Cultural Competence and Limited English Proficiency Frequently Asked Questions
Frequently Asked Questions
Question: What is Cultural Competence?
Answer: Many definitions of cultural competence have been put forward, but probably the most widely accepted are the following:
Cultural and linguistic competence is a set of coinciding behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations. “Culture” refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, social, or religious groups. “Competence” implies having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities.
Stated more simply, cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes.
Also, cultural competence can be defined as services that are sensitive and responsive to cultural differences whereby caregivers are aware of the impact of culture and possess the skills to help provide services that respond appropriately to a person's unique cultural differences, including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability.
Question: Where can I find information and resources to provide cultural competence training for staff development?
Answer: There are several agencies and organizations that will provide the resources and/or training to implement cultural competence within an organization. Think Cultural Health provides free online and accredited culturally competency continuing education programs for physicians, pharmacists, nurses, and social workers. TrainingFinder Real-time Affiliate Integrated Network or TRAIN.org provides free online training on cultural competency skills that includes health literacy and Limited English Proficiency. This training module can be taken for credit and non-credit and is appropriate for health care professionals.
- National Center for Cultural Competence (NCCC)
Located at Georgetown University. Contributes a variety of services for health and mental health programs wishing to design, implement, and evaluate culturally and linguistically competent service delivery systems. Services include a resource database, tools for self-assessment, technical assistance, consultation and training events.
- Office of Minority Health (OMH)
Established by the U.S. Department of Health and Human Services (HHS). Develops health policies and programs to eliminate health disparities and also serves as a national resource and referral service on minority health issues.
- Office of Minority Health Resource Center (OMHRC)
Collects and distributes information on a wide variety of health topics. Website is available in Spanish and consumer health resources can be found in several different languages.
- Cross Cultural Health Care Program (CCHCP)
Through a combination of cultural competency trainings, medical interpreter trainings and assessment tools, serves as a bridge between communities and health care institutions to ensure full access to quality health care that is culturally and linguistically appropriate. The Northwest Resource Center, a division of the CCHCP, is staffed by librarians who provide links to information and resources on the CLAS standards, cultural competence and health disparities.
Question: Are there guidebooks available on Cultural Competence?
Answer: Several guidebooks are available online.
- Guide for Advancing Family-Centered and Culturally and Linguistically Competent Care
Published by the National Center for Cultural Competence, discusses how family-centered care and cultural and linguistic competence can be integrated to support and sustain a community-based system of services that provide high quality of care to families who have children with special health care needs.
- Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups
Designed by the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the Western Interstate Commission for Higher Education (WICHE). Provides readers with the tools and knowledge to help guide the provision of culturally competent mental health services within today's managed care environment. Information was derived from experts from four core racial/ethnic populations: Hispanics, American Indians/Alaska Natives, African Americans, and Asian/Pacific Islanders.
- Physician Toolkit and Curriculum: Resources to Implement Cross-Cultural Clinical Practice Guidelines For Medicaid Practitioners
Published by the Office of Minority Health ” to aid healthcare providers in the practical application of the Cross-Cultural Clinical Practice Guidelines. This guide introduces the basic fundamentals of cross-cultural practice and offers steps and processes essential to delivering quality care to culturally diverse populations.
- Building Culturally and Linguistically Competent Services to Support Young Children, Their Families, and School Readiness
Written by Kathy Sietzinger Hepburn and funded by the Annie E. Casey Foundation, this guide provides the tools and resources that will assist communities in building culturally and linguistically competent services, supports, programs, and practices related to young children and their families.
- Culturally and Linguistically Appropriate Services (CLAS) Toolkit
Developed by the New Mexico Department of Health Division of Policy and Performance. Provides implementation strategies and resources both statewide and regionally to address the four mandated Language Access Services Standards.
Question: Who is a Limited English Proficient (LEP) individual?
Answer: Individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English can be limited English proficient, or "LEP." These individuals may be entitled language assistance with respect to a particular type or service, benefit, or encounter.
Question: What are the federal laws concerning language access for LEP individuals?
Answer: Federal laws applicable to language access include Title VI of the Civil Rights Act of 1964, and the Title VI regulations, prohibiting discrimination based on national origin, and Executive Order 13166 issued in 2000. Many individual federal programs, states, and localities also have provisions requiring language services for LEP individuals.
Also, the Department of Health and Human Services Office of Minority Health developed a collective set of 14 culturally and linguistically appropriate services mandates, guidelines, and recommendations identified as the National Standards on Culturally and Linguistically Appropriate Services (CLAS). These standards are organized by three themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Support for Cultural Competence (Standards 8-14). Language Access Services Standards 4-7 are federally mandated for all recipients of federal funds whereas Standards 1-3 and 8-14 are recommended.
Question: What is Executive Order 13166?
Answer: An Executive Order is an order given by the President to federal agencies. The “LEP” Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, states that people who are LEP should have meaningful access to federally conducted and federally funded programs and activities.
Executive Order 13166 requires all agencies that provide federal financial assistance to issue guidance on how recipients of that assistance can take reasonable steps to provide meaningful access consistent with Title VI and the Title VI regulations. The Order also requires that federal agencies create plans for ensuring that their own activities also provide meaningful access for persons who are LEP.
Question: What federal activities are covered by the Executive Order?
Answer: The Executive Order covers all "federally conducted programs and activities." Anything a federal agency does falls within the scope of federally conducted programs or activities. All of the federal agencies are responsible for developing and implementing "federally conducted plans" to ensure that persons who are LEP have meaningful access to all the federal programs and activities.
Question: Where can I find a copy of Executive Order 13166?
Answer: The Executive Order 13166: Improving Access to Services for Persons with Limited English Proficiency is available online from the U.S. Department of Justice.
Question: How do these laws affect limited English proficient students?
Answer: Federal law requires programs that educate children with limited English proficiency to be based on a sound educational theory; adequately supported, with effective staff and resources to ensure a positive outcome; and be periodically evaluated and/or revised.
Question: Where can I find other resources and guidance for implementing a program that improves access to services for persons with limited English proficiency?
Answer: The Let Everyone Participate (LEP.gov) acts as a clearinghouse, providing and linking to information, tools, and technical assistance regarding Limited English Proficiency and language services for federal agencies, recipients of federal funds, users of federal programs and federally assisted programs, and other stakeholders.
Health Resources and Services Administration produced the Health Care Language Services Implementation Guide, a guide to help healthcare organizations implement effective language access services to meet the needs of their patients with limited English proficiency (LEP). In addition the Agency for Healthcare Research and Quality provides two, in both English and Spanish to measure an individual's reading comprehension in a medical context. These tools can be used for research, clinical or program planning purposes.
Question: Who will enforce the LEP rules?
Answer: Most federal agencies have an office that is responsible for enforcing Title VI of the Civil Rights Act. To the extent that a recipient's actions are inconsistent with their obligations under Title VI, then such agencies will take the necessary corrective steps. The Coordination and Review Section of the Civil Rights Division of the Department of Justice has taken the lead in coordinating and implementing this Executive Order.
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Last revised 05/25/2011
