Closing the Gap
A newsletter of the Office of Minority Health, U.S. Department of Health and Human Services
Office of Minority Health Publishes Final Standards
for Cultural and Linguistic Competence
By Houkje Ross
n late December 2000, the Office of Minority Health care is an issue that appears over and over in literature,
(OMH), U.S. Department of Health and Human Ser- research, and studies that examine the lowered health sta-
vices, published the final recommendations on national tus of our nation’s minority populations.
standards for culturally and linguistically appropriate ser- The CLAS standards that deal with language assis-
vices (CLAS) in health care. Federal and state health agen- tance services are consistent with HHS’ Office of Civil
cies, policy makers, and national organizations now have a Rights (OCR) written policy guidance to help ensure that
blueprint to follow for LEPs can effectively access
building culturally com- critical health and social ser-
petent health care organi- vices. The OCR standards
zations and workers. were introduced in August
The 14 standards are 2000 (See story, page 4).
based on an analytical re- The remaining CLAS Stan-
view of key laws, regula- dards are recommendations
tions, contracts, and stan- suggested by OMH for
dards currently in use by voluntary adoption by
federal and state agencies health care organizations
and other national organi- (Standard 14) and guide-
zations. The standards lines or activities recom-
were developed with in- mended by OMH for adop-
put from a national tion by federal, state, and
project advisory committee composed of individuals rep- national accrediting agencies (Standards 1-3; 8-13).
resenting State and Federal agencies, health care organiza-
tions and professionals, consumers, unions, and health care Leveling the Playing Field
accrediting agencies. OMH conducted a four-month pub-
lic comment period and held three regional meetings in “At a very basic level these standards are about ensur-
early 2000 to solicit testimony and advice for the first ing that all persons entering the health care system, re-
draft of the standards. gardless of race or ethnicity, receive equal, fair, and quality
Although many excellent standards do exist, many treatment,” said Guadalupe Pacheco, project officer at
are limited in their scope—they address only a specific OMH. According to OMH’s final report, the CLAS stan-
issue, geographic area, or subfield of health care such as dards are a means to correct inequities that currently exist
mental health, according to OMH’s final report. in the provision of health services and to make these ser-
Four of the standards (4-7) reflect existing federal vices more responsive to the individual needs of all pa-
guidance that address language assistance services for people tients and consumers. “The standards are also a way for
with limited-English proficiency (LEP). Language barri- providers, policymakers, and others in the health care com-
ers are a problem for many Hispanic and Asian Americans munity, to create accountability within their organizations
with limited English proficiencies. Take for example, a for providing equitable, quality services,” he said.
recent Asian American or Hispanic immigrant who speaks When it comes to treating minority patients and con-
OFFICE OF PUBLIC HEALTH
little or no English. The person may live a block from the sumers, what is fair and equal treatment needs to be looked
AND SCIENCE local hospital, but be unable to receive adequate medical at closely. Current research and literature point to over-
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
care if there are no interpreters available. Accessing health whelming disparities in health status of minorities when
...continued on page 2
CLAS Standards...from page 1
Closing the Gap
compared to whites. Minorities have higher need for special initiatives, or measure progress
prevalence and mortality rates of diseases like made by state initiatives.
Closing the Gap is a free newslet- cancer, diabetes, and cardiovascular diseases. For To gain a better understanding of the
ter of the Office of Minority example, African American men have some of health problems that exist in minority popula-
Health, Office of Public Health the highest incidences and mortality rates of tions, CLAS Standard 10 recommends that
and Science, U.S. Department cancer. And in many American Indian and health care organizations collect data on an in-
of Health and Human Services. Alaska Native communities, diabetes is rampant. dividual patient’s race, ethnicity, and spoken
Send correspondence to: Editor,
Wilbur Woodis, management analyst and and written language. CLAS guidelines also rec-
Closing the Gap, OMHRC,
PO Box 37337, Washington,
a behavioral health specialist for the Indian ommend that organizations maintain a current
D.C. 20013-7337. Call toll-free Health Service, noted that acknowledging the demographic, cultural, and epidemiological pro-
to get on our mailing list, 1-800- problems of minority populations is only the file of the community, as well as a needs assess-
444-6472, or access Closing the first step to eliminating health disparities. It has ment, to accurately plan for and implement ser-
Gap on the OMH Web site: long been known that American Indians and vices that respond to the cultural and linguistic
http://www.omhrc.gov. Alaska Natives (AI/ANs) have high incidences characteristics of a service area.
of behavioral health issues such as suicide, sub- Unfortunately, discrimination is still a fac-
Staff stance abuse, and mental health problems. “It is tor in the quality of health care services some
easy to acknowledge the problems and the gov- minorities receive. A recent study from the Kai-
Executive Editor: ernment programs that work to address these ser Family Foundation, Perceptions of How Race
Blake Crawford problems. What is harder, however, is acknowl- & Ethnic Background Affect Medical Care, found
edging how culture influences the health of AI/ that minority patients are often distrustful of
Senior Editor: AN and other minority populations,” said the U.S. health care system. Reasons cited for
Brigette Settles-Scott Woodis. the lack of trust included lack of time and at-
“Culture and language are an integral part tention given to patients by health care profes-
of how we define who we are. The CLAS stan- sionals and the perception that health care pro-
dards bring attention to the need and impor- fessionals hold negative stereotypes of minority
tance of culture and language for people of patients.
Meredith Burke Lawler color,” said Woodis, who also served on the To help curb discrimination, the CLAS stan-
Rodney G. Hood, MD CLAS advisory committee that helped review dards recommend that health care organizations
Beatriz Roppe draft standards. develop participatory, collaborative partnerships
Under the CLAS standards (see page 3 for with minority and ethnically diverse commu-
Production Coordinator: full list), health care organizations are encour- nities. There are many formal and informal
John I. West aged to ensure that patients receive understand- mechanisms available for this, including par-
able and respectful care that is compatible with ticipation in governing boards, developing com-
Graphic Designer: their cultural health beliefs, practices, and pre- munity advisory committees and ad hoc advi-
Stephanie L. Singleton ferred language. This may mean providing an sory groups, or conducting interviews or focus
environment in which patients from diverse cul- groups, according to OMH. Health care orga-
tural backgrounds feel comfortable discussing nizations are also encouraged to develop cultur-
Inside cultural health beliefs or practices; using com- ally and linguistically sensitive grievance resolu-
munity workers as a check on the effectiveness tion processes for resolving cross-cultural con-
CLAS Standards 3
of communication and care; or encouraging flicts or complaints by patients and consumers.
Limited English Proficiency 4 patients to express their spiritual beliefs and A 1999 study conducted by the Oregon
Leadership Summit 6 cultural practices, according to OMH. Office of Multicultural Health, Strategies in Col-
Minority Health Perspective 7 laboration, supports the CLAS recommenda-
Minority Health Perspective 8 Data Issues And Discrimination Also Addressed tion for including minorities in health care or-
Linguistic Competence 9
ganizations. The study notes that central to be-
Ensuring that our minority populations re- ginning the process of gaining trust from eth-
ceive culturally appropriate care is only one of a nic minorities is finding ‘natural leaders’ from
Accessing Health Care 11
handful of problems addressed by the CLAS within the minority communities. “Mainstream
Dental Health 12 standards. For some minority groups like Asian agencies need to foster opportunities for ethnic
Bereavement 13 Americans and Pacific Islanders and American community leaders to meet within and across
Resources 14 Indians and Alaska Natives, statistical data on communities. This will help clarify needs, in-
Conferences 16 disease mortality and prevalence are either not cluding how services need to be adapted to fit
available or limited. Limited data on racial and each community,” said the study.
ethnic minority health can make it difficult for
agencies to identify health disparities, justify the continued on page 10...
Closing the Gap 2 February/March 2001
Revised CLAS Standards
From the Office of Minority Health
1. Health care organizations should ensure that patients/con- 9. Health care organizations should conduct initial and on-
sumers receive from all staff members, effective, understand- going organizational self-assessments of CLAS-related ac-
able, and respectful care that is provided in a manner com- tivities and are encouraged to integrate cultural and lin-
patible with their cultural health beliefs and practices and guistic competence-related measures into their internal
preferred language. audits, performance improvement programs, patient satis-
faction assessments, and outcomes-based evaluations.
2. Health care organizations should implement strategies to re-
cruit, retain, and promote at all levels of the organization a 10. Health care organizations should ensure that data on the
diverse staff and leadership that are representative of the de- individual patient’s/consumer’s race, ethnicity, and spo-
mographic characteristics of the service area. ken and written language are collected in health records,
integrated into the organization’s management informa-
3. Health care organizations should ensure that staff at all levels tion systems, and periodically updated.
and across all disciplines receive ongoing education and train-
ing in culturally and linguistically appropriate service deliv- 11. Health care organizations should maintain a current de-
ery. mographic, cultural, and epidemiological profile of the
community as well as a needs assessment to accurately plan
4. Health care organizations must offer and provide language for and implement services that respond to the cultural
assistance services, including bilingual staff and interpreter and linguistic characteristics of the service area.
services, at no cost to each patient/consumer with limited
English proficiency at all points of contact, in a timely man- 12. Health care organizations should develop participatory,
ner during all hours of operation. collaborative partnerships with communities and utilize a
variety of formal and informal mechanisms to facilitate
5. Health care organizations must provide to patients/consum- community and patient/consumer involvement in design-
ers in their preferred language both verbal offers and written ing and implementing CLAS-related activities.
notices informing them of their right to receive language
assistance services. 13. Health care organizations should ensure that conflict and
grievance resolution processes are culturally and linguisti-
6. Health care organizations must assure the competence of lan- cally sensitive and capable of identifying, preventing, and
guage assistance provided to limited English proficient pa- resolving cross-cultural conflicts or complaints by patients/
tients/consumers by interpreters and bilingual staff. Family consumers.
and friends should not be used to provide interpretation
services (except on request by the patient/consumer). 14. Health care organizations are encouraged to regularly make
available to the public information about their progress
7. Health care organizations must make available easily under- and successful innovations in implementing the CLAS stan-
stood patient-related materials and post signage in the lan- dards and to provide public notice in their communities
guages of the commonly encountered groups and/or groups about the availability of this information.
represented in the service area.
8. Health care organizations should develop, implement, and *Note: The standards are organized by three themes.
promote a written strategic plan that outlines clear goals, 1. Culturally Competent Care (Standards 1-3)
policies, operational plans, and management accountability/ 2. Language Access Services (Standards 4-7)
oversight mechanisms to provide culturally and linguistically 3. Organizational Supports for Cultural Competence
February/March 2001 3 Closing the Gap
Limited English Proficiency
HHS’ Office of Civil Rights Focuses on Title VI Policy
Provides Guidance for Ensuring Linguistic Access
By Houkje Ross
n August 2000, the U.S. Department of Health and Human the key to meaningful access, whether it is a hospital, a clinic or a
Services’ (HHS) Office of Civil Rights (OCR) released a written benefits program. Failure to communicate effectively can have seri-
policy guidance to help ensure that persons with limited English ous consequences for millions of Americans.”
skills can effectively access critical health and social services. According to the Cross Cultural Health Care Program
The guidance outlines the legal responsibilities of providers who (CCHCP), a non-profit organization in Seattle, many institutions are
receive federal financial assistance from HHS. Providers such as hos- now depending upon family members, friends, or support staff such
pitals, HMOs, and human service agencies now as receptionists and technicians, to provide lan-
have an outline for complying with the “Policy guage assistance. But family members are noto-
Guidance on the Prohibition Against National
“No person in the U.S. shall, on riously bad interpreters because they routinely
Origin Discrimination As it Affects Persons with the ground of race, color or edit, add, or change messages from patient to
Limited English Proficiency.” The guidance doctor, according to CCHCP.
applies to part of Title VI of the Civil Rights
national origin, be excluded Providing health care across language barri-
Act of 1964, which prohibits discrimination from participation in, be ers without the use of an interpreter can be like
on the basis of national origin. walking blindfolded across a minefield. The prac-
Publication of the OCR guidance makes
denied the benefits of, or be tice can be dangerous, and in some cases, life-
HHS the first federal agency to publish guid- subjected to discrimination threatening.
ance since the issuance of Executive Order “A doctor in our hospital was treating a dia-
13166 on serving persons with limited En-
under any program or activity betic patient who only spoke Spanish,” said
glish skills. Signed in August 2000, the execu- receiving federal financial Estela McDonough, coordinator of training and
tive order requires each federal agency to have education at the Interpreter Services Program at
written policies on providing effective service
assistance.” –Title VI the University of Massachusetts Memorial Medi-
to those with limited English proficiency who cal Center.
are served by federally funded programs. According to McDonough, the doctor said he did not need an
The OCR policy guidance recommends that health care agen- interpreter because he said he knew Spanish. But the physician failed
cies and providers develop a plan for providing written materials in to pick up that the patient had been fasting due to religious beliefs.
languages other than English. This should be done in areas where a The patient was in a much more serious sugar crisis than the physi-
significant number or percentage of the affected population needs cian was aware of. Luckily, the interpreter had stayed in the room as
services or information in a language other than English to commu- a precaution. “Later on, the doctor told me that for many years he
nicate effectively. To ensure satisfactory services to limited-English- thought he had been communicating accurately with his patients.
proficient (LEP) clients, providers also should: He had no idea he was putting his patients at risk,” said McDonough.
n Have policies and procedures in place for identifying and assess-
ing the language needs of the individual provider and its client Interpreting - More than Words
n Provide a range of oral language assistance options, appropriate Interpreting is more than just translating the words, according
to each facility’s circumstances; to McDonough. “The interpreter acts as the conduit between the
n Provide notice to LEP persons of the right to free language patient and the health care provider. A trained and qualified inter-
assistance; preter has to have certain skills, including memory, concentration,
n Provide staff training and program monitoring, and knowledge of medical terminology, anatomy, physiology, and an un-
n Establish a plan for providing written materials in languages derstanding of how to deliver a message in the target language,” she
other than English. added.
Using professional on-site interpreters is a more reliable approach
Meaningful Access Must be Provided for providers because these persons have been screened for their lan-
guage skills, trained in interpretation ethics and techniques –which
According to OCR, agencies and providers must ensure mean- includes learning to be accurate, complete, and to consider cultural
ingful access to LEPs. Office of Civil Rights (OCR) Director Thomas frameworks— and contracted only to interpret, according to CCHCP .
Perez commented in a press release that, “Effective communication is continued on page 5...
Closing the Gap 4 February/March 2001
Limited English Proficiency
Professional interpreters should also requirements that doctors who accept Med- Financing Administration’s State Children’s
have a good grasp of the nuances of culture icaid funds provide and pay for interpreter Health Insurance (SCHIP) and Medicaid
and language, according to McDonough. “I services for patients with limited English programs.
had an interpreter who came to our program speaking abilities. The high cost of the re- Some of the most common complaints
from Europe. She had a full year of training quirements will place an “unreasonable bur- OCR works to resolve include: failing to in-
in Spain, but she still misunderstood what den” on physician practices, critics say. OCR form LEP persons of the right to receive free
the patients from Puerto Rico were saying officials maintain that the guidelines do not interpreter services or requiring them to pro-
when describing “fatiga,” which in her na- represent a new initiative but are intended vide their own interpreter; or providing ser-
tive Spain means “tired.” For the patients to more fully explain existing policies in place vices to LEP persons that are not as effective
from Puerto Rico, “fatiga” is a word used to to enforce Title VI of the Civil Rights Act of as those provided to persons with proficiency
describe wheezing from asthma,” said 1964. in English.
McDonough. Although some physicians and other or- In cases where OCR has found health
Massachusetts is one of a handful of ganizations may feel the OCR guidance is care organizations to provide inadequate ac-
states that has standards for the use of medi- burdensome, there are ways to get everyone cess for LEP patients, the agency has required
cal interpreters. The Massachusetts Medical on the same page. A 1995 study conducted these agencies to establish a system for track-
Interpreter Association’s (MMIA) standards by the New York Task Force on Immigrant ing LEP clients and client needs. It has also
address issues of interpreter skill, behavior, Health, Access through Medical Interpreter and required organizations to publicize the avail-
linguistic and cultural knowledge, and eth- Language Services, found that motivation to ability of no cost programs and services in
ics. In April 2000, the Massachusetts Emer- develop an interpreter program is often non-English community media outlets and
gency Room Interpreter Bill was signed into shaped by several factors. These include: pres- to provide cultural sensitivity training for
law. The law requires that all hospitals, pub- sure from physicians; a desire to gain a larger staff.
lic or private, which provide acute care, ei- share of the market through increased pa- For information on the OCR guidance,
ther in emergency rooms or in acute psychi- tient volume; the threat of malpractice law go to http://www.hhs.gov/ocr/lep/ or call OCR
atric facilities, when treating non-English suits; a response to the influx of refugees and at (800) 368-1019. To contact the Inter-
speakers, must use competent interpreter ser- immigrants; and the fact that providing in- preter Services Program at University of Mas-
vices. The law goes into affect in July 2001. person interpreter services is more cost-effec- sachusetts Memorial Medical Center, call (508)
tive than telephone interpreter services. 856-5793. MMIA can be reached at (617)
Getting Everyone on the Same Page Federal funds are available for States’ 636-5479.v
expenditures related to the provision of oral
Some medical associations and other crit- and written translation administrative activi-
ics of the OCR guidance strongly oppose ties and services provided for the Health Care
Good Communication is Good Medicine
I n a recent study conducted by the Office of Ethics and Health Policy Initiatives at the Albert Einstein Healthcare Network in
Philadelphia, focus group participants who were limited-English-proficient felt that their ability to communicate with providers
was restricted. One focus group participant in the 1999 study, Approaches to End-of-Life Care in Culturally Diverse Communities,
commented, “If you don’t speak English, you’re a handicap. You’re going to take a long time to deal with. I’m going to leave you for
last, and I’m going to help that person who speaks English.” Richard Lerner, MD, a general practitioner at the University of
Massachusetts Medical Center in Worcester, admits that it does take more time to use an interpreter. “But without them, the
interaction between provider and patient would be limited,” he said.
In 1999, the Agency for Healthcare Research and Quality sponsored a workshop on cultural competency in health systems,
entitled Providing Care to Diverse Populations: State Strategies for Promoting Cultural Competency in Health Systems. Workshop
presenters indicated that research and anecdotal evidence suggest that the improved communication between doctors and patients
leads to greater patient satisfaction.
Looking for more information on communicating in health care? Check out the third edition of Health Communication:
Strategies for Health Professionals, by Peter G. Northouse, Ph.D, and Laurel L. Northouse. The 1998 book, which provides health
care professionals with theory-based strategies they can use to improve communication with patients, families, and other health care
professionals, includes a chapter on intercultural communication.v
February/March 2001 5 Closing the Gap
On The Road to the
National Leadership Summit
By John West
First in a series of articles on the upcoming National Leadership Summit, to be held in Washington, DC, September 4-6, 2001.
ince its inception in 1985, The Office Kelley, who has been involved in the
of Minority Health (OMH), U.S. De- event’s planning from the start, also said that
partment of Health and Human Ser- the Summit will strive to establish meaning-
vices has been committed to improving the ful and lasting partnerships. “We want to
health of all Americans by helping to elimi- create an atmosphere of developing relation-
nate disparities in health. To further this ships with traditional and non-traditional,
goal, OMH and its federal and non-federal community-based, faith-based, and tribal
partners will convene a National Leadership organizations working at the community
Summit for the Elimination of Racial and level,” he said. “There are a lot of good things
Ethnic Disparities in Health Sept. 4-6, 2001, being done out there that should be shared,”
in Washington, D.C. Kelley added.
The Summit is slated to bring together In addition to the Summit, Kelley said
nearly 1,000 participants who work at the that OMH will put together a compendium
community and policy-making levels to set of recommendations and best practices that OMH’s working partner for Summit
up partnerships and engage in a dialogue on will be known as the “Community Toolkit.” planning is Betah Associates, Inc., of Be-
strategies and activities that promote healthy “This Toolkit will contain many useful things thesda, MD, which will handle all seminar
communities. such as ideas and workable models that people scheduling and logistics to include registra-
According to Capt. Howard L. Kelley, can utilize to tailor programs for their own tion and exhibition planning.
DDS, MPH, OMH project director, the communities,” Kelley said. “Their advice In addition to the Summit program cur-
Summit is designed to be a cohesive and an and recommendations for this “Toolkit” will rently being developed, Kelley said that there
on-going partnership. “This summit repre- focus on activities, projects, policies, and will be many opportunities for exhibitors
sents a federal effort to foster public and pri- evaluation methods that would be effective and sponsors. “We welcome all organiza-
vate sector collaboration with community in programs intended to eliminate racial and tions or individuals who are interested in
organizations and generate community par- ethnic health disparities in communities exhibiting or sponsoring to contact us for
ticipation in policies and strategies for im- around the country,” he added. more information,” he said. “We want to
proving health for all of us,” Kelley said. make this Summit a viable and interesting
event for all attendees,” he added.
The official program for the National
Leadership Summit will contain advertising
.7% Puerto Rican (mainland) Racial & Ethnic Backgrounds pages to complement participation. Ads can
of Medical Student Graduates: be camera-ready color art or film. However,
.8% American Indian/Alaska Native program officials said that no tobacco or al-
1999-2000 cohol advertisements would be accepted.
1.2% Puerto Rican (other) *All other students includes white Information on the National Leadership
students (not of Hispanic origin) Summit can be obtained by calling toll-free
and non-US citizen foreign stu- 1-888-516-5599. (This is the first in a series
1.9% Other Hispanic dents of various racial and ethnic of articles designed to keep our readership in-
formed about the upcoming National Leader-
2.8% Mexican American Data Source: Barzansky, B, Jonas,
HS, and Etzel, SI. Education pro- ship Summit to be held in Washington, D.C.
grams in US medical schools, 1999- in September 2001. Mr. West is a member of
7.4% African American
2000. JAMA. 2000;284:1114- the OMH Closing The Gap Staff and assists in
1120. Summit event planning.)v
18% Asian/Pacific Islander
67.1% All other students*
Closing the Gap 6 February/March 2001
Minority Health Perspective
Diversity Training in Medical School:
AMSA Tests Pilot Curriculum
Guest Editorial by Meredith Burke Lawler, American Medical Student Association
ur Nation is growing more diverse. By 2010, minority adapt the curriculum to reflect the characteristics of their institu-
populations will constitute 32 percent of the U.S. popu- tion and surrounding community and resources.
lation. By 2050, nearly half of the U.S. population will For example, Wake Forest University in North Carolina
be composed of members of ethnic and racial minorities. In order adapted the PRIME curriculum to respond to the presence of
to become effective and responsible physicians, medical students Hispanic, Hmong, and American Indian populations that sur-
need to learn to respond to the unique needs of patients from round the school. Speakers during the fall 2000 semester have
varying ethnicities, races, sexual orientations, and cultural back- focused on common cultural and demographic misconceptions of
grounds. Medical schools have a responsibility to prepare their the above populations, as well as their important values and health
students for cross-cultural relationships with their patients. beliefs. Students have given excellent feedback on the small group
In an effort to foster cultural competency curricula in medical sessions, which last from two to four hours each and are led by
schools, the American Medical Student Association (AMSA), in physicians, community leaders, and Wake Forest faculty.
conjunction with the Promoting, Reinforcing and Improving The Medical University of South Carolina has adapted the
Medical Education (PRIME) project, funded by the U.S. Depart- PRIME curriculum to reflect the unique population of South
ment of Health and Human Services, has developed a one-year Carolina, including migrant farm workers and the nearby Gullah
pilot curriculum for addressing issues of diversity in medicine. community. Noon-time presentations have attracted a much greater
audience than expected, with 146 students attending a recent
Culture and Diversity Pilot Curriculum “Religious Diversity” presentation.
The University of Kansas School of Medicine has also incor-
The educational goal of the Culture and Diversity curricu- porated the PRIME goals into its medical school curricula. The
lum is to provide a curriculum on cultural competency that will school focused its curricula on eliminating biases. Small group class
help physicians-in-training develop the attitudes, skills, and knowl- sessions included discussions of the Tuskegee Project, obtaining a
edge base to serve diverse populations effectively, especially relevant and complete cultural history, and the relationship be-
underserved and vulnerable populations. tween economics and health.
The curriculum is based on specific core competencies that The PRIME project also developed the Community Respon-
each school must address. Some of the core competencies include: sive Curriculum Project, which focuses on teaching medical stu-
cultural models of health, disease and illness, cultural/traditional dents the skills necessary to be a physician in underserved areas.
health care practices, negotiating cultural conflicts in the doctor- For more information on the PRIME curriculum projects, please
patient relationship, effective communicating and interviewing, go to http://www.amsa.org/programs/prime.html or contact Shadia
and using interpreters. Medical schools participating in PRIME Garrison, PRIME Project Manager, at firstname.lastname@example.org
How Do Physicians-in-Training Become Culturally Competent?
L isten with sympathy and understanding to the patient’s perception of the problem.
E xplain your perceptions of the problem and your strategy for treatment.
A cknowledge and discuss the differences and similarities between these perceptions.
R ecommend treatment while remembering the patient’s cultural parameters.
N egotiate agreement. It is important to understand the patient’s explanatory model so that medical treatment fits in their cultural framework.
Source: A Teaching Framework for Cross-Cultural Health Care. Berlin EA, Fowkes WC Jr, Western Journal of Medicine. 1983, 139:934-938.
February/March 2001 7 Closing the Gap
Minority Health Perspective
National Medical Association Supports
Culturally and Linguistically Appropriate Services
Guest Editorial by Rodney G. Hood, MD, President, National Medical Association
he National Medical Association (NMA) supports the HHS nate the racial biases and practices that unfortunately influence the
Office of Minority Health’s (OMH) commitment and ef- manner in which care is delivered today.
forts to develop the Culturally and Linguistically Appro- CLAS Standards 1-3 address the critical need for health care
priate Services (CLAS) Standards. The final standards provide organizations to ensure that their staffs reflect the communities
comprehensive direction to health care organizations and medical they serve and that they are sensitive to their language needs and
professionals on what they can do to ensure that patients/consum- cultural differences. Standards 8-14 provide critical guidance on
ers are able to access health care that is sensitive to their cultural how health care organizations can institutionalize practices and
backgrounds and linguistic needs. procedures to strengthen their ability to fully serve and effectively
However, NMA believes there must be tools in place to en- address the health needs of all their patients. Racial and ethnic
sure that the CLAS Standards are enforced. Without federal en- minority patients have historically been subjected to biases as-
forceability of each of these standards, there is no effective means sumed by providers and entrenched throughout the nation’s health
of ensuring that our nation’s proficiency in providing culturally care system in medical decision-making and treatment. OMH has
and linguistically sensitive health care improves in any way. provided critical guidance on how health care organizations and
In spite of the fact that this nation has experienced tremen- providers can correct the current inequities that exist in the nation’s
dous advances in biomedical research and the practice of medicine, health care system and better serve all of their patients. These
the benefits of these developments have not fully translated into standards are important to improving the nation’s effectiveness in
better health status or health care for African Americans and other addressing racial/cultural biases, improving clinical outcomes, and
racial and ethnic minorities. In fact, communities of color con- closing the racial and ethnic health gap.
tinue to be unduly plagued by disproportionate rates of death and Nationally recognized standards of cultural and linguistic com-
disease. The CLAS Standards are extremely critical. If properly petence in health care service delivery are essential and long over-
implemented and administered, these standards will help to elimi- due. NMA applauds this effort.v
• The Health Resources and Services Administration (HRSA) has a technical assistance center for use by faculty and staff of
minority institutions of higher education. Those working at Historically Black Colleges and Universities, Hispanic Serving
Institutions, and Tribal Colleges and Universities can receive hands-on assistance in preparing proposals for submission to the
HRSA bureaus or offices. The technical assistance center can provide guidance on refining and specifying the objectives;
conceptualizing the technical approach; or researching the background and rationale for a proposal. For more information, call
(301) 585-7588 or e-mail email@example.com
• The National Institute of Environmental Health Sciences, in collaboration with six other National Institutes of Health (NIH)
components, announced the start of 12 five-year projects that will provide scientists with a better understanding of how social
and environmental factors interact and affect the health of racial and ethnic minorities. For a list of principal investigators who
are receiving NIH grants, go to http://www.nih.gov/news/pr/jan2001/niehs-04.htm
• A report from the HHS Office of the Inspector General says that federally funded health centers are one of the best ways to enroll
eligible children into the State Children’s Health Insurance Program (SCHIP). These health centers are often relied on to target
hard-to-reach and minority populations in underserved rural and urban areas. According to the National Association of
Community Health Centers, there are more than 1,029 community-based health centers in the U.S. today, serving over 11
million people through 3,200 delivery sites. Over four million of these patients are uninsured.
Closing the Gap 8 February/March 2001
Checklist to Facilitate the Development of Looking for
Linguistic Competence within Cultural Competency
Primary Health Care Organizations Assessment Tools?
ealth care organizations have been slow to develop and implement policies and Campinha-Bacote, J. (1998). Inventory for
structures to guide the provision of interpretation and translation services. In the Assessing the Process of Cultural Competence
absence of policies, structures and fiscal resources, the burden of such services (IAPCC) Among Health Care Profession-
remain at the practitioner and consumer level. als.
The following checklist is designed to assist primary health care organizations in devel- Write to: Transcultural C.A.R.E. Associ-
oping policies, structures, practices and procedures that support linguistic competence. ates, 11108 Huntwicke Place, Cincin-
nati, OH 45241.
Does the primary health care organization or program have:
Mason, James L. (1995). Cultural Compe-
tence Self-Assessment Questionnaire: A
þ A mission statement that articulates formation in formats that meet the
Manual for Users.
its principles, rationale, and values for literacy needs of patients?
Write to: Portland State University, Re-
providing linguistically and cultur- search and Training Center on Family
ally competent health care services? þ Policies and procedures to evaluate Support and Children’s Mental Health,
the quality and appropriateness of Regional Research Institute for Human
þ Policies and procedures that support interpretation and translation ser- Services, Graduate School of Social Work,
staff recruitment, hiring, and reten- vices? P.O.Box 751, Portland, OR 97207-
tion to achieve the goal of a diverse 0751.
and linguistically competent staff? þ Policies and procedures to periodi-
cally evaluate consumer and person- National Public Health and Hospital Insti-
þ Position description and personnel/ nel satisfaction with interpretation tute (1997). Self-Assessment of Cultural
and translation services that are pro- Competence.
performance measures that include
vided? Write to: NPHHI, 1212 New York Av-
skill sets related to linguistic compe- enue, NW, Suite 800, Washington, DC
þ Policies and resources that support
þ Policies and resources to support on- community outreach initiatives to Roizer, M (1996). A Practical Guide for the
going professional development and persons with limited English profi- Assessment of Cultural Competence in
inservice training (at all levels) related ciency? Children’s Mental Health Organizations.
to linguistic competence? Write to: Technical Assistance Center for
þ Policies and procedures to periodi- the Evaluation of Children’s Mental
þ Policies, procedures and fiscal plan- cally review the current and emer- Health Systems, Judge Baker Children’s
ning to insure the provision of trans- gent demographic trends for the geo- Center, 295 Longwood Ave., Boston,
lation and interpretation services? graphic area served in order to deter- MA 02115.
mine interpretation and translation
services? Success by 6/United Way of Minneapolis
þ Policies and procedures regarding the and Hennepin Medical Society (1996).
translation of patient consent forms, Cultural Competence Clinic Assessment Tool.
educational materials, and other in- Write to: Center for Cross Cultural
Health, W-227, 410 Church St., Min-
neapolis, MN 55455.
Definitions: The terms interpretation and translation are often used interchangeably. The Tirado, Miguel D. (1996). Tools for Moni-
National Center for Cultural Competence makes a distinction between the two terms and has toring Cultural Competence in Health
provided the following definitions. Translation typically refers to the written conversion of Care.
written materials from one language to another. Interpretation is the oral restating in one Write to: Latino Coalition for a Healthy
language of what has been said in another language. California, 1535 Mission Street, San
Francisco, CA 94103.
Source: “Linguistic Competence In Primary Health Care Delivery Systems: Implications for Policy
Makers,” January 2001: Policy Brief 2. National Center for Cultural Competence.
February/March 2001 9 Closing the Gap
Minority Recruitment and Retention Critical to
Enrollment Minority Health Professionals
Total enrollment in schools for selected health
professions by race and ethnicity 1996-97 By John West
Dentistry Percent of Students
American Indian .5 any observers believe that the cul- physician workforce, will be among the some
Non-Hispanic Black 5.4 tural competency displayed by 16,100 receiving their symbolic “white coats”
Hispanic 4.0 health care workers in all levels of this month. “At a time when
an organization—or lack of it—has critically underrepresented minorities make up more
Nursing (RN ) Percent of Students important effects on the quality of care re- than 21% of our country’s increasingly di-
American Indian .8 ceived by that organization’s patients and verse population, having barely 10.5% of
Non-Hispanic Black 9.9 customers. our classes drawn from these communities is
Hispanic 3.9 Better education and training of staff downright alarming,” he said (Reporter, Vol-
currently providing services in health care ume 9, Number 12; September 2000). In-
Optometry Percent of Students systems and facilities could creased efforts must be made
go a long way toward im- “To impact the education, to enact public policy that
American Indian .5
proving patient-provider in- recruitment, practice, and values and endorses cultural
Non-Hispanic Black 2.4
teractions. Equally critical is retention of physicians, competence in the health care
improved recruitment and pharmacists, advanced prac- workforce.
retention of minority stu- tice nurses, dentists, registered Associate Director of the
Pharmacy Percent of Students
dents into health and allied nurses, physician assistants, Institute of Public Health at
American Indian .4
health professions. and other allied health pro- Florida A & M University,
Non-Hispanic Black 2.8
US Census projections fessionals will require a ‘back and Publisher of the Na-
indicate that by the year to basics’ approach....” tional Black Health Leader-
Podiatry Percent of Students 2010, the U.S. minority ship Directory, Nathaniel
American Indian .6 population will increase by 60 percent. Wesley, Jr. said that increasing the number
Non-Hispanic Black 3.7 Jordan J. Cohen, M.D., president of of individuals entering and exiting the pipe-
Hispanic 3.4 AAMC said, “this raises the question of line as health care professionals is the key.
whether or not enough medical students are “The basics of creating a culturally compe-
Minority groups listed are underrepresented developing the necessary cultural awareness tent and diverse workforce requires access
in health care professions. Information can and competence skills.” and opportunity,” Wesley said. “Equal op-
be found in United States Health According to Nycal Anthony, president portunity is still as critical today as during
Workforce Personnel Factbook 2000. This of Alliances for Quality Education, Inc., a the civil rights movement,” he added.
fact book is a compilation of data from sec- Washington-based, health and education Wesley also said that without additional
ondary sources, such as the American Medi- resource development firm, there is not an incentives, it is difficult for an undergradu-
cal Association, and the Federal Bureau of automatic fix to building a more culturally ate student to rationalize choosing a health
Labor Statistics. To order, call the Health competent health care workforce. “Balanc- care career with a staring salary of $30,000
Resources and Services Administration ing the supply and demand needs is essen- in comparison to an engineering career with
(HRSA) at 1-888-Ask-HRSA or visit http:/ tial,” she said. “To impact the education, a starting salary of $45,000.
/www.ask.hrsa.gov recruitment, practice, and retention of phy- “In the future, we must return to pipe-
sicians, pharmacists, advanced practice line programs that foster students through
CLAS...from page 2 nurses, dentists, registered nurses, physician summer work study programs, encourage
assistants, and other allied health profession- mentoring of new entrants into health care
The CLAS standards and the final re-
als will require a ‘back to basics’ approach. fields, and provide career counseling to mid-
port documenting all phases of the project
We need to strengthen the pipeline connect- level health professions,” Wesley said.
issues related to the standards are available
ing people, education systems, legislatures, According to Wesley, mentoring should
online at http://www.omhrc.gov/CLAS. A
and many others to identify and implement not be monolithic in nature. “There has to
hard copy can also be requested by writing:
strategies to succeed,” she added. be more open and meaningful communica-
Attn: CLAS/Guadalupe Pacheco, Office of
Cohen further stated that despite the tion and development across all levels,” he
Minority Health, 5515 Security Lane, Suite
hard work of medical schools across the coun- said. There must be a diverse cooperative
1000, Rockville, MD, 20852. Or e-mail
try, no more than 1,700 individuals from pathway for success.v
racial/ethnic groups, underrepresented in the
Closing the Gap 10 February/March 2001
Accessing Health Care
Linking Minorities to Health Services:
Successful Strategies for Outreach Workers
By Houkje Ross
ccessing health care is a major challenge for minority and eth- the American Indian Community Center. The women are en-
nic groups who may be unknowledgeable, fearful, or dis- couraged to come together and stay all day, where they could eat
trustful of ‘mainstream’ medical services. Community health food, drink coffee or tea, and socialize.
workers, sometimes known as ‘lay’ health workers, are often the key
to linking minority and other underserved communities to health n Structure your program. The National Asian Women’s Health
care services. Organization’s program, Communicating Across Boundaries, was
Part of being a successful community health worker is being designed to increase the responsiveness of health care providers
knowledgeable about the community you serve. “When you con- to Asian American women through cultural competency train-
duct outreach, you have to know the ‘flavor’ of the community— ing. The program—a four-year cooperative agreement with the
you have to be able to fit into and function within it,” said Delores Centers for Disease Control—clearly lays out its goals, audience,
Burgess, coordinator for minority/community outreach and educa- design, process, and expected outcomes. Now in its final year,
tion program at the Mental Health Association of Allegheny County the program has been successful in opening a dialog with the
Pennsylvania (MHAACP). Burgess conducts outreach to unserved community and establishing a platform of resources to offer the
and underserved minority populations. community.
A large part of Burgess’ job as a community outreach worker is to
be able to gain the trust of those she tries to reach. “You can’t walk n Link existing community services. To keep herself and her com-
into a community with a superior attitude. You have to be able to munity aware of other public services, Burgess meets every other
take information to individuals in the community and relate your life month with other community-based organizations like the Ur-
to theirs,” said Burgess. ban League, health care organizations, and even congressional
Under a grant from the National Mental Health Association’s representatives. Not only does it help Burgess stay abreast of the
(NMHA) National Consumer Supporter Technical Assistance Cen- services available, but it keeps the organizations aware of each
ter, MHAACP is working to create a manual on minority outreach other’s services.
programs that can be replicated by other consumer-supporter orga-
nizations. For more information on Health Link, contact Dr. Jim Cowan,
Some other things to consider when conducting outreach to program director, (704) 638-2907. For more information on Commu-
minority communities: nicating Across Boundaries, contact Cindy Moon, program coordina-
tor, (415) 989-9758. For more information on Denver Health, call
n Conduct a community needs assessment. The Health Link pro- (303) 436-6000. To contact MHAACP, call (412) 391-3820.v
gram in Rowan County, North Carolina, identifies community
needs by holding focus groups and community meetings where Looking for More Information on
resident needs are identified. The program seeks to make African Lay Health Workers?
American families aware of existing services for babies and young Check out these stories, from past issues in
children through age 5. Community volunteers and outreach
Closing the Gap:
workers ‘link’ infants and children to existing services. The pro-
gram also offers free transportation to health and social services
ð Closing the Gap. August 2000 Issue: Lifting the Unequal Bur-
throughout the county.
den of Cancer on Minorities and the Underserved. Page 4. Viet-
namese Women and Cervical Cancer: Lay Health Workers Can Help
n Bring services to the community. Discomfort with western
Change Behaviors. (Publication # 422)
medical practices can make some minority groups, like American
Indians and Alaska Natives reluctant to use ‘mainstream’ medi-
ð Closing the Gap. March 2000 Issue: State Children’s Health
cal services. Terrence Shea, director of community health nurs-
Insurance Program. Page 9. Reaching Rural Communities. Border
ing at Denver Health, a community health service provider in
Vision Fronteriza: Tapping Into Community Workers and Volun-
Colorado worked with the director of a local Native American
teers. (Publication #412)
non-profit group, Native American Cancer Initiatives, Inc., to
learn how to best reach women in the area. To make cancer
Call the Office of Minority Health Resource Center at (800) 444-6472
screening more culturally appropriate, Shea set up screenings in
and ask to speak to an information specialist.
February/March 2001 11 Closing the Gap
Dental Program Brings Latino Values
To California Community
By Beatriz Roppe, Director of Health Promotion at Colaborativo Saber
uesday mornings you will find Imelda Perez in front of a tates working in unison to problem solve issues that affect the com-
group of 10 to 12 mothers waving tooth brushes, dental munity. As members of the target community and its social network,
floss, and a large plastic model of perfect teeth. Imelda will promotoras are ideal individuals to promote health and reach their
talk to the group about the difference between cleaning teeth versus community.
merely brushing. The parents who attend the Sonrisitas program have confianza in
Imelda is one of seven promotoras de salud, or health promoters, the promotoras. Promotoras help change behavior through the Latino
who teaches an eight-week dental health curriculum called Sonrisitas, value of the extended family. Familismo, seeing the family as the
or Little Smiles. The program is part of Colaborativo Saber, a school primary social unit and support system, is an important Latino char-
and community-based organization in San Diego, California. Span- acteristic. The value works to keep parents open to education and
ish-speaking parents, mostly mothers, come to information programs that will assist them in
the Sherman Heights Community Center for keeping the family healthy and well.
the program. After the pláticas, or talks, the par-
ents are better prepared to help their families Curriculum is User-Friendly
and children develop good oral health practices.
As a local resident of the predominantly The Sonrisitas curriculum is user
Latino community, Imelda and her fellow friendly, has a pleasing and professional presen-
promotoras, Hilda, Berta, Angeles, Rosario, and tation. It is written in Spanish for the
Obdulia, are the best individuals to share health promotoras, who are not required to memorize
information with fellow Latinas. Many parents the material. From the precision of the graphics
are monolingual, far from home, confused, and illustrations, to the quality of the paper
frightened, or suspicious of the U.S. medical and the binder, the curriculum values the sen-
and dental systems. Imelda and the other dedi- sibilities of the Latino culture by acknowledg-
cated promotoras understand and live the val- ing the emphasis placed on appearance. The
ues of the community they serve. They are proud of their commu- effort taken to give the materials a professional look reflects the re-
nity and proud of the work they do. Orgullo, or pride, is an important spect the Instituto de Promotoras holds for the promotoras who use
motivator for Latinas and drives the development of the health pro- the materials and the participants who take the materials home to
motion work that goes on in Sherman Heights. share with family and friends.
The curriculum fosters lasting behavior change through role
Culturally Appropriate Care modeling, group activities, skill building, and goal setting. The
Sonrisitas curriculum acknowledges the high degree of family forma-
Sonrisitas is a culturally appropriate program that relies on the tion, structure, and function of Latino households. The curriculum
traditional Latino promotoras model to change behavior and educate accentuates the positive and recognizes that Latinos have healthy
the community about dental health. The model uses the natural habits, including good nutrition practices as well as moderate smok-
support system that exists within the Latino community. It is an ing and drinking habits.
informal system that helps people and families, utilizes existing re- The eight-week, hour-long sessions emphasize family dental
sources as well as alternative sources of support, and is based on health throughout the lifespan. Topics covered include: the primary
confianza (confidence) and respecto (respect). Latinos value interper- teeth and the importance of preventing baby bottle tooth decay;
sonal relationships and turn to individuals to confide in. To assure proper teeth cleaning and the use of dental floss; the basics of nutri-
the success of our promotoras model, the community we serve has to tion and choosing healthy snacks for children; the importance of
respect and have confidence in our promotoras and our messages. sealants and fluoride; and locating and accessing dental resources in
To help ensure success, our promotoras are recruited and edu- the community. In true Latino fashion, the classes conclude with a
cated through Colaborativo Saber’s Instituto de Promotoras. graduation fiesta where the whole family is invited and the partici-
Colaborativo Saber’s dental health program—Sonrisitas—is one of pants receive a diploma!
four projects and was developed and designed with input from For more information on the Sonrisitas program and Colaborativo
promotoras and parents. Working together in a collaborative effort is Saber’s Instituto de Promotoras, on developing a promotora model, or
one attribute of the Latino culture. Colectivismo (working together), on-site training for existing promotoras, contact: Beatriz Roppe, (619)
is associated with high levels of personal interdependence and facili- 225-1032 or e-mail firstname.lastname@example.org
Closing the Gap 12 February/March 2001
End-of-Life Care Issues Need
Culturally Sensitive Approaches
By Houkje Ross
or Carol and Carolyn Bloch, dying with dignity is a right that Health Care Workers Face Moral, Ethical Struggles
needs to be granted to every person facing the end of life—
regardless of race, ethnicity, religion, or socioeconomic status. Health care workers are often confronted with even tougher
The Bloch twins are certified transcultural nurse specialists and moral and ethical issues. “In some cultures, the family may not want
transcultural/diversity consultants for the Los Angeles County De- their family member to know that he or she is dying,” said Carol
partment of Health Services. They teach a class for the county called Bloch. “An Iranian family stayed by their mother’s bedside 24 hours
Transcultural Perspective on Death and Dying. a day to prevent her from finding out she was dying. The family
believed that if the mother knew she was dying she would lose hope
Respecting Cultural Beliefs and die sooner,” said Bloch.
“In these instances, a physician or health care worker may feel a
Not knowing about a patient’s culture, religion, or ritual prac- strong moral or ethical obligation to tell the patient,” said Bloch. But
tices surrounding end-of-life can make already tense and emotional Marjolein Ross, a home health care nurse who specializes in geriatric
situations even more hurtful, according to Carol Bloch. “End of life and end-of-life care says, “It is our job as health care workers to take
issues are ingrained with cultural identity and affiliation,” according care of the patient as best we can, not to judge the family’s decisions.”
to Carol Bloch. Learning what death means for a patient and a family Complicating the issue is a lack of policy regarding these situations.
is an essential part of becoming a culturally competent health care The Bloch twins strongly recommend that hospitals and other health
worker. care organizations establish consent forms regarding end-of-life deci-
Carolyn Bloch recounted the story of an Asian boy who had sion-making. The forms could be similar to living wills, which would
died: Chinese culture dictates that the boy’s body be dressed at the allow a patient to legally give up his or her rights to a family member,
hospital, not at the funeral home. The beliefs of this particular family said the Bloch sisters.
include life after death. The body usually is accompanied by jewelry, Often, end-of-life care can be improved for minority and cul-
personal belongings, and money. A nurse manager came into the turally diverse patients by simply asking what is and is not acceptable
room and told the family they couldn’t dress the boy at the hospital for a family or individual, and finding ways to coordinate a patient’s
due to policy. The family was understandably upset. needs with hospital policy, said Carolyn Bloch. Other things health
There are ways to accommodate cultural beliefs, customs, and care professionals should consider when treating end-of-life patients
traditions, and still work within the boundaries of hospital policies, from ethnically, religiously, or racially diverse backgrounds include:
according to the Blochs. In the situation with the Chinese boy for
example, the Bloch twins suggest that the nurse manager inform the n Being aware of family dynamics when discussing medical care
family that the boy’s body will have to be transported and handled and choices. Health care workers should be aware that in some
by other health care workers and personnel. “Health care workers cultures, the key decision-maker concerning medical treatment
could have suggested to the family that it would be better to dress may not be the patient, so talking with a patient about end-of-
the body at the funeral home, so that the boy’s money or valuables life care medical choices may not be appropriate. “In some cul-
do not get lost or misplaced,” said the Bloch sisters. tures, the patient isn’t even aware of the disease they are suffer-
ing from. Family members make all the decisions regarding treat-
ment,” said Carol Bloch.
Resource Persons Network • Connecting with Communities n Building trust. Some minority groups, such as African Ameri-
cans and Hispanics are distrustful of the health care system due
B oth Bloch sisters are members of the OMHRC Resource
Persons Network, a group of professionals who volunteer
their services in support of the Resource Center’s mission to
to historical events like the Tuskegee Syphilis study (conducted
by the US Public Health Service between 1932 and 1972) or to
improve the health status of racial and ethnic minority groups in fears surrounding immigration status. Taking the time to talk to
the United States. and explain medical treatments and options is an important step
If you have experience working with culturally diverse popula- in establishing trust.
tions, please contact OMHRC today to receive information on join-
ing the Resource Persons Network. 1-800-444-6472 or e-mail
continued on page 14...
February/March 2001 13 Closing the Gap
American Medical Association Bureau of Primary Health Care
515 North State Street Health Resources and Services Administration
Chicago, IL 60610 4350 East-West Highway
(312) 464-5000 Bethesda, MD 20814
http://www.ama-assn.org (301) 594-4100
American Medical Student Association
1902 Association Drive Cross Cultural Health Care Program
Reston, VA 20191 Pacific Medical Clinics
(800) 767-2266 1200 Twelfth Avenue, South
http://www.amsa.org Seattle, WA 98144
American Translators Association http://www.xculture.org
225 Reinekers Lane, Suite 590
Alexandria, VA 22314 Hispanic-Serving Health Professions Schools, Inc.
(703) 683-6100 1411 K Street, NW
http://www.atanet.org Suite 200
Association for Multicultural Counseling and Development (202) 783-5262
5999 Stevenson Avenue http://www.hshps.com
Alexandria, VA 22304
(800) 347-6647 Health Resources and Services Administration
(703) 823-9800 Information Center
http://www.counseling.org 2070 Chain Bridge Road, Suite 450
Vienna, VA 22182-2536
Association of American Medical Colleges 888-ASK-HRSA (888-275-4772)
2450 N Street, NW http://www.ask.hrsa.gov
Washington, DC 20037-1127
(202) 828-0400 Indians Into Medicine (INMED) Program
http://www.aamc.org University of North Dakota School of Medicine
P. O . Box 9037
Association of Clinicians for the Underserved Grand Forks, ND 58202-9037
501 Darby Creek Road, Suite 20 (701) 777-3037
Lexington, KY 40509-1606 http://www.med.und.nodak.edu/dept/inmed/home.htm
Bereavement...from page 13
n Establishing effective communication. n Providing culturally appropriate pub- Lewis. In order to better serve and reach
If a patient is limited-English-proficient, lications and information. According minority communities about hospice
this may make him or her less likely to to Joan Lewis, project director for a Rob- services, Lewis recommends that health
ask questions about a medical diagnosis ert Wood Johnson Foundation grant on care organizations produce materials
or treatment options, according to a end-of-life care at the District of Co- that take into account cultural views.
1999 study Approaches to End-of-Life lumbia Hospital Association, many mi- The Palliative Care Council of South Aus-
Care in Culturally Diverse Communities. norities underutilize hospice services, tralia and Palliative Care Victoria recently
The study was conducted by the Of- which generally thrive in suburban ar- published Multicultural Palliative Care
fice of Ethics and Health Policy Initia- eas and with white patients. “We took a Guidelines. They are available online at
tives, at the Albert Einstein Healthcare look at our publications and noticed that http://www.pallcare.asn.au To contact
Network in Philadelphia. Having an in- the information, including pictures and Carol or Carolyn Bloch, call (213) 240-
terpreter on hand is recommended. presentation, was geared for whites,” said 7710.v
Closing the Gap 14 February/March 2001
Intercultural Cancer Council
PMB - C Publications
n Cultural Competence: A Journey, available from the Bureau of
Houston, TX 77030
Primary Health Care (BPHC), profiles BPHC-supported pro-
grams designed to eliminate financial, geographic, or cultural
barriers to health care. To order, call (800) 400-BPHC or go to
http://www.bphc.hrsa.gov/culturalcompetence/ Ask for publi-
cation number PC546
n Cultural Competence Compendium, available from the Ameri-
National Alliance for Hispanic Health
can Medical Association (AMA), is a 460-page guide designed
1501 16th Street, NW
to help physicians and other health professionals to communi-
Washington, DC 20036
cate with patients and deliver individualized, respectful, pa-
tient-centered care. To place an order contact e-mail Enza
Messineo at email@example.com or call (312) 464-
5333 or (800) 621-8335 or visit http://www.ama-assn.org/
National Center for Cultural Competence
Georgetown University Child Development Center
3307 M Street, NW, Suite 401
n Eliminating Health Disparities in the United States, describes
Washington, DC 20007-3935
the Health Resources and Services Administration’s (HRSA) goal
of 100% access to health care and zero health disparities. It
outlines the Agency’s new strategic direction for obtaining the
goal. It contains detailed information about the Agency’s cur-
National Dental Association
rent and future activities related to health disparities and to the
3517 16th Street, NW
Federal Department of Health and Human Services’ 1998 Ini-
Washington, DC 20010
tiative to Eliminate Racial/Ethnic Disparities in Health. To or-
der, call toll-free (888) ASK-HRSA or go to http://
www.hrsa.dhhs.gov/OMH/OMH/disparities/ Ask for publica-
tion number HRS00167.
National Hispanic Medical Association (NHMA)
1411 K Street, N.W. Suite 200
n A National Agenda for Nursing Workforce Racial / Ethnic
Washington, DC 20005
Diversity presents issues related to racial/ ethnic diversity in
nursing education and practice and recommends goals and ac-
tions that can serve as national agenda to be undertaken to
address those issues. Report points out the need to have a cultur-
National Indian Health Board
ally diverse workforce to meet the health care needs of our
1385 South Colorado Blvd., Suite A-707
country’s population. To order, call toll-free (888) ASK -HRSA
Denver, CO 80222
or go to http://www.ask.hrsa.gov/training.cfm?content=training.
Ask for publication number BHP00082.
n Policy Brief 3 Cultural Competence in Primary Health Care:
National Medical Association (NMA)
Partnerships for a Research Agenda, Summer 2000 and Policy
1012 Tenth Street, NW
Brief 2 Linguistic Competence In Primary Health Care Deliv-
Washington, DC 20001
ery Systems: Implications for Policy Makers, January 2001 are
just two of several cultural competence-specific publications avail-
able from the National Center for Cultural Competence at
Georgetown University. To order, call (800) 788-2066 or go to
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F HHH Bldg.
Washington, DC 20201 For a list of journal articles on cultural competency,
(800) 368-1019 call the OMH Resource Center at 800-444-6472.
February/March 2001 15 Closing the Gap
DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of Public Health and Science
Office of Minority Health Resource Center PRSRT STD
P.O. Box 37337 POSTAGE AND FEES PAID
Washington DC 20013-7337 DHHS/OPHS
PERMIT NO. G-280
Penalty for Private Use $300
Closing the Gap
April 19-21: American Indian Nursing Edu- May 5:"HIV/AIDS In The African American May 16-17: "Mind Body and Spirit” - the
cation Conference. Salish Kootenai College, Community!" - the Brothers Fifth Annual 6th Annual Conference of The Center On Eth-
Pablo, MT. For more information, contact Health Issue Series Conference. Decatur c n rt i , nc Holiday Inn, City
ni & M i o iyAgng I .
Sandi Ovitt at 406-675-4800 ext.343 or e- Holiday Inn Hotel and Conference Plaza, Line Avenue, Philadelphia, PA. For more
mail firstname.lastname@example.org Decatur, GA. For more information, con- information, contact Dr. Norma D. Thomas
tact Don Speaks at (404) 778-5433 or visit Widner at (610) 499-1133 or e-mail
April 27-29: Voices from the Community: http://www.minority-health.org/ Norma.D.Thomas@widener.edu University
Building Community Readiness to Improve Center for Social Work Education.
Asian American and Pacific Islander Health. May 5 - 8: Health for All in 2010: Confirm-
Sponsored by the Asian & Pacific Islander ing Our Commitment -Taking Action. Spon- June 18-22: 7th Annual Summer Public
American Health Forum. Hotel Sofitel San sored by the National Community-Campus Health Research Videoconference on Minority
Francisco Bay. Redwood, CA. Contact: Partnerships for Health (CCPH) at the Cen- Health. Sponsored by The Minority Health
APIAHF (415) 954-9988. ter for the Health Professions at the Univer- Project, University of North Carolina at
sity of California, San Francisco. Westin Chapel Hill. For more information, go to
Riverwalk Hotel, San Antonio, TX. For a http://www.minority.unc.edu or e-mail
registration brochure, call CCPH's fax-on- Minority_Health@unc.edu
demand service at 1-888-267-9183 and se-
lect document #203. Or call Jane Stahl at
Closing the Gap 16 February/March 2001