Blog: National Partnership for Action
Cultural & Linguistic Competency
Posted on 9/11/2013 by Pamela Ascon
You are in a foreign country and your child is feeling sick. You rush her to the hospital and want to quickly speak to a doctor. Instead, you are given a long form asking many questions in a complete different language. You ask for help, but no one seems to comprehend your heavy accent.
This is the reality that my family and I encountered when visiting medical facilities for many years. As a child who had recently arrived to America, I attempted to act as a translator between the doctor and my mother with the few vocabulary words that I had learned so far in school. I remember my mother’s face emanating discomfort with her inability to fully express her feelings and concerns.
I now understand that the helpless look on my mother’s face was a true reflection of the challenges consistently encountered by many minority populations.
Some of the most significant barriers between healthcare providers and patients are language and cultural differences, which can play a crucial role in patient health outcome. If patients have a hard time communicating with their healthcare provider, this can lead to errors in diagnosis or treatment. With the ample range of cultures in the United States, patients’ cultural beliefs are of equal importance. If a patient’s belief interferes with their treatment option, the clinician should respectfully accommodate the patient while ensuring that they have a successful health outcome.
In 2050, it is estimated that the minority population will account for almost half of the U.S population [PDF | 283KB], underscoring the necessity of culturally and linguistically appropriate approaches. To inform these approaches, the U.S Department of Health and Human Services has recently released the Enhanced National Standards for Culturally and Linguistically Appropriate Services in health and health care, also known as the CLAS Standards. This blueprint guides implementation to advance and sustain culturally and linguistically appropriate health services. It also highlights the importance of providing quality and equal health services to minorities.
Currently, CLAS Standards are being utilized to improve operational functions within the workplace by equipping culturally and linguistically competent staff to serve the needs of the populations that they serve. CLAS Standards improve quality of care and patient safety while decreasing the liability risk for health care providers. They will ultimately prepare health and healthcare organizations to meet the needs of minorities while improving health care quality.
Therefore, I encourage health and health care organizations to adopt and implement CLAS Standards. Working as a team, we can narrow the cultural and language gaps within the health care system and eliminate a major barrier to achieving health equity in the nation.
Posted in: Health Minority Populations Promising Practices Health Disparities Federal CLAS Cultural & Linguistic Competency Health Care Minority Health | Comments | Add a Comment | Comment Policy | Permalink
Posted on 7/30/2013 by Larke Nahme Huang, Ph.D.
A visit to the doctor can be daunting enough, but imagine how much more challenging it could be if you couldn’t understand your doctor or if your doctor didn’t take into account your health beliefs or practices? Language and culture are critical factors to consider in providing high quality health care and services, and with the rapidly changing demographics of the nation, cultural and linguistic competency has never been more important.
In April, the U.S. Department of Health and Human Services’ Office of Minority Health unveiled the enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards), expanding the definition and scope of the first CLAS standards issued in 2000. The CLAS standards are intended to advance health equity, improve quality and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. So what do the CLAS standards mean for behavioral health care systems and practitioners?
Research shows that there are disparities in behavioral health among racial, ethnic, sexual and gender minority populations. A recent report on 2003-2011 data from the National Survey on Drug Use and Health (NSDUH) found that Hispanics are more likely than non-Hispanics to have a need for substance use treatment but are less likely to receive treatment at drug or alcohol rehabilitation facilities, hospitals or mental health centers. Combined 2003 to 2011 NSDUH data also indicates that African Americans were less likely than persons of other racial and ethnic groups to need alcohol use treatment in the past year, but more likely to need illicit drug use treatment. Another NSDUH report found that substance use rates were generally higher among American Indian or Alaska Native adolescents compared with national averages. Among individuals admitted for substance abuse treatment, methamphetamines were reported as the primary substance of abuse for three times as many Asian Americans and Pacific Islanders (AAPIs) than for all other races combined, according to data from the Treatment Episode Data Set (TEDS). Studies have also shown that minority populations have less access to behavioral health care, receive lower quality care and experience worse outcomes even when they do receive care. Barriers such as stigma, cultural beliefs and limited English proficiency can contribute to these disparities.
Implementing strategies to improve and ensure cultural and linguistic competency in our behavioral health care systems is a powerful way to address these disparities and ensure all populations have equal access to services and supports. Capacity building efforts focused on improving cultural and linguistic competency and incorporating the CLAS standards in systems can elevate awareness; enhance the ability to monitor program access, service use and outcomes; and improve quality as a result. The enhanced standards emphasize the importance of strong leadership and governance and how all members of an organization play a critical role in more fully serving the health care needs of their communities. Practitioners and administrators can participate in training to better understand clients and be responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. At a systems level, some states have taken steps to weave the cultural and linguistic competency into the fabric of their health systems, by passing legislation to implement cultural competency standards.
This National Minority Mental Health Awareness Month, I invite you to learn more about the enhanced CLAS standards and think about how you can advance behavioral health equity by incorporating these practices, starting with checking out the Blueprint for extensive explanations of the standards and implementation strategies. You can also find more information about behavioral health disparities and behavioral health resources on SAMHSA’s Office of Behavioral Health Equity website and the National Network to Eliminate Disparities in Behavioral Health website.
Posted in: Health Health Disparities CLAS Cultural & Linguistic Competency Mental Health Minority Health Minority Mental Health Month | Comments | Add a Comment | Comment Policy | Permalink
Posted on 7/5/2013 by MaJose Carrasco
Originally posted on NAMI Blog
They say that "what we don't know can't hurt us." I disagree.
While mental health conditions were part of my family's story, it took me finding NAMI to realize this. I still remember the first time someone at NAMI asked me if I had a family member with mental illness. I had just started working at NAMI. I responded that I did not have a family member but had a close friend living with severe depression. Months later, when someone else asked me the same question, my answer was quite different: yes, I have a loved one living with mental illness. You see, up until then I had not realized I was not only a friend but also a family member of someone with mental illness.
After learning more about the signs and symptoms of different conditions and hearing stories from people with mental illness and family members I started to notice that I had seeing and experienced some of the things I was hearing about. I started to recognize my uncle's behavior in some of the NAMI materials I was reading. Suddenly I remembered that my uncle had something… something we did not talk much about. Up to this point, I had never fully realized that one of my uncles has a mental illness even though, at some point in my childhood, I had heard words such as schizophrenia mentioned in hushed tones. This started a process of discovery and healing.
Finding out about mental health, what it is, what it means and what to do about it should not be left to luck or to going through years of struggle. Unfortunately, lack of information and understanding about mental health conditions perpetuate the stigma attached to these illnesses and prevent communities across the country from talking about them and helping people understand that it is okay to have a mental illness.
This is particularly the case in multicultural communities where research shows that the levels of stigma associated to mental health conditions are much higher. In recognition of this fact, July was declared as National Minority Mental Health Awareness Month in order to improve access to mental health care through increased awareness of mental health conditions among people from diverse backgrounds .
We have a month-long opportunity to spread the word and help communities across the country understand that mental health conditions are real and treatable. For those of us who are members of diverse communities, we have an opportunity to help our communities start a much needed conversation and dialogue around mental health.
If you are not a person of color or a lesbian, gay, bisexual and transgender individual (LGBT) you may think you can stop reading this now since this does not apply to you. Though, think about it for a minute. Think about your neighbors, your coworkers, your friends, people at your place of worship, the gym, school, etc. You can make a difference in their lives. I certainly wish someone would have shared with me about mental illness long before I found NAMI. This could have helped me and my family.
So, what can you do to help?
Posted in: Health Minority Populations Health Disparities Cultural & Linguistic Competency Health Care Health Equity Minority Mental Health Month | Comments | Add a Comment | Comment Policy | Permalink
Posted on 6/27/2013 by Margaret Korto
On National HIV Testing Day, we must remember all messages about testing and prevention are not the same. Culture plays a major role in what motivates our behavior.
There are over a million African immigrants living in the United States today. While this group boasts a striking diversity in languages, traditions and experiences, there is one common experience that highlights a fairly universal challenge - adapting to the U.S. health care system and the stark reality that their own beliefs and American medicine are frequently at odds with each other.
Many African cultures have a holistic view of life and believe that life is a journey that each person takes. This journey is marked by different stages or phases, including birth, childhood, puberty (adolescence), youth, adulthood, old age and death. Through cultural norms and practices, society ensures that individuals understand their roles in their journey from stage to stage. Why is this important to awareness about HIV testing and prevention?
Folk religion and cultural practices, including belief in gods and ancestral spirits, is central to many African belief systems. Despite the spread of formal health care systems, some Africans, including those in the Diaspora, often bypass these systems for traditional providers - such as herbalists and priests - for a number of reasons. The traditional healers tend to be closer to the culture of the Africans patients, and this fosters a strong relationship between the patient and the healer.
Within the African religious system, diseases are thought to be caused by supernatural forces. For some Africans, diseases such as HIV/AIDS are believed to be punishment from a "higher being" and as such, they may not want to seek medical intervention. And for some Africans the textbook distinctions between "religion" and "medicine" are not relevant. For example, religious practices, including the use of amulets and visits to shrines, dominate the practice of folk medicine. It is therefore not uncommon to see Africans express views on health, illness and mortality in a spiritual rather than a medical way. As a result of this, Africans tend to be suspicious of western medicine. When it comes to HIV testing, some even believe that there is something sinister about blood draws, claiming, "they want to do something with my blood."
For clinicians, it's important to understand how this translates to behaviors - from reluctance to seek care to failure to adhere to prescribed treatments. In my work with organizations like the Adventist HealthCare Center on Health Disparities , we have observed that clinicians will likely get more history from an African patient through an informal conversation than by going down a checklist during the first visit, as storytelling is huge part of African cultures. Additionally, it helps if clinicians ask probing questions during the conversation show they care about the client not only the disease.
Culture and language influence attitudes and shape behaviors around health, healing and wellness. Both the provider and the patient bring their individual learned patterns of language and culture to the health care experience. To achieve equal access to quality health care for all, we must learn to transcend these disparate experiences and strengthen communication between patient and provider.
The Office of Minority Health Resource Center provides free resources, including cultural competency training, for providers working with African immigrant communities. For more information, please contact Margaret Korto at firstname.lastname@example.org.
Read more about African immigrant health issues at http://minorityhealth.tumblr.com/
Posted in: Health Minority Populations OMH Promising Practices Health Disparities Prevention Cultural & Linguistic Competency Health Care Health Equity HIV/AIDS Minority Health | Comments (2) | Add a Comment | Comment Policy | Permalink
About the Blog
The NPA works to achieve health equity -- the highest level of health for all people. This blog is a venue for professionals from all fields and sectors to share their thoughts on pressing issues, news and events pertaining to health equity. Follow and participate in this candid discussion.
Recent Blog Posts
→ Achieving Health Equity and Longevity for Men in Communities of Color
→ The Mid-Atlantic RHEC Resource Guide: Engaging Youth in Health Equity Issues
→ Unraveling the Latino Paradox by Strengthening Promotoras/Promotores de Salud
→ Promoting Health Equity in Latino Communities
→ Newly Released: A White Paper for Health Care Providers on Cultural Competency
→ Proclaiming April as National Minority Health Month
→ Promoting Health Equity through Sexual Orientation Inclusion Work at the University of Colorado School of Medicine
→ Limited English Proficiency among the Deaf and Hard of Hearing Population: A Consideration for Care
→ The Mid-Atlantic Regional Health Equity Council Explores How Unconscious Bias Impacts Health
→ National Minority Mental Health Awareness Month: Lifting the Burden of Disparities