Building a Bridge from Eligible to Enrolled
California Pan-Ethnic Health Network
(February 2012, 8 pages)

This brief, developed in partnership with UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education, highlights findings from the California Simulation of Insurance Markets (CalSIM) model estimating the effects of specific provisions of the ACA on family and employer decisions about insurance coverage in California, with a focus on communities of color and adults with limited English proficiency.

Reducing Racial and Ethnic Health Disparities: Key Health Equity Provisions
Families USA
(March 2010, 6 pages)

This policy brief discusses how health reform will improve language access and cultural competence, strengthen the federal Office of Minority Health, increase workforce diversity, and reauthorize the Indian Health Care Improvement Act.

What's in a Word: A Guide to Understanding Interpreting and Translation in Health Care
American Translators Association
(2010, 32 pages)

This guide describes the differences between oral interpreting and written translation, including the skills needed to competently undertake each.

Health Literacy Universal Precautions Toolkit
U.S. Department of Health & Human Services - Agency for Healthcare Research & Quality
(April 2010 pages)
The toolkit offers primary care practices a way to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific areas.

Ethnic Health Assessment for African Americans in California
California Black Health Network and the California Program on Access to Care
(August 2010, 36 pages)
This report provides an overview of the social determinants and key health concerns of African Americans in California.

American Indian and Alaskan Native Health Assessment in California
California Rural Indian Health Board and the California Program on Access to Care
(August 2010, 58 pages)
This report provides an overview of the major determinants of American Indian and Native Alaskan health and various health indicators.

Ethnic Health Assessment for Latinos in California
Latino Coalition for a Healthy California and the California Program on Access to Care
(August 2010, 49 pages)
This report provides an overview of the health behaviors and health status indicators of the Latino community in California.

Ethnic Health Assessment for Asian Americans, Native Hawaiians, and Pacific Islanders in California
Asian & Pacific Islander American Health Forum and the California Program on Access to Care
(August 2010, 57 pages)
This report provides an overview of the environmental contexts of health and key health concerns facing California's Asian American, Native Hawaiian, and Pacific Islander communities.

Building Quality and Equitable Health Care Systems
California Pan-Ethnic Health Network
(October 2010, 12 pages)

Building Quality and Equitable Health Care Systems, a report from CPEHN’s latest conference, includes a summary of accomplishments on language access, cultural competence, and health disparities reduction in California and nationwide; a look at opportunities available through health care reform and health information technology; and questions and issues to consider as we move forward.

Investing in a Future for all Californians: A Primer on California Budget and Tax Policy
California Pan-Ethnic Health Network
(October 2010, 16 pages)
This policy brief provides a general overview of factors fueling California's budget crisis and poses key questions to help you analyze new proposals.

The Impact of Race/Ethnicity and Language on Access and Experience of Care California's Commercially Insured Adults
California Pan-Ethnic Health Network
(February 2007, 3 pages)

Funded by the California Program on Access to Care, this study explores the role of race/ethnicity and language in access to, and experience of, care among adult Californians enrolled in the state's seven major health plans.

Improving Patient-Provider Communication
The Joint Commission
(November 2009, N/A pages)

This free movie helps health care organizations determine the best methods for meeting their patients' communication needs.

Many Californians with Asthma Have Problems Understanding Their Doctor
UCLA Center for Health Policy Research
(January 2009, 8 pages)
This policy brief outlines communication barriers for California's asthma patients.

The Language Portal
Migration Policy Institute
This resource website provides a searchable digital library of close to 600 resources relating to the use of language access services in social services and public safety agencies.

Please Hold: Medicare Plans Leave Limited English Beneficiaries Waiting for Access
California Medicare Part D Language Access Coalition
(December 2008, 26 pages)
This report finds that non-English speaking beneficiaries have difficulty getting Medicare information.

National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities
Drexel University School of Public Health's Center for Health Equality
The National Resource Center is the nation's first online clearinghouse and information exchange portal designed to facilitate communication, networking, and collaboration to improve preparedness, build resilience, and eliminate disparities for racially and ethnically diverse communities in public health emergencies.

Creating Equity Reports: A Guide for Hospitals
The Disparities Solutions Center at Massachusetts General Hospital
(2008, 78 pages)
This report describes the process of creating a health disparities report, including how to collect patient data and train staff, what quality measures should be included, and how to develop strategies based on findings.

Improving Access to Language Services in Health Care: A Look at National and State Efforts
Mathematica Policy Research
(April 2009, 13 pages)
This brief examines the state and national efforts to address language barriers, and highlights the challenges and successes of language services work in California, Minnesota, and New York.

Health Care Language Services Implementation Guide
Office of Minority Health at the U.S. DHHS
An interactive web-based learning tool developed by the Office of Minority Health at the U.S. DHHS, is designed to help health care professionals plan, implement, and evaluate language access services within their organizations.

The Landscape of Opportunity: Cultivating Health Equity in California
California Pan-Ethnic Health Network
(June 2009, 44 pages)
This report highlights some of the social and environmental inequities that lead to the health disparities experienced by California's communities of color. It includes charts and maps, all by race/ethnicity, and is accompanied by additional mapping resources on our website at www.cpehn.org/landscape.php.

Holding Health Plans Accountable: The Provision of Culturally and Linguistically Competent Services by Health Plans Participating in the Healthy Families Program
California Pan-Ethnic Health Network
(March 2006, 12 pages)
This brief provides a review of the state's current process of overseeing health plan compliance with the Healthy Families cultural and linguistic requirements and provides recommendations for improvements.  

Taking Cultural Competency From Theory to Action
California Pan-Ethnic Health Network
(October 2006, 28 pages)

Supported by the Commonwealth Fund, this paper provides principles and recommendations for implementing cultural competency in the field. Based on interviews with leaders in the field of cultural competency, the authors discuss best practices and important lessons in the implementation of cultural competency initiatives.

A Blueprint for Success: Bringing Language Access to Millions of Californians
California Pan-Ethnic Health Network
(January 2009, 12 pages)

This brief documents CPEHN's advocacy efforts on SB 853. The first of its kind in the country, this law holds health plans accountable for the provision of language services - requiring health plans and health insurers to provide their enrollees with interpreter services, translated materials, and to collect race, ethnicity, and language data.

Improving Communication - Improving Care
American Medical Association
(2006, 144 pages)
A consensus report by the American Medical Association's Ethical Force Program, Improving Communication - Improving Care, explores how health care organizations can ensure effective, patient-centered communication with people from diverse populations.

Medi-Cal Language Access Services Taskforce Report
MCLAS Taskforce
(March 2009, 43 pages)

This report provides recommendations for the creation of a system to provide language services for California Medi-Cal enrollees.

More Than Words Toolkit Series
Hablamos Juntos
(April 2009, n/a pages)

The More Than Words Toolkit Series, a resource developed by Hablamos Juntos with support from the Robert Wood Johnson Foundation, clarifies the translation process and provides a roadmap to help health care organizations improve the quality of their translated materials in order to get better results.

Diversity in California’s Health Professions: Physicians
Center for the Health Professions
(May 2008, 7 pages)
This analysis confirms that ethnic disparities exist in California's physicians' workforce.

Speaking Together Toolkit
Robert Wood Johnson Foundation
(June 2008, n/a pages)
A toolkit created from learnings from the Robert Wood Johnson's Speaking Together initiative, provides detailed guidance to other hospitals nationwide on how to build a high-quality language services program.

Curriculum for Culturally Responsive Healthcare
Radcliffe Publishing
(2008, 264 pages)

This is a creative, comprehensive and user-friendly manual comprising a curriculum for residencies and medical schools looking to implement new, or enhance existing, curricula in culturally responsive care.

Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations
American Journal of Health Behavior
(2007, 12 pages)

This study explored the interrelationship of literacy, culture, and language and the importance of addressing their intersection.

Building Culturally Competent Health Systems in California
The California Endowment
(March 2007, 40 pages)
On March 28-29, 2007, The California Endowment hosted a convening, "Building Culturally Competent Health Systems in California," held in Los Angeles. The participants of this convening included over 130 individuals from California’s public and nonprofit hospital systems and other organizations working on issues of language access, cultural competency, health disparities, and workforce diversity.

Paying For Language Services in Medicare: Preliminary Options and Recommendations
Center on Budget and Policy Priorities
(October 2006, 28 pages)
This report discusses how the federal government could design payment systems for language services in Medicare.

Telephone Interpreting in Health Care Settings: Some Commonly Asked Questions
ATA Chronicle
(June 2007, 4 pages)
The following frequently asked questions regarding telephone interpreting in health care settings may be helpful for interpreters, language service companies, and health care providers who wish to learn more about telephone interpreting, as well as its potential benefits and limitations in health care scenarios.

Hospital Language Services for Patients with Limited English Proficiency: Results from a National Survey
Health Research and Educational Trust
(October 2006, 28 pages)
This report examines both language access issues and ways Medicare could fund programs to assist Limited English Proficient populations.

Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature
Health Services Research Journal
(2007, 1 page)
This article presents a systematic review of literature to determine if professional medical interpreters have a positive impact on clinical care for limited English proficient (LEP) patients.

Eliminating Health Disparities: Strengthening Data on Race, Ethnicity, and Primary Language in the United States
National Committee on Vital and Health Statistics
(November 2005, 75 pages)
This report provides recommendations to address four major components of the collection on race, ethnicity, and primary language data, outlining how to obtain, collect, and store health data in ways that are usable, properly interpreted, and adequately protected.

Summary of State Law Requirements Addressing Language Needs in Health Care
National Health Law Program
(January 2008, 137 pages)
This chart offers citation to, and a short description of, each state’s laws regarding services to limited English proficient (LEP) persons in health care settings.

California Speaks: Language Diversity and English Proficiency by Legislative District
Asian Pacific American Legal Center
(February 2006, 193 pages)
This report uses Census 2000 data to assess the extent of langauge diversity and language barriers for every legislative district in California. Data includes size of racial and ethnic groups, rates of foreign birth, primary languages spoken, and rates of limited English proficiency (defined as speaking English less than very well).

Giving Voices to the Voiceless: Language Barriers & Health Access Issues of Black Immigrants of African Descent
The California Endowment
(March 2005, 75 pages)
This report by the Summit Health Institute for Research and Education, Inc., takes an initial step toward identifying language and cultural issues that impede access to culturally competent health care for immigrants of African descent in California.

National Standards of Practice for Interpreters in Health Care
National Council on Interpreting in Health Care
(September 2005, 20 pages)
The NCIHC's National Standards of Practice are designed to help improve the quality and consistency of interpreting in health care. Just like clinical protocols for physicians, these new standards will provide guidance as to what is expected of health care interpreters and what constitutes good practice.

When You Can’t Talk to Your Doctor: Understanding your rights and responsibilities when you need language services
Asian Pacific American Legal Center

The Asian Pacific American Legal Center of Southern California (APALC) has developed pieces for consumers explaining their rights to interperter services. The pieces are available in mulitiple languages:English version, Hindi version, and Bengali version .

Improving Cultural Competency in Children's Health Care
National Initiative for Children's Healthcare Quality
(July 2005, 36 pages)
This report explores how to improve the quality of health for children, including elminating health dispariteis, improving quality, and providing timely, safe care.

Straight Talk: Model Hospital Policies & Procedures for Language Access
California Health Care Safety Net Institute
(2005, 72 pages)
Straight Talk guides hospital leadership through the legal and regulatory requirements for provision of language services, providing practical, operational policies and procedures that ensure hospitals and other health care settings can meet those requirements. 

Looking Forward: Immigrant Contributions To the Golden State 2010
California Immigrant Policy Center
(May 2010, 12 pages)
This report is a compilation of recent research findings on immigrants in California and their economic and social contributions to our state. 

The Interpreter's World Tour: An Environmental Scan of Standards of Practice for Interpreters
National Council on Interpreting in Health Care
(March 2005, 54 pages)
This report provides an environmental scan analyzing standards of practice for interpreters focusing on general interpreting, health care/medical interpreting, court and legal interpreting, community and liaison interpreting, conference interpreting, and sign language interpreting. The underlying goal of the scan is to support the development of national standards of practice for interpreters.

Medi-Cal Threshold Languages by County
California Department of Health Care Services, Medi-Cal Managed Care Division
(June 2002, 2 pages)
CPEHN's advocacy helped create cultural and linguistic requirements for Medi-Cal Managed Care health plans. The Department of Health Services released a Policy Letter and chart listing the languages in each county for which health plans must provide translated documents.

Medi-Cal Cultural and Linguistic Policy Letters

(April 1999, 29 pages)
In 1999, the Medi-Cal Managed Care division of DHS released a set of policy letters to Medi-Cal managed care health plans requiring them to develop and implement policies and procedures to ensure cultural and linguistic access to services.  CPEHN's advocacy was a critical part of the development of these requirements.

Policy Letter 99-01  - Community Advisory Committees
Policy Letter 99-02  - Needs Assessments
Policy Letter 99-03  - Linguistic Services
Policy Letter 99-04  - Translation of Written Documents
Policy Letter 99005  - Cultural Competency

Addressing Language Access in Your Practice: A Toolkit for Physicians and Their Staff Members
California Academy of Family Physicians
(2005, 42 pages)
This toolkit provides a practical and comprehensive look at how physicians can make their practices more accessible to limited English proficiency (LEP) patients. Resources include model policies and procedures, information about assessing staff and physician language skills, and much more.

Asian Americans and Pacific Islanders in California
Asian & Pacific Islander American Health Forum
(March 2005, 2 pages)

An overview of demographics, health status, and access to health care services for Asian Americans and Pacific Islanders.

Latino Health
Latino Coalition for a Healthy California
(March 2005, 3 pages)
An overview of and statistics on cultural and linguistic access to care as well as public benefits for Latinos.

Diverse Patients, Disparate Experience: The Use of Standardized Patient Satisfaction Surveys in Assessing the Cultural Competence of Health Care Organizations
California Pan-Ethnic Health Network
(March 2001, 72 pages)
Funded by the California HealthCare Foundation, this project examined whether standardized surveys of consumers' experience and satisfaction with health care could provide useful information on certain dimensions of the cultural competency of health care organizations.

Limited English Proficient Enrollee Access to Health Plan Grievance Systems
California Pan-Ethnic Health Network
(December 2004, 20 pages)
Health plans and the Department of Managed Health Care must do more to ensure LEP access to grievance procedures. CPEHN conducted an analysis of the reports health plans submitted to DMHC which found critical limitations and provides recommendations for improvement. You can also download the Executive Summary (10 pages).

Disparities in Patient Experiences, Health Care Processes, and Outcomes: The Role of Patient-Provider Racial, Ethnic, and Language Concordance
The Commonwealth Fund
(July 2004, 29 pages)
The research reviewed here documents ongoing racial and ethnic disparities in health care and links patient-physician race and ethnic concordance with higher patient satisfaction and better health care processes.

Cultural Competency in Health Care: Emerging Frameworks and Practical Approaches
The Commonwealth Fund
(October 2002, 40 pages)
This report spotlights a diverse group of health care organizations striving to improve access to and quality of care for a communities of color and immigrant populations. The study also provides a comprehensive framework for health care organizations seeking to address cultural barriers in health care delivery.

Multicultural Health 2002: An Annotated Bibliography
The California Endowment
(2002, 91 pages)
This bibliography compiles summaries of articles, reports, and books in the field of multicultural health.  Includes section on cultural competency, language access, health disparities, work force diversity, access to care, and model of community responsiveness.

Compendium of Cultural Comptence Initiatives in Health Care
Henry J. Kaiser Family Foundation
(January 2003, 28 pages)
This compendium describes public and private sector organizations involved in activities that seek to reduce cultural and communication barriers to health care.

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