● Linguistic competence: Providing readily available, culturally appropriate oral and written language services to limited English proficiency (LEP) members through bilingual/bicultural staff, trained medical interpreters, and qualified translators. ● Cultural competence: A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals which enable effective interactions in a cross-cultural framework. ● Cultural and linguistic competence: The ability of health care providers and health care organizations to understand and respond effectively to the cultural and Cultural competency and health care education Cultural competence is recognized by governmental and accreditation agencies as essential for improving client or patient health status and access to health care, as well as eliminating disparities in treatment delivery. Health care system interventions to increase cultural competence can include programs to recruit and retain a staff that reflects the cultural diversity of a community, retain the use of interpreter services or bilingual providers, offer cultural competency training for health care providers, provide the use of linguistically and culturally appropriate health education materials, and offer culturally specific health care settings. Health may be improved through these approaches because clients gain trust and confidence in accessing health care; health care providers increase their ability to understand and treat a culturally diverse clientele. The effectiveness of these interventions can be assessed through intermediate outcomes - as well as through health outcomes. Need for linguistic competency A wide range of approaches has been used to provide interpretive services for patients with limited English proficiency (LEP), ranging from using family members or friends, community language banks, telephone, video or computer interpreters, contracted interpreters, bilingual staff, and on-staff salaried interpreters. Although family members or friends are commonly used, confidentiality is breached. The quality of interpretation is frequently inadequate and may lead to misunderstandings. Given the fact that more than one hundred languages are spoken in the United States, all health care professionals should be adequately trained in how to work with interpreters. As the client completes the initial medical and informed consent intake process, it is important to address the language barriers. It is a fundamentally ethical and legal obligation to mention the foundation of an effective relationship between a caregiver and client or patient. The risk of medical malpractice associated with language discordance between providers and patients is reduced when competent medical interpretation is provided. Define race, ethnicity, and culture Changes in the racial and ethnic composition of the United States have important consequences for the nation’s health care: measures of disease and disability often differ significantly by race and ethnicity. One of the main goals of U.S. public health policy is the elimination of racial and ethnic disparities. Diversity has long been a characteristic of the U.S., but the racial and ethnic composition of the nation has changed over time. According to data from the U.S. Census Bureau in 2016, about 40 percent of adults (and over 24 percent of children) were racial or ethnic minorities. The percentage of the population identifying as Hispanic or Asian has more than doubled in recent decades. Individuals
linguistic needs brought by the patient to the health care encounter. (HHS, 2016) Cultural competence requires organizations and their personnel to incorporate the following concepts in practice: ● Value diversity. ● Acquire and institutionalize cultural knowledge. ● Adapt to diversity and the cultural contexts of the individuals and the communities served. (LCME, 2016) ● Conduct ongoing self-assessments. ● Manage the dynamics of difference. The Accreditation Council for Graduate Medical Education (ACGME), as revised in 2016, identified six core competencies for physicians: patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, as well as systems-based practice. Each competency pertains to knowledge, skills, and attitudes related to treating clients from diverse populations. The third competency specifically requires interpersonal and communication skills, and will result in an effective information exchange and collaboration with patients, families, and other health professionals by “communicating effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.” Professionalism, the fourth competency, states that, “sensitivity and responsiveness to a diverse patient population, including but not limited to, diversity in gender, age, culture, race, religion, disabilities, and sexual orientation” (ACGME, 2016). The federal government has recognized barriers that can be created by language discordance between providers and clients. It has articulated the responsibilities of service providers toward LEP clients. These responsibilities have a legal basis in Title VI of the Civil Rights Act of 1964, which states that, “no person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance” (Civil Rights Act of 1964, Section 601, 78 Stat. 252 [42 USC 2000d]). The Department of Health and Human Services (HHS) regulations require that all recipients of federal financial assistance from HHS provide meaningful access to LEP persons - at no cost to the client [45 CFR § 80.3(b)(2)]. Guidelines have been published in accordance to this that elaborates what constitutes “meaningful access” for LEP patients (Office for Civil Rights, 2003). reporting they were foreign born were 13.1 percent, and 20.9 percent of the respondents reported that a language other than English was spoken at home. Noncitizen, foreign-born persons are disproportionately low-income and uninsured (Kaiser Commission on Medicaid and the Uninsured, 2015). They are also more likely than naturalized citizens to face other barriers to accessing health care - including ineligibility for many government-sponsored programs as well as difficulty in finding providers who speak their language and provide culturally sensitive care.
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Book Code: MMD0724
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