Cultural and Linguistic Competence
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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.
Medi-Cal Language Access Services Taskforce Report In response to Senate Bill 1405 (Soto), a task force (Medi-Cal Language Access Services Taskforce) was created to develop recommendations for a system to provide language services for California Medi-Cal enrollees. The ultimate vision of this effort was to design a system that could accommodate large numbers of persons whose primary language was other than English and to generate federal financial participation for reimbursement of State expenditures.
MCLAS Taskforce
(March 2009, 43 pages)
More Than Words Toolkit Series 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.
Hablamos Juntos
(April 2009, n/a pages)
Physician Diversity in California: New Findings from the California Medical Board Survey
Center for California Health Workforce Studies
(March 2008, 39 pages)
A recent poll by the Field Research Corporation showed that six in ten voters agree that it is important for California to have enough health professionals who reflect the racial and ethnic diversity of the patients they serve. This report examines new data from the California Medical Board Relicensure Survey that provide a detailed profile of the ethnic characteristics of physicians in the state. The findings of this report document that a huge gap remains in California between the ethnic composition of the state’s population and the state’s physician workforce.
Speaking Together Toolkit For millions of people in the United States, language barriers in the health care system are a daily reality, leaving patients who speak or understand limited English unable to communicate effectively with their doctors and nurses. They risk receiving poorer quality of care—and have worse outcomes—as a result. Learnings from Speaking Together have been compiled into a toolkit offering detailed guidance to other hospitals nationwide on how to build a high-quality language services program.
Robert Wood Johnson Foundation
(June 2008, n/a pages)
Curriculum for Culturally Responsive Healthcare 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. It meticulously describes teaching strategies that will prove engaging to learners and faculty alike, challenging them to grow in their attitudes, awareness, desire, knowledge and skills to effectively practice culturally responsive medicine. It demonstrates commitment to teaching culturally responsive medicine towards the elimination of health disparities, be they related to gender, race/ethnicity, income, sexual orientation, religious background or world view. The manual includes a step-by-step guide for each year of the curriculum, with detailed session descriptions, and sections on teaching techniques, evaluation tools, cultural competence exercises, together with information on further resources. The curriculum provides a solid foundation upon which educational programs can build as they evolve to meet the needs of patients and their communities toward preventing and treating illness, and improving access to excellence in medical care.
Radcliffe Publishing
(2008, 264 pages)
Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations Objective: To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods: Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results: Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion: Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language.
American Journal of Health Behavior
(2007, 12 pages)
Death in the Golden State: Why Do Some Californians Live Longer?
Public Policy Institute of California
(August 2007, 28 pages)
A black man in California can expect to live 68.6 years on average, which is far below the life expectancy of the average California white male, who can expect to live 75.5 years. Despite the impressive gains in American longevity over the past century, significant disparities in life expectancies such as this one persist across racial and ethnic groups in California. These racial and ethnic disparities reflect underlying differences in specific causes of death, which is the focus of this issue of California Counts. Understanding the causes of death that contribute to racial and ethnic differences in life expectancies can shed light on the underlying factors that drive inequalities in health and can inform state health officials trying to identify more effective avenues of prevention.
From Policy to Action: Addressing Racial and Ethnic Disparities
Centers for Health Care Strategies
(August 2007, 11 pages)
Health care disparities can impose a tremendous burden on individuals and communities, and account for considerable costs to our society as a whole. This brief, drawing from efforts supported by The Commonwealth Fund and the Robert Wood Johnson Foundation, outlines practical strategies to address documented gaps in care.
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.
The Impact of Race/Ethnicity and Language on Access and Experience of Care Among California’s Commercially Insured Adults
California Program on Access to Care
(February 2007, 3 pages)
Having health insurance has been associated with improved access to medical care, as well as with better quality of care and higher enrollee satisfaction. However, studies of uninsured populations have demonstrated the existence of racial/ethnic disparities in access to, and experience of, care, which may also be found among those who are insured. As California becomes more diverse, absorbing greater numbers of immigrants, race/ethnicity may intertwine in complex ways with English language proficiency to affect health care access and experience. These complexities must be examined and understood in order to address health care disparities.
Paying For Language Services in Medicare: Preliminary Options and Recommendations
Center on Budget and Policy Priorities
(October 2006, 28 pages)
To improve access to health care, advance the quality of care and reduce the risk of medical errors, many organizations have proposed that insurers, including the federal Medicare program, provide funding for language services, such as professional interpretation, for patients who are limited English proficient (LEP). Such a step would serve as a counterpart to current federal civil rights policies that interpreter services be made available for LEP patients, as well as to nationwide efforts to improve the quality of care, which suffers when patients and their doctors (or other caregivers) are unable to communicate because of language barriers. 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)
In the United States, 52 million people speak a language other than English at home -- but many may face language barriers when trying to obtain quality health care. This report examins both language access issues and ways Medicare could fund programs to assist Limited English Proficient populations.
Collection and Use of Race and Ethnicity Data for Quality Improvement
America's Health Insurance Plans
(2006, 17 pages)
The issue brief on the 2006 AHIP and the Robert Wood Johnson Foundation (RWJF) survey highlights progress made by health insurance plans on collecting and using data on race, ethnicity, and primary language to help address disparities.
Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature Objective. To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients. Data Sources. A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 and September 2005, and a search of the Cochrane Library. Study Design. Any peer-reviewed article which compared at least two language groups, and contained data about professional medical interpreters and addressed communication (errors and comprehension), utilization, clinical outcomes, or satisfaction were included. Of 3,698 references, 28 were found by multiple reviewers to meet inclusion criteria and, of these, 21 assessed professional interpreters separately from ad hoc interpreters. Data were abstracted from each article by two reviewers. Data were collected on the study design, size, comparison groups, analytic technique, interpreter training, and method of determining the participants' need for an interpreter. Each study was evaluated for the effect of interpreter use on four clinical topics that were most likely to either impact or reflect disparities in health and health care. Principal Findings. In all four areas examined, use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers. Conclusions. Published studies report positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care.
Health Services Research Journal
(2007, 1 page)
Eliminating Health Disparities: Strengthening Data on Race, Ethnicity, and Primary Language in the US
National Committee on Vital and Health Statistics
(November 2005, 75 pages)
Compelling evidence exists that differences in health status, access to care, and the provision of physical and mental health services are significantly related to race, ethnicity, primary language, geography, and various measures of socioeconomic position, such as educational status, income, wealth, and conditions in childhood. Efforts to improve health care and eliminate health disparities in the
Language as a Barrier to Health Care for New York City Children in Immigrant Families
New York Academy of Medicine
(May 2006, 17 pages)
More than half of New York City’s Haitian, Russian, and Latino first-generation immigrants interviewed for this report say that language barriers lead to reduced quality care for their children, prevent them from fully using healthcare services, and leave them dissatisfied with their medical care. Federal, state, and city laws require that interpreter services and translated documents be provided to non-English-speaking patients at all healthcare facilities that serve Medicare and Medicaid patients, including hospitals, health clinics, and Medicaid offices. For example, the New York State Patients’ Bill of Rights requires that a hospital provide interpreters in any language spoken by at least 1 percent of the hospital’s service area. But implementation of these requirements has been slow and remains inadequate.
Summary of State Law Requirements Addressing Language Needs in Health Care
National Health Law Program
(January 2006, n/a pages)
State laws provide a source of potential protection for limited English proficient (LEP) persons. In recent years, state legislatures and administrative agencies have increasingly recognized the need for linguistically-appropriate health care and have adopted measures that require or encourage health and social service providers to overcome language barriers. The following chart offers citation to, and a short description of, each state’s laws regarding services to LEP persons in health care settings. It updates and replaces the listing of state laws first published by the National Health Law Program in August 2003 as part of its language access manual, Ensuring Linguistic Access in Health Care Settings: Legal Rights and Responsibilities (covering the time period up to July 2003).
Cultural Competence California Style
U.S. Department of Health & Human Services - Agency for Healthcare Research and Quality
(February 2006, 24 pages)
California health plans have led the country in implementing innovative practices to improve health care for diverse populations. This article reports on eight leading California plans’ cultural competence activities, and how they were influenced by California’s promulgation of cultural and linguistic competence standards for public insurance programs. While plans engaged in a variety of cultural competence activities before the standards were issued, some activities were clearly initiated or enhanced in response to the state standards. California’s experience provides guidance to states considering following its lead, as well as to health plans and the federal government.
Giving Voices to the Voiceless: Language Barriers & Health Access Issues of Black Immigrants of African Descent
The California Endowment
(March 2005, 75 pages)
Immigrants of African descent in California have been systematically marginalized within the health care system. 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 this population.
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 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.
Asian Pacific American Legal Center
Improving Cultural Competency in Children's Health Care
National Initiative for Children's Healthcare Quality
(July 2005, 36 pages)
The National Initiative for Children’s Healthcare Quality (NICHQ), with its mission of eliminating the gap between what is and what can be in health care for all children, is committed to taking action to eliminate disparities. The challenge before us is how best to create a healthcare system in which all children receive care that is safe, effective, efficient, timely and family centered, regardless of background or cultural differences. What practical changes in processes can make healthcare providers and the systems in which they work more effective in responding to the needs of diverse children? And how can health care delivery organizations track their progress? This report describes our initial efforts to answer these questions, and provides recommendations and findings from early pilot test results.
Straight Talk: Model Hospital Policies & Procedures for Language Access
California Health Care Safety Net Institute
(2005, 72 pages)
Straight Talk serves as a roadmap for hospitals to ensure patients have access to interpreter services. 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 can meet those requirements. While these Policies and Procedures are focused on the hospital setting, they are also a tool to be used in outpatient departments, community clinics and other health care settings.
Crossing Cultures in Mental Health
National MultiCultural Institute
(2001, 160 pages)
This collection of articles focuses on working with Latinos, Southeast Asian refugees and sojourners and on the nature of cross-cultural transistions. It addresses issues in cross-cultural counseling and communication such as culture shock, post traumatic stress disorder, and exploring one's own cultural identity. Several articles contain workshop and counseling models.
Cultural Competency in Healthcare: A Guide for Trainers
National MultiCultural Institute
(2003, 383 pages)
A comprehensive training manual for health care professionals on diversity issues in the workplace. Incorporating NMCI's popular guides for trainers, Teaching Skills and Cultural Competency and Developing Diversity Training for the Workplace, it provides step-by-step guidelines for developing an experiential workshop to meet the specific training needs of health care professionals, including providers and administrators. The manual includes models of cultural competency in health care, barriers to providing culturally competent care, exercises, lecturettes, tips for designing effective needs assessments and case studies, sample training designs, and an extensive bilbiography.
Looking Forward: Immigrant Contributions To the Golden State
California Immigrant Welfare Collaborative
(May 2005, 4 pages)
This report is a compilation of recent research findings on immigrants in
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)
Around the world, the need for trained interpreters in public services is acute. Yet the professionalization of interpreting is rough and uneven, in part because most interpreters lack national codes of ethics and standards of practice to guide their work. In the
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 requirments 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
California Department of Health Care Services, Medi-Cal Managed Care Division
(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)
In this toolkit, the authors have taken 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 & Pacific Islander American Health Forum - Fact Sheet
Asian & Pacific Islander American Health Forum
(March 2005, 2 pages)
An overview of demographics, health disparities, insurance coverage, and statistics on cultural and linguistic access to care for Asian Americans and Pacific Islanders.
Latino Coalition for a Healthy California - Fact Sheet
Latino Coalition for a Healthy California
(March 2005, 3 pages)
An overview of adult and child uninsurance rates, and statistics on cultural and linguistic access to care 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)
Ethnic minorities are poorly represented among physicians and other health professionals. In what is called "race-discordant" relationships, patients from ethnic groups frequently are treated by professionals from a different ethnic background. 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. Based on this research, the authors issue the following recommendations: 1) health policy should be revised to encourage workforce diversity by funding programs that support the recruitment of minority students and medical faculty; 2) health systems should optimize their providers' ability to establish rapport with minority patients to improve clinical practice and health care delivery; 3) cultural competency training should be incorporated into the education of health professionals; and 4) future research should provide additional mechanisms by which concordance of patient and physician race, ethnicity, and language influences processes and outcomes of care.
Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans
The Commonwealth Fund
(March 2002, 80 pages)
This survey by The Commonwealth Fund reveals that on a wide range of health care quality measures - including effective patient-physician communication, overcoming cultural and linguistic barriers, and access to health care and insurance coverage - minority Americans do not fare well as Whites. African Americans, Asian Americans, and Hispanics are more likely than Whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor, and to feel they would receive better care if they were of a different race or ethnicity.
Providing Language Interpretation Services in Health Care Settings: Examples from the Field
The Commonwealth Fund
(May 2002, 64 pages)
The National Health Law Program, with funding from The Commonwealth Fund, undertook an assessment of programs under way to improve access to interpreter services in health care settings. It examined several different methods of providing oral interpretation, including use of bilingual providers/staff, hiring staff interpreters, contracting with qualified interpreters, and creating interpreter pools. Because of time and cost limitations, this report does not address translation of written materials, interpretation in government offices, or other promising practices.
In the Right Words: Addressing Language and Culture in Providing Health Care
Grantmakers in Health
(August 2003, 54 pages)
This Issue Brief calls on grantmakers to take a leadership role in shaping the language access agenda to ensure that all individuals have equal access to quality health care. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients; strategies for improving language access; and roles for foundations in supporting improved language access, including examples of current activities.
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 growing minority and immigrant population. According to the report, these organizations are working to dismantle the cultural and communication barriers to quality health care through innovative programs that develop minority leadership, promote health system redesign, and train health care providers to better understand and manage social and cultural differences. 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)
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)
Describes public and private sector organizations involved in activities that seek to reduce cultural and communication barriers to health care.
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