Promising Programs in Racial and Ethnic Disparities in Health and Health Care Addressing... researched and compiled by Sarah McCloskey, Erin Kennedy, and Michele Sloan December 2004 and updated March 2008
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California | Massachusetts | New Hampshire | Oklahoma | Texas | Washington | National Programs
Background
Cultural competence combines awareness of patients’ diverse values,
behaviors, language, and needs, with the ability to provide responsive and
effective health care. A successful culturally competent healthcare system and
workforce is able to provide high-quality care to all patients, regardless of
background. Barriers include a lack of diversity in the healthcare workforce
and poor communication between patients and providers. Providers have
difficulty understanding and working with lingual barriers and socio-cultural
factors, which results in patient dissatisfaction and poor health outcomes.
However, when appropriate languages and approaches are used, diagnosis is
accelerated and the likelihood of patient compliance increases. When
researching health disparities, cultural competency initiatives and models are
among the most common areas focused on as a key in the efforts to eliminate
disparities. Because of the wealth of information available on this topic, we
will present here select examples which we feel demonstrate best practices,
innovative strategies, and the direction that culturally linguistic programs are
taking to eliminate health disparities.
State Programs
Existing programs address components of cultural competence, specifically language. Through translator programs, states hope to limit error in diagnosis and decrease healthcare costs. To date, many of the cultural competence programs have focused on services at the provider and insurer level.
California Los Angeles County Office of Diversity Programs – Cultural and linguistic standards have been set for the Los Angeles County healthcare system by the L.A. Department of Health Services (DHS). Half of the households in the county speak a language other than English, with 83 different nationalities represented. DHS trains staff with cultural and linguistic competency and skills and tries to recruit bilingual and bicultural workers. Furthermore, services are available to document patients' language of preference and records are kept of patients' use of services. ladhs.org/odp/docs/dhsexecsumm.pdf 
MassachusettsCompetent Interpreter Services in the Delivery of Certain Acute Health Care Services – Acute-care hospitals must have an interpreter in the emergency room for any non-English speaking patients. The decision to hire interpreters or to keep one on-call is left to the discretion of the hospital. However, hospitals must provide interpreter services and cannot deny care to non-English speaking patients. (Acts of 2000) www.mass.gov/legis/laws/seslaw00/sl000066.htm
Department of Public Health: Hospital Translation Services Poster – A sign is displayed throughout hospitals conveying in over 30 languages: "You have the right to a medical interpreter at no cost to you." Patients and visitors can point to their language, and hospital officials will contact the appropriate interpreter. www.mass.gov/dph/omh/interp/interpreter.htm
Boston Public Health Commission Cultural Competence Assessment Tool
(CCAT) – CCAT was created by the Boston public Health Commission in
response to the CLAS standards which call for a self-evaluation of the
organization cultural and linguistic competence. This tool provides
organizations and health care professionals a framework for providing cultural
appropriate care. This tool provides steps necessary for evaluation as well as
questions to ask staff and worksheets to keep track of the minority population
being served. The BPHC believes that improving culturally competent care is
one way to help solve disparities, but to improve this care, hospitals and
institutions must first evaluate how care is delivered to racial and ethnic
minorities in order to improve it. www.bphc.org/director/pdfs/disparities_assess-tool.pdf
New HampshireNew Hampshire Minority Health Coalition – A Cultural-Competency Group works to develop leadership among minorities, train private- and public-sector educators, work with healthcare agencies to increase their awareness, policies, images, and resources, and assist in eliminating barriers. Counselors will come to an organization, specifically those in healthcare, human services, and outreach programs, to provide cultural education. Other programs include cultural forums, the Mental Health of Greater Manchester Cultural Competency Initiative, and the Weed and Seed Cultural Competency Priority. www.nhhealthequity.org
OklahomaCultural Competency and Diversity Training – This program provides training that addresses cultural differences and barriers between minority patients and healthcare providers. The program works to help underserved populations, especially those who speak limited English. Employees of the Oklahoma Department of State Health are required to complete cultural-competency and diversity training as a part of their annual performance evaluations. www.health.state.ok.us/program/omh
Texas Hablemos de su Salud, Fort Worth, Tex. – This program seeks to eliminate language barriers that lead to health disparities. The project focuses on patient-provider communication and promotion of science-based standards for linguistic competence in the healthcare setting. Source: APHA. For more information, contact Dr. Holly Jacobson at 817-735-2365. www.hsc.unt.edu/education/sph/documents/Spanish_Materials.pdf and www.hablamosjuntos.org/ep/profiles/texas.asp
House Bill 161 – Texas HB 161, which as of April 2007 had been approved by the Texas House Committee on Public Health, would create a 24-hour, toll-free, bilingual hotline that medical professionals could use when they need a translator for a patient and none is available. By creating access to interpreter services, it is thought that care to non-English speakers will become faster and more efficient and medical liabilities because of miscommunication will be reduced. The authors of this bill believe the service will begin in September, 2008. www.legis.state.tx.us/BillLookup/History.aspx?LegSess=80R&Bill=HB161
WashingtonCertification of Interpreters or Translators – The Washington Department of Social and Health Services provides and pays for certified interpreters for all health services patients, including Medicaid patients, receive. DSHS ensures the quality of interpreters through standardized written and oral examinations. Certifications are offered in eight languages: Spanish, Vietnamese, Russian, Cambodian, Laotian, Mandarin, Cantonese, and Korean. www1.dshs.wa.gov/msa/ltc/itsvcs.html
National ProgramsCultural and linguistic competency has also becoming a focus of federal programs. Departments and programs have emerged concerning this topic nationwide. Many of the national initiatives, as well as state programs, revolve around the Culturally & Linguistically Appropriate Services (CLAS) Standards and seek to make care more responsive to the needs of others. Other national programs focus on improving cultural competency through creating networks of research and information on best practices throughout the country.
Kaiser Permanente – On the state and national level [in the area of managed care], Kaiser Permanente makes efforts to increase cultural and linguistic competence. Nationally, six Institutes for Culturally Competent Care focus on the areas of African-American Populations, Latino Populations, Linguistic and Cultural Services, Women's Health, Disabilities, and Eastern-European Populations. On the state level, programs in linguistic and cultural services have been especially effective. The California Endowment granted funds to Kaiser Permanente to assess outcomes and programs for linguistic and cultural services. Specifically, the San Francisco facility focuses on providing services to Chinese and Latino patients. An extensive translation unit offers 14 dialects and languages and ensures that clients are aware of and understand healthcare services. Additionally, all staff members, from clinical nurses to health educators, have undergone cultural understanding training and many are bilingual. *Note: Currently, Kaiser Permanente does not provide an external website for its Permanente National and Linguistics & Cultural Programs.
Hablamos Juntos (Let's Talk Together) – This national program [of The Robert Wood Johnson Foundation] strives to improve access to quality health care for Latinos with limited English proficiency. It focuses on improving the availability and quality of interpreter and language services, allowing people to communicate orally. Another aspect is the promotion of multi-lingual medical-facility signage. www.hablamosjuntos.org
National Standards for Culturally and Linguistically Appropriate Services (CLAS Standards) – The CLAS Standards were developed by the OMH in 1999 after an intense of programs that were currently in place followed by a period of feedback regarding proposed standards. The purpose of the CLAS Standards is to create a common definition for cultural competency, create a framework and structure for programs which seek to become more culturally responsive, and to make recommendations concerning culturally competent practices. These standards have provided the basis for many state and national initiatives, including Medicaid and the Quality Improvement for Managed Care. Overall, the CLAS Standards have become a backbone of cultural competency initiatives nationwide in the twenty-first century. www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=3
Center for Linguistic and Cultural Competence in Health Care – This center was created in 1995 in response to Congress’ call to eliminate linguistic barriers to health care. This center provides information about cultural competency, different initiatives and policies, standards, reports and data, as well as tools for healthcare providers to use to create a more culturally competent practice. www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=3
NCCC – The NCCC is a center housed in Georgetown University whose goal is to design and implement culturally and linguistically competent health care delivery systems. The NCCC has not only developed programs related to creating culturally competent practices, such as the Initiative for Decreasing Disparities in Depression, but they also provide resources and tools for practitioners and policy makers. For example, on their website one may find policy and practitioner assessment tools as well as ideas on ‘cultural brokering’, such as ideas on how to implement practices which bridge cultural divides. www11.georgetown.edu/research/gucchd/nccc
Speaking Together: National Language Services Network – Sponsored by the RWJF, this is a national program which aims at improving the language services provided by hospitals to patients with limited English proficiency. So far, this program has recruited ten hospitals throughout the country to form a network of places instituting new, innovative measures to enhance language services in their facility. By collecting data and working collaboratively, this program seeks to develop measures and programs that can better language services in all hospitals. In addition, the website provides useful links and resources to learn more about programs promoting cultural competency. www.speakingtogether.org/home
Diversity Rx – A clearing house of information focused on finding the information, resources, and technical assistance to design and implement linguistically and culturally appropriate health care programs and policies. This website includes information on models and programs used in areas such as interpreter service, laws pertaining to cultural competency and how policy makers have implemented plans, and a network that allows health care providers and managers to connect people to share information and practices. www.diversityrx.org/HTML/DIVRX.htm
Plain Talk/Hablando Claro – Plain Talk was a program originally designed and funded by the Annie E. Casey Foundation in 1994. This program recruits local organizations to map the community and assess its basic needs, and communicate with community members on topics such as teen pregnancy and HIV/AIDS. Through activities such as Walkers and Talkers and Home Health Parties, local organizations educate adults in the community on how to communicate with their youth about safe sex. The program was evaluated in 3 communities between 1994 and 1998, and it is estimated that in these communities there was an 11 percent reduction in teen pregnancy because of the program. Since then, Plain Talk sites have been implemented in communities across the country, and many organizations are still applying to become a site. In many cases, Plain Talk seeks to serve the underserved population and many areas, such as New Mexico and Georgia, focus on culturally competence outreach to the Hispanic and African American communities. www.plaintalk.org
Existing programs address components of cultural competence, specifically language and assessment of cultural competency. Through translator programs, states hope to limit error in diagnosis and decrease healthcare costs. To date many of the cultural competence programs have focused on services at the provider and insurer level.
Certification of Interpreters or Translators – The Washington Department of Social and Health Services provides and pays for certified interpreters for all health services patients, including Medicaid patients, receive. DSHS ensures the quality of interpreters through standardized written and oral examinations Certifications are offered in eight languages: Spanish, Vietnamese, Russian Cambodian, Laotian, Mandarin, Cantonese, and Korean.
For more information, contact Eric Jacobson (302-831-1711).
photo on this page courtesy of the Administration on Aging
