Scenario 2: Cultural and linguistic competency in communication; working with interepreters

The director of an agency that provides services and supports to people with ID, many of whom have first languages other than English, wants to assure that her staff is culturally and linguistically competent.  What resources can she consult to learn more about cultural and linguistic competence and to develop and offer high quality staff training?

Cultural and language differences impact the effectiveness of communication in health care settings.  Cultural and linguistic competency is required to support optimal health outcomes.  Organizations must assure that providers of services and supports develop cultural competence, become aware of their own biases and work to eliminate them, and are skillful in working across language and cultural differences.   Professionals must make this commitment individually.  Organizations should utilize professional language interpretation services for communication between staff and clients with limited English proficiency. 


RESOURCES:

Topic:  The Impact of Bias, Stigma, and Discrimination on Communication and Health

Title:  Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Careers.  (Ali et al, 2013)

Source:  PLOS One

Find at:  http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0070855&type=printable

Description:  Quotations from abstract and conclusion-“People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care… The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years…Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability…”

Title:  Cultural Competence:  It all starts at the front desk (Bronheim)

Source:  National Center for Cultural Competency, Georgetown University

Find at:  https://nccc.georgetown.edu/documents/FrontDeskArticle.pdf

Description:  “A great deal of training and effort has been directed at supporting health care and other professionals to provide culturally and linguistically competent services and supports. For most families, however, many interactions precede the actual encounter with the health care provider. Families must make appointments, ask questions about insurance, check in and provide information at each visit, and be escorted in to see the professional. These encounters are typically with staff in the health care provider’s office or in a hospital, clinic, or agency setting. Families’ experiences in getting services are affected as much, if not more, by these interactions than by their encounters with the health care provider. Unfortunately, too many families continue to encounter the insensitivity, lack of courtesy and respect, bias, and even discrimination in their experiences with the front desk. For the purposes of this article, staff and the interactions they have with families will be referred to as the ‘front desk.’”

Title:  Disability stigma and your patients (2016)

Source:  University of Washington

Find at:  http://agerrtc.washington.edu/info/factsheets/stigma

Description:  “For people with disabilities, stigma can be a major barrier to participation. Stigmatizing attitudes about disabilities can also affect relationships between patients and providers. However, health care providers can be allies with their patients and help reduce the impact of stigma.”


Topic:  Disability as culture

Title:  Transcultural care and individuals with an intellectual disability (Crotty and Doody, 2016)

Source:  Journal of Intellectual Disabilities, 20 (4); 389-396

Find at:  https://www.ncbi.nlm.nih.gov/pubmed/26669608 (abstract)

Description:  Quotation from the abstract-  “Healthcare delivery today reflects a history of change, which has responded to lifestyle changes, cultural diversity, population needs and expectations. In today’s health-care environment it is crucial for health-care professionals to be mindful of cultural factors that affect health…This article presents the transcultural care challenges for people with intellectual disability, through highlighting the biomedical/sociocultural perspectives of healthcare, communication and inequality experienced by those with intellectual disability.”


 Topic:  Other aspects of cultural and linguistic competence

Title:  The evidence base for cultural and linguistic competency in health care (Goode, Dunne, and Bronheim, 2006)

Source:  The National Center for Cultural Competence, Georgetown University

Find at:  http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf

Description:  The authors examine the evidence for the impact of cultural and linguistic competence on health.

Title:  Promoting cultural and linguistic competency self-assessment checklist for personnel providing primary health care services (Goode, 2009)

Source: National Center for Cultural Competency, Georgetown University

Find at:  https://nccc.georgetown.edu/documents/Checklist%20PHC.pdf

Description:  “This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural and linguistic cultural competence in health, mental health and human service settings. It provides concrete examples of the kinds of beliefs, attitudes, values and practices which foster cultural and linguistic competence at the individual or practitioner level…”

Title:  National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (2011)

Source:  Think Cultural Health, U.S. Department of Health and Human Services

Find at:  https://www.thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf

Description:  “The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations.” 


Topic:  Working with interpreters

Title:  Appropriate use of medical interpreters (Juckett and Unger, 2014)

Source:  American Family Physician

Find at:  https://www.aafp.org/afp/2014/1001/p476.html

Description:   “More than 25 million Americans speak English ‘less than very well,’ according to the U.S. Census Bureau. This population is less able to access health care and is at higher risk of adverse outcomes such as drug complications and decreased patient satisfaction. Title VI of the Civil Rights Act mandates that interpreter services be provided for patients with limited English proficiency who need this service, despite the lack of reimbursement in most states. …..The use of professional interpreters (in person or via telephone) increases patient satisfaction, improves adherence and outcomes, and reduces adverse events, thus limiting malpractice risk.”

Title:  Cross-cultural medicine and working with interpreters (multimedia package; about 30 minutes)

Source:  University of Washington School of Medicine

Find at: https://courses.washington.edu/fcmweb/.modules/CrossCulturalMed/story_html5.html

Description:  This on-line self-paced module was developed for the medical school’s Foundations of Clinical Medicine course to help medical students explore cultural differences and languages difference and to develop skills for working cross culturally and with medical interpreters.

Title:  Clinicians’ obligations to use qualified medical interpreters when caring for patients with limited English proficiency (Basu et al, 2017)

Source:  American Medical Association Journal of Ethics

Find at:  http://journalofethics.ama-assn.org/2017/03/pdf/ecas2-1703.pdf

Description:   Quotation from the abstract-  “Access to language services is a required and foundational component of care for patients with limited English proficiency (LEP). National standards for medical interpreting set by the US Department of Health and Human Services and by the National Council on Interpreting in Health Care establish the role of qualified medical interpreters in the provision of care in the United States…Clinicians are obliged to create systems and a culture that ensure quality care for patients with LEP.”

Title:  Guidelines for use of medical interpreter services

Source:  Association of American Medical Colleges (AAMC)

Find at:   https://www.aamc.org/download/70338/data/interpreter-guidelines.pdf

Description:   A two pages guideline for working with medical interpreters.

Title:  Working with interpreters for deaf and hard of hearing persons in the courtroom

Source:  The Supreme Court of Ohio

Find at:  https://najit.org/wp-content/uploads/2016/09/benchcardohio.pdf

Description:   “The Americans with Disabilities Act (ADA) assures equal access to justice for people who are deaf, deaf-blind, or hard of hearing. Courts must work closely with interpreters, parties and witnesses to determine effective communication methods.  Possible accommodations may include sign language interpreters, specialized interpreter services, computer-assistive transcription services, and assistive listening devices.”


To further build knowledge and skills for cultural and linguistic competence,  promoting health equity, and recognizing and eliminating racism, we recommend these rich and multifaceted web-based resources:

  • The Website of the National Center for Cultural Competence at Georgetown University Center for Child and Human Development: https://nccc.georgetown.edu . “The mission of the NCCC is to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity.”
  • The “Diversity and Inclusion Toolkit” of the Association of University Centers on Disabilities (AUCD): http://www.implementdiversity.tools/.  “This toolkit will serve as a foundation for a national effort that will enhance diversity, inclusion, and cultural and linguistic competence; cultivate partnerships; respond to increasingly diverse communities across the country; and develop strategies for continuing efforts to better serve diverse populations.”