Transforming
the Face of Health Professions Through Cultural
& Linguistic Competence Education:
The Role of the HRSA Centers of Excellence
Chapter 10: Resources
The field of cultural and linguistic competence
in health care has undergone extensive development
in the last decade and a half. As a result,
a number of curricular approaches and models
have been tried, many with excellent success,
as pedagogical strategies. Additionally, the
number of tools available to curriculum designers,
such as video case studies, Web-based training
modules, and culturally sensitive patient assessments,
has greatly expanded. Websites and training
centers are devoted to cultural and linguistic
competence in health care, and extensive bibliographies
have been compiled to aid in the integration
of cultural factors into course content. In
this chapter is a list of what the Expert Team
considers the best of these materials and tools.
Section I looks at the tremendous amount of
public and professional support that has been
given to the issues surrounding cultural and
linguistic competencies in health care. Section
II provides a wealth of information on the types
of approaches that have been used in creating
courses and curricula on the topic, including
specific courses and curricular offerings, Web-based
modules, and patient assessments. Section III
provides assessment tools and criteria for personal,
organizational, and curricula evaluation. Section
IV lists excellent audiovisual resources that
have been designed to enhance cultural and linguistic
competency curricula. Section V directs the
curriculum designer to specific Websites providing
tools, discussion materials, and ongoing and
current topics on related issues. Section VI
lists a number of educational and training centers
that devote attention to cultural and linguistic
competency subject matter and training programs.
Finally, Section VII is a compilation of bibliographies
that address both broad and specialized epidemiological,
diagnostic, and treatment issues in diverse
populations. This section is useful in integrating
culture-specific information into course material.
Since the resources are extensive, curriculum
and course designers may wish to first browse
these sections, noting entries that appear to
best suit their specific educational purposes
before delving more deeply during subsequent
readings.
I. Professional and Public Support for
Cultural Competence Education in the Health
Professions
In this section, the reader is directed to
specific statements and materials from the health
professions and public policy-making bodies
that endorse the need for cultural and linguistic
competence education and culturally and linguistically
competent health care practice. Statements such
as these help make the case for cultural and
linguistic competence education as an accepted
aspect of quality health care that are useful
for discussing these issues with administrators,
those in charge of curriculum content or resource
allocation, and any other professionals who
have not been persuaded as to the importance
of cultural and linguistic competence education
in the health professions. It is recommended
that curriculum designers first become familiar
with these key materials before embarking on
a program to implement cultural and linguistic
competence education. In many cases, links to
Websites are provided.
A. Standards and Policies of Accreditation
Agencies and Professional Organizations.
1. Accreditation Council for Graduate Medical
Education Outcome Project: General Competencies.
www.Outcomes@acgme.org
Professionalism is made up of the following:
1) A commitment to carrying out professional
responsibilities, adherence to ethical principles
and sensitivity to a diverse population; and
2) Sensitivity and responsiveness to patients’
culture, age, gender, and disabilities.
2. 1998 Association of American Medical Colleges.
Teaching and Learning of Cultural Competence
in Medical School. Contemporary Issues in Medical
Education, Feb.; Vol. 1(5). Division of Medical
Education, AAMC, Washington, D.C.
www.aamc.org
3. Liaison Committee on Medical Education.
Standard on Cultural Diversity. Full text of
LCME Accreditation Standards (from Functions
& Structure of a Medical School, Part 2).
www.lcme.org
Faculty and students must demonstrate an understanding
of the manner in which people of diverse cultures
and belief systems perceive health and illness
and respond to various symptoms, diseases, and
treatments. Medical students should learn to
recognize and appropriately address gender and
cultural biases in health care delivery, while
considering first the health of the patient.
4. 2001 American Academy of Family Physicians
(AAFP). Cultural Proficiency Guidelines. The
guidelines were approved by the AAFP Board of
Directors in March 2001. For more information,
contact AAFP at 11400 Tomahawk Creek Parkway,
Leawood, KS 66211 or call (913) 906-6000. Website:
www.aafp.org.
The AAFP believes in working to address the
health and educational needs of our many diverse
populations. A list of issues to consider in
preparing informational or continuing medical
education material and programs has been developed
to ensure cultural proficiency and to address
specific health related issues as they relate
to special populations of patients and providers.
5. 2001 American College of Emergency Physicians.
Cultural Competence and Emergency Care. Approved
by the ACEP Board of Directors, October. For
more information, contact ACEP at 1125 Executive
Circle, Irving, TX 75038-2522 or call (800)
798-1822. www.acep.org
The American College of Emergency Physicians
believes that quality health care depends on
the cultural competence as well as the scientific
competence of physicians. It also believes that
cultural competence is an essential element
of the training of health care professionals.
6. 1998 The American College of Obstetricians
and Gynecologists (ACOG) Committee on Health
Care for Underserved Women. Committee Opinion,
No. 201, March. Copyright Clearance Center,
Danvers, MA 01923. Call (978) 750-8400. For
more information, contact ACOG at 409 12th Street,
SW, PO Box 96920, Washington, D.C. 20090-6920.
www.acog.org
Culture and Health Care
During every health care encounter, the culture
of the patient, the culture of the provider,
and the culture of medicine converge and affect
the patterns of health care utilization, compliance
with recommended medical interventions, and
health outcomes.
7. The American Dentistry Association. http://www.ada.org
The ADA is “committed to reducing health
disparities by supporting initiatives that broaden
access to dental care for people who otherwise
cannot afford it and encourages more dentists
to practice in designated underserved areas.”
As part of its core values, or Guiding Lights,
the ADA Foundation “…embraces diversity
and cultural competency as essential components
in its programs, partnerships, and coalition
activities.”
8. The American Association of Pediatric Dentists
“AAPD values the diversity of children,
their families, and their communities and respects
the contribution of culture to the attainment
of oral health and use of dental services.”
9. 1999 The American Medical Association. Cultural
Competence Initiative: Cultural Competence Compendium.
Guide and resources for cultural competence
in medicine. www.ama-assn.org
10. The American Medical Student Association.
www.amsa.org
Cultural competency is “a set of academic
and personal skills that allow us to increase
our understanding and appreciation of cultural
differences between groups.” Becoming
culturally competent is a developmental process.
11. American Nurses Association. Position Statements:
Cultural Diversity in Nursing Practice. http://www.nursingworld.org/readroom/position/ethics/etcldv.htm
Knowledge of cultural diversity is vital at
all levels of nursing practice. Ethnocentric
approaches to nursing practice are ineffective
in meeting health and nursing needs of diverse
cultural groups of clients. Knowledge about
cultures and their impact on interactions with
health care is essential for nurses, whether
they are practicing in a clinical setting, education,
research or administration.
12. 1990 American Psychological Association.
Guidelines for Culturally Diverse Populations:
APA Guidelines Approved by the APA Council of
Representatives in August. For more information,
write to 750 First Street, NE, Washington, DC
20002. Tel. (202) 336-5500. www.apa.org/pi/guide
13. 2002 American Psychological Association.
Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change
for Psychology. www.apa.org/pi/multiculturalguidelines/pdf
14. 1999 Committee on Pediatric Workforce and
the American Medical Association Advisory Committee
on Minority Physicians. Culturally Effective
Pediatric Care: Education and Training Issues.
American Academy of Pediatrics, Jan; Vol. 103
(1): 167-170.
This policy statement defines culturally effective
health care and describes its importance for
pediatrics. The statement also defines cultural
effectiveness, cultural sensitivity, and cultural
competence and describes the importance of these
concepts for training in medical school, residency
and continuing medical education curricula.
15. Society for the Teachers of Family Medicine.
Core curriculum guidelines on culturally sensitive
and competent health care. These are recommendations
that can be used to help train family physicians
to provide culturally sensitive and competent
health care. http://www.stfm.org/corep.html
16. Society for Public Health Education (SOPHE).
Code of Ethics for the Health Education Profession.
http://www.sophe.org/ (click on “About
SOPHE” and then click “Ethics.”
By acknowledging the value of diversity in
society and embracing a cross-cultural approach,
the Society for Public Health Educators supports
the worth, dignity, potential, and uniqueness
of all people.
B. Standards, Policies, and Related Reports
of Public and Private Policy-making Agencies
and Organizations.
1. Culturally and Linguistically Appropriate
Services in Health Care (CLAS Standards). U.S.
Department of Health and Human Services, Office
of Minority Health. www.omhrc.gov/clas/finalcultural1a.htm
This policy statement provides Federal guidance
to health care organizations on providing culturally
and linguistically appropriate patient care.
2. State of New Jersey Senate bill 144; Assembly
Bill 492, signed into law on March 23, 2005.
This law requires cultural competence training
for licensure and relicensure to practice medicine
in New Jersey. Additional information about
the bill can be obtained at the New Jersey Legislature
Website: http://www.njleg.state.nj.us.
"Cultural awareness and cultural competence
are essential skills for providing quality health
care to a diverse patient population….
The public interest in providing health care
to all segments of society dictates the need
for a formal requirement that medical professionals
be trained in the provision of culturally competence
health care as a condition of licensure to practice
medicine in New Jersey."
3. 2000 Guidance on the Mandated Provision
of Language Service in Health Care. Department
of Health and Human Services Office of Civil
Rights www.hhs.gov/ocr/lep/revisedlep.html
4. 2000. White House. Executive Order: Improving
Access to Services for Persons with Limited
English Proficiency. Federal Register, 65 (159):
50121-50122.
5. 2003 Ensuring Linguistic Access in Health
Care Settings: Legal Rights and Responsibilities.
National Health Law Program (NheLP). www.healthlaw.org
6. 2002. Principles and Recommended Standards
for the Cultural Competence Education of Health
Care Professionals The California Endowment.
Guidelines for curricular content, pedagogy,
evaluation. www.calendow.org
7. 1998 Cultural Competence Standards in Managed
Care Mental Health Services: Four Underserved/Underrepresented
Racial/Ethnic Groups. Western Interstate Commission
for Higher Education (WICHE). Center for Mental
Health Services, Substance Abuse and Mental
Health Services Administration; U.S. Department
of Health and Human Services.
www.wiche.edu/MentalHealth?Cultural_Comp/ccslist.htm
8. 2002 Unequal Treatment. Confronting Racial
and Ethnic Disparities in Health care. Institute
of Medicine. Washington, D.C. National Academy
Press. www.nap.edu
“Sociocultural factors are critical to
the medical encounter, yet cross-cultural curricula
have been incorporated into undergraduate, graduate,
and continued health professions only to a limited
degree…” in Chapter 6, Interventions:
cross-cultural education in the health professions.
9. 2004 Missing Persons: Minorities in the Health
Professions. A Report of the Sullivan Commission
on Diversity in the Health care Workforce. www.sullivancommission.org
“There is an unbalance in the makeup
of the Nation’s physicians, dentists,
and nurses. This imbalance contributes to the
gap in health status and impaired access to
health care experienced by a significant portion
of our population.”
II. Curricular Strategies and Approaches
Used in the Teaching of Cultural and Linguistic
Competencies to Health care Professionals
Work in the area of cultural competence curriculum
design for health professionals has been ongoing
for several years at various medical, nursing,
and pharmacy schools, and residency programs.
Lessons have been learned and innovative techniques
have proven to be successful. This section provides
specific information on different types of curricular
activities used in educating health care professionals
about cultural competency. Section A contains
articles and books in which health care professionals,
professors, and trainers discuss different approaches,
techniques, and curricular content that they
have used in cultural and linguistic competency
education. Also included are seminal works on
cultural competency. Section B contains Web-based
curricular programs and modules.
A. Articles and Books
(Note: There are now thousands of articles
on cultural competency as it relates to treatment
modalities and the needs of specific populations.
The references below are focused mainly on the
pedagogy of cultural competence training for
the health care professions.)
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Carolinas Medical Center, Charlotte, North Carolina.
2. 2004 American Journal of Managed Care, 10(SP),
September. Theme Issue – Health care Disparities.
3. 2003 American Journal of Public Health,
93(2). Theme-Issue – Racial/Ethnic Bias
in Health Care.
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Note that this entire issue of Academic Medicine
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83. 1999 Mezzich, J.E., Kirmayer, L.J., Kleinman,
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84. 1996 Mezzich, J.E., Kleinman, A., Fabrega,
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87. 1982 Ness, R.C. Medical Anthropology in
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89. 1997 Novins, D.K., Bechtold, D.W., Sack,
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90. 2000 Nunez, A.E. Transforming Cultural
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91. 2002 Office of Minority Health, U.S. Department
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94. 2000 Paniagua, F.A. Culture-bound Syndromes,
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95. 1989 Pedersen, P. A Handbook for Multicultural
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96. 1992 Pico, E., Wimbley, M., & Wells,
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97. 2003. Physicians for Human Rights. The
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98. 1986 Poulton, J., Rylance, G.W., &
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100. 2003 Purnell, E.C. & Paulanka, B.
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105. 2004 Satterfield, J.M., Mitteness, L.S.,
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106. 1996 Shapiro, J. & Lenahan, P. Family
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107. 2002 Smedley, B.D., Stith, A.Y., &
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Racial and Ethnic Disparities in Health care.
Institute of Medicine. Washington, D.C.: National
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or www.amazon.com.) This critical book is
accompanied by a CD-ROM with several useful
articles.
108. 1994 Stein, T.S. A Curriculum for Learning
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109. ND Streeter, R., Campa, D., & McDiarmid,
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121. 2000 Yeo, G. Ed. Core Curriculum in Ethnogeriatrics.
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B. Web Accessible Cultural Competence
Curricular Modules for Health Care Professionals
These easily accessible teaching modules and
curricula designed by health care professionals
can be used to augment curriculum or in “blended”
(such as face-to-face and distance learning)
training programs. Curriculum designers should
familiarize themselves with the approaches used
in these modules to determine how they might
best be integrated into the overall curriculum.
1. American Medical Student Association. Promoting,
Reinforcing and Improving Medical Education
Culture and Diversity Curriculum, One Year Model
Curriculum, Topics and Core Competencies. Can
be downloaded. Contains useful resource material.
www.amsa.org/programs/diversitycurriculum.cfm
2. 2004 Betancourt, J.R, Green, A.R., &
Carrillo, J.E. Quality Interactions: A Patient-Based
Approach to Cross-Cultural Care. This is an
e-learning, case-based, interactive course,
carrying CME credits. Cost per student depends
on number of students.
www.criticalmeasures.net/mccg/
3. The Center for the Health Professions at
University of California, San Francisco offers
several learning modules based on Toward Culturally
Competent Care: A Toolbox for Teaching Communication
Strategies, a 170-page curriculum focused on
teaching clinicians to recognize cultural differences
in patient interactions and use specific skills
to improve patient care. The toolbox costs $75.
Included among the learning modules in the toolbox
are:
• Cultural Competence in Pharmaceutical
Care Delivery
• Cultural Competence Training Template
• An Outline for a Half Day Cultural Competency
Training Program
This manual can be ordered at http://www.futurehealth.ucsf.edu/cnetwork/resources/curricula/diversity.html.
4. The Office of Minority Health offers The
Cultural Competency Curriculum Modules for Physicians
within “A Family Physician's Practical
Guide to Culturally Competent Care.” These
modules carry nine hours of CME credit with
AMA/AAFP. www.cultureandhealth.org.
5. Cultural Positivity: Cultural Competence
in Health care. A Diversity and Cross-Cultural
Teaching Module for the Internet. Detailed teaching
guide for family practice residents and preceptors.
www.gvhc.org/cultural/pod’s_online.htm
6. Provider's Guide to Quality and Culture.
A web-based training on health care quality
and culture, developed by the Health Resources
and Services Administration.
http://erc.msh.org/quality&culture
7. Virtual Lecture Hall. CME web-based course
by Randa Kutob, MD, Department of Family Medicine,
University of Arizona. Culturally Effective
Care. Diabetes/Cultural Competency with patient
education materials and references. Case-based
skill building. www.vlh.com/shared/courses/course_info.cfm?courseno=1786
C. Cross-Cultural Patient Assessment
These resources discuss and model how to conduct
a variety of patient assessments while taking
cultural factors into consideration.
1. 1995 Campinha-Bacote, J. The Quest for Cultural
Competence in Nursing. Nursing Forum, 30(4):
19-25.
2. 2002 Committee on Cultural Psychiatry. Cultural
Assessment in Clinical Psychiatry. Group for
the Advancement of Psychiatry, Report No. 145.
Washington, DC: American Psychiatric Publishing,
Inc.
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Patient Assessment: A Method of Advancing Dental
Care. The Dental Assistant, 67(6): 34-43.
4. 1991 Giger, J. & Davidhizer, R. Transcultural
Nursing Assessment and Intervention. St. Louis:
CV Moseby.
5. 2002 Group for the Advancement of Psychiatry.
Cultural Assesesment in Clinical Psychiatry,
Washington, D.C.: American Psychiatric Press.
6. 1999 Huff, R.M. & Kline, M.V. The Cultural
Assessment Framework. In R.M. Huff and M.V.
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Oaks, Calif.: Sage.
7. 1995 Leininger, M. Culture Care Assessment
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McGraw-Hill.
8. 1988 Like, R.C., Rogers, J., and McGoldrick,
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9. 1995 Lu, F.G., Lim, R.F., Mezzich, J.E.
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M. (eds.) Review of Psychiatry, 14: 477-510
III. Tools for Assessing Cultural Competence
Cultural competence assessment tools fall into
three categories: evaluation of the individual
clinician’s cultural competencies, evaluation
of a health care organization or service delivery
program, and evaluation of training programs.
Curriculum planners can examine the criteria
for clinician cultural competence in Section
A below to determine the hoped-for characteristics
of a culturally competent clinician. Section
B looks at how the cultural competence of health
care organizations, such as hospitals or clinics,
might be assessed. Section C contains tools
for assessing training programs. See above for
culturally sensitive patient assessments.
A. Clinical or Personal Assessments
1. 2002 Campinha-Bacote, J. Inventory for Assessing
the Process of Cultural Competence Among Health
care Professionals-Revised (IAPCC-R). Transcultural
C.A.R.E. Associates: Cincinatti, OH. Contact
Dr. J. Campinha-Bacote at www.transcultural.net
2. 2004 Clinical Cultural Competency Questionnaire
in Like, R.C., Fulcomer, M.C., Kairys, J.A.,
Wathington, K.D., & Crosson, J. Final Report
Assessing the Impact of Cultural Competency
Training Using Participatory Quality Improvement
Methods, Aetna 2001 Quality Care Research Fund/Aetna
Foundation, April 30, 2004 (additional information
available from the Center for Healthy Families
and Cultural Diversity, Department of Family
Medicine, University of Medicine and Dentistry
at New Jersey – Robert Wood Johnson Medical
School, New Brunswick, New Jersey, http://www2.umdnj.edu/fmedweb/chfcd/index.htm).
3. 1992 Bhawuk, D.P.S., Brislin, R. The Measurement
of Intercultural Sensitivity Using the Concepts
of Individualism and Collectivism. InterNational
Journal of Intercultural Relations, 16:413-36.
For more information, contact Dr. R. Brislin
at 808-944-7111.
4. 1993 Child Welfare League of America. Cultural
Competence Self-Assessment Instrument. Washington,
D.C. For more information, contact Jean Tucker
Mann at the National Task Force on Cultural
Competency of the CWLA, Inc. at 440 First Street,
NW, Suite 310, Washington, DC 20001 or call
202-638-2952.
5. 1996 Culhane-Pera, K.A. Ethnosensitivity
in Medicine Questionnaire with Key. Department
of Family and Community Medicine, St. Paul Ramsey
Medical Center. For more information, contact
K. Culhane-Pera at kathiecp@yahoo.com
or 651-602-7565.
6. ND Culhane-Pera, K.A. Five Levels of Cultural
Competency in Medicine and Self-Evaluation of
Five Levels of Cultural Competence. Ramsey Family
and Community Medicine Residency, St. Paul Ramsey
Medical Center. For more information, contact
K. Culhane-Pera at kathiecp@yahoo.com
or 651-602-7565.
7. 1991 D’Andrea, M., Daniels, J., Heck,
R. Multicultural Awareness-Knowledge-and-Skills
Survey (MAKSS). Journal of Counseling and Development,
70:143-50.
8. 2004 Duffy, F.D., Gordon, G.H., Whelan,
G., Cole-Kelly, K., Frankel, R., Buffone, N.,
Lofton, S., Wallace, M., Goode, L., Langdon,
L., and Participants in the American Academy
of Physician and Patient's Conference on Education
and Evaluation of Competence in Communication
and Interpersonal Skills. Assessing Competence
in Communication and Interpersonal Skills: the
Kalamazoo II Report. Academic Medicine, 79(6):
495-507.
9. 2002 Epstein, R.M. and Hundert, E.M. Defining
and Assessing Professional Competence. Journal
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10. 1994 Family and Youth Services Bureau,
U.S. Department of Health and Human Services.
Cultural Competency Administration Self-Assessment.
For more information, write to the Administration
for Children and Families, 370 L’Enfant
Promenade, SW, Washington, DC, 20201.
11. 2000 Goode, T. Promoting Cultural and Linguistic
Competency. Self-Assessment Checklist for Personnel
Providing Primary Health Care Services. National
Center for Cultural Competence, Georgetown University,
Washington, D.C. www.gucdc.georgetown.edu/nccc/ncc11.html
12. N.D. Harvard University. Implicit Association
Test. Deals with unconscious bias and categorization.
www.implicit.harvard.edu/implicit/demo/index.jsp
13. 1991 Ho, M.K. Use of Ethnic-Sensitive Inventory
(ESI) to Enhance Practitioner Skills with Minorities.
Journal of Multicultural Social Work, 1(1):
57-67.
14. 1999 Jeffreys, M.R. Construct Validation
of the Transcultural Self-Efficacy Tool. Journal
of Nursing Education, 38(5): 222-7.
15. 1991 LaFromboise, T.D, Coleman, H.L.K,
& Hernandez, A. Development and Factor Structure
of the Cross-Cultural Counseling Inventory-Revised.
Professional Psychology: Research and Practice,
Vol. 22:380-8. For further information, contact
T. LaFromboise at Stanford University, Counseling
and Psychological Services at 606 Campus Drive,
Stanford, CA 94305 or call 415-723-1202. Email:
lafrom@leland.stanford.edu.
16. 1995 Mason, JL. Cultural Competence Self-Assessment
Questionnaire: A Manual for Users. Portland,
OR: Research and Training Center on Family Support
and Children’s Mental Health, Portland
State University. For more information, contact
J. Mason at Portland State University, Graduate
School of Social Work, 5914 N. Commercial Avenue,
Portland, OR 97217 or call (503) 287-7260.
17. 1997 National Public Health & Hospital
Institute. Self-Assessment of Cultural Competence.
Washington, D.C. For more information, contact
D. Andrulis at NPHHI at 1212 New York Avenue,
NW, Suite 800, Washington, DC 20005 or call
202-408-0229.
18. 1997 Ponterotto, J.G. Multicultural Counseling
Knowledge and Awareness Scale (MCKAS). New York,
NY. For further information, contact J. Ponterotto
of the Division of Psychological & Educational
Services at Fordham University at Lincoln Center,
113 W 60th Street, New York, NY 10023 or call
212-636-6480.
19. N.D. Ponterotto, J.G. Quick DiscrimiNation
Index (QDI). New York, NY. For further information,
contact Joseph Ponterotto of the Division of
Psychological & Educational Services at
Fordham University at Lincoln Center, 113 W
60th Street, New York, NY 10023 or call 212-636-6480.
20. 1992 Ramer, L. Nursing Issues for the 21st
Century-Module 1: Culturally Sensitive Caregiving
and Childbearing Families. Further information
can be obtained from: Education & Health
Promotion Department, March of Dimes Birth Defects
Foundation, 1275 Mamaroneck Avenue, White Plains,
NY 10605.
21. 2003 Rew, L., Becker, H., Cookston, J.,
Khosropour, S., & Martinez, S. Measuring
Cultural Awareness in Nursing Students. Journal
of Nursing Education, 42(6): 249-257.
22. 1998 Robins, L.S., Alexander, G.L.,Wolf,
F.M., Fantone, J.C., & Davis, W.K. Development
and Evaluation of an Instrument to Assess Medical
Students’ Cultural Attitudes. Journal
of American Medical Women’s Association,
53(3, Supplement): 124-7.
23. 2001 Robins, L.S., White, C.B., Alexander,
G.L., Gruppen, L.D., & Grum, C.M. Assessing
Medical Students’ Awareness of and Sensitivity
to Diverse Health Beliefs Using a Standardized
Patient Station. Academic Medicine, 76: 76-80.
24. 2005 Schirmer, J.M., Mauksch, L., Lang,
F., Marvel, M.K., Zoppi, K., Epstein, R.M.,
Brock, D., and Pryzbylski, M. Assessing Communication
Competence: A Review of Current Tools. Family
Medicine, 37(3): 184-92.
25. 1994 Sodowsky, G.R., Taffe, R.C., Gutkin,
T.B., & Wise, S.L. Development of the Multicultural
Counseling Inventory: A Self-Report Measure
of Multicultural Competencies. Journal of Counseling
Psychology, 41(2): 137-8.
26. 1998 Tirado, M. Tools for Monitoring Cultural
Competence in Health Care; The Health Plan Audit;
Health Plan Administrator Survey. Monitoring
the Managed Care of Culturally and Linguistically
Diverse Populations. Health Resources and Services
Administration, Center for Managed Care. Contact:
National Clearinghouse for Primary Care Information
at primarycare@circsol.com
or call 800-400-2742.
B. Assessing the Cultural Competence of Organizations
That Deliver Health care Services
1. 2000 Abernethy, A., Baars, L., Luu, Q.,
Hong, J., Olivares, T., & Ruiz, L. Culturally
Competent Assessment and Treatment Planning
Curriculum. Monroe County, Rochester, N.Y.
2. 2002 Anderson, C.C. (Mike) & Anderson,
M.P.A. Linguistically Appropriate Access and
Services: An Evaluation and Review for Health
care Organizations. Working Paper Series, Vol.
6, The National Council on Interpreting in Health
Care. http://www.ncihc.org.
3. 1999 Andrulis, D., Delbanco, T., Avakian,
L., & Shaw-Taylor, Y. The Cultural Competence
Self-Assessment Protocol. February; A Publication
of the National Public Health and Hospital Institute,
Washington, D.C. Project Support: The Robert
Wood Johnson Foundation. Contact: Gartrell Wright
at 718-270-7727 or email gartrell.wright@downstate.edu.
4. 1999 Aponte, C. Cultural Competence: Self-Assessment
Survey. Western Region of New York State, New
York State Office of Mental Health.
5. 2004 Beach, M.C., Lead Investigator. Strategies
for Improving Minority Health care Quality.
Summary, Evidence Report/Technology Assessment
No. 90 (Prepared by the Johns Hopkins University
Evidence-Based Practice Center, Baltimore, MD)
AHRQ Publication No. 04-E008-01. Rockville,
Md. Call AHRQ Clearninghouse: 800-358-9295.
http://www.ahrq.gov/clinic/epcsums/minqusum.pdf.
6. 2001 California Pan-Ethnic Health Network.
Diverse Patients, Disparate Experience: The
Use of Standardized Patient Satisfaction Surveys
in Assessing the Cultural Competence of Health
Care Organizations. California Health care Foundation,
Oakland, CA. www.chcf.org.
7. 1993 The Child Welfare League of America,
Inc. Cultural Competence Self-Assessment Instrument.
For more information, contact the CWLA Publications
Department at: 440 First Street, NW, Suite 310,
Washington, D.C. 20001-2085.
8. 1991 Cross, T. The Northwest Indian Child
Welfare Association, Inc. Organizational Self-Study
on Cultural Competence. Portland, OR. For more
information, contact T. Cross at The National
Indian Child Welfare Association located at
3611 SW Hood Street, Portland, OR 97201 or call
503-222-4040.
9. 1994 Family and Youth Services Bureau, U.S.
Department of Health and Human Services. Cultural
Competence Self-Assessment: Staff Survey.
10. 1991 Isaacs, M.R. & Benjamin, M.P.
Screening Survey for Culturally Competent Agency/Program.
Towards a Culturally Competent System of Care
Volume II: Programs Which Utilize Culturally
Competent Principles. Washington, DC: CASSP
Technical Assistance Center. For more information,
contact the National Center for Cultural Competence,
Georgetown University Medical Center, Child
Development Center at: 3307 M Street, NW Suite
401, Washington, DC 20007 or call 202-687-5387.
11. 2002 The Lewin Group, Inc. Indicators of
Cultural Competence in Health Care Delivery
Organizations: An Organizational Cultural Competence
Assessment Profile. Washington, D.C. Prepared
for The Health Resources and Services Administration,
U.S. Department of Health and Human Services.
To view this report, visit the HRSA Website,
under Minority Health at www.hrsa.gov/omh.
12. 1995 Mason, J. & Williams-Murphy, T.
Cultural Competence Self-Assessment Questionnaire:
A Manual for Users. Research and Training Center
on Family Support and Children’s Mental
Health; Regional Research Institute for Human
Services; Graduate School of Social Work, Portland
State University, P.O. Box 751, Portland, OR
97207-0751 or call 503-725-4040.
13. 1998 Missouri Department of Mental Health
and the Missouri Institute of Mental Health.
Cultural Competence Self-Assessment Tool. For
further information, contact James Topolski,
Ph.D., at University of Missouri–Columbia,
School of Medicine, 5400 Arsenal Street, St.
Louis, MO 63139; or call 314-644-8657 or email:
mimhjt@showme.missouri.edu.
14. 1995 Myers, L.J. Culturally Competent Service
Outcomes Assessment Tools: Guidelines for Upgrading
Quality Assurance. Ohio Department of Mental
Health, Consumer Services Department.
15. ND National Maternal and Child Health Resource
Center on Cultural Competency, Texas Department
of Health. Journey Towards Cultural Competency:
Lessons Learned. Contact: Don Lawson 512-458-7111.
16. 1998 The New York State Office of Mental
Health; The Research Foundation of New York
State; The Center for the Study of Issues in
Public Mental Health; Substance Abuse and Mental
Health Services Administration, Center for Mental
Health Services. Cultural Competence Performance
Measures for Managed Behavioral Health care
Programs.
17. 2002 Siegel, C., Haugland, G., & Chambers,
E. Cultural Competency in Mental Health Systems
of Care: Selection and Benchmarking of Performance
Measures. The New York State Office of Mental
Health, Nathan S. Kline Institute for Psychiatric
Research, Center for the Study of Issues in
Public Mental Health.
18. 1996 Roizner, M. A Practical Guide for
the Assessment of Cultural Competence in Children’s
Mental Health Organizations. The Technical Assistance
Center for the Evaluation of Children’s
Mental Health Systems at Judge Baker Children’s
Center at 295 Longwood Ave., Boston, MA 02115
or call 617-232-8390.
19. 1997 Saldaña, D. Cultural Competency
Scorecard for Mental Health Facilities (Pilot
Instrument). Development of a Cultural Competency
Scorecard for Mental Health Facilities: Paper
presented at the Seventh Annual National Conference
on State Mental Health Agency Services Research
and Program Evaluation. For further information,
contact Dr. Delia Saldaña with the Department
of Psychiatry at the University of Texas Health
Science Center at 7703 Floyd Curl Drive, San
Antonio, TX 78284 or call 210-531-7918. Email:
saldana@uthscsa.com
20. 1998 Tirado, M. Tools for Monitoring Cultural
Competence in Health Care; The Health Plan Audit;
Health Plan Administrator Survey. Monitoring
the Managed Care of Culturally and Linguistically
Diverse Populations. Health Resources and Services
Administration, Center for Managed Care. Contact:
National Clearinghouse for Primary Care Information
at primarycare@circsol.com
or call 800-400-2742.
21. 1996 Weiss, Carol; Minsky, Shula. Program
Self-Assessment Survey for Cultural Competence:
A Manual. New Jersey Division of Mental Health
and Hospitals. Trenton, NJ. For more information,
contact Carol Weiss with the Department of Human
Services, Division of Mental Health Services,
50 East State Street, P.O. Box 727, Trenton,
NJ 08625-0727 or call 609-777-0821. Email: cweiss@dhs.state.nj.us.
20. 1998 Western Interstate Commission on Higher
Education (WICHE). Cultural Competence Report
Card Items, Jan. Boulder, CO. For further information,
contact WICHE Mental Health Program at P.O.
Box 9752, Boulder, CO 80301 or call 303-541-0258.
Website: www.wiche.edu.
C. Tools to Evaluate Cultural Competence Curricula
1. 2004 American Association of Medical Colleges
a Tool for the Development of Cultural Competence
Training (TACCT). This document should be available
after March 2005 (contact ddanoff@aamc.org).
2. 2003 Pena-Dolhun, E., Munoz, C., & Grumback,
K. Cross-Cultural Education in U.S. Medical
Schools: Development of an Assessment Tool.
Academic Medicine, 78 (6): 615-622.
3. 2003 Crandall, S.J., George, G., Marion,
G.S. & Davis, S. Applying Theory to the
Design of Cultural Competency Training for Medical
Students: A Case Study. Academic Medicine, 78:
588-594. Contains evaluation material.
IV. Audio-Visual Resources
Next to an actual in-person clinical encounter,
well-constructed video case studies can promote
many teachable moments and foster in-depth discussion.
Fortunately, several organizations have developed
a number of high quality case-based videos that
can richly augment curricula focused on cultural
competence education. The videos deal with subject
matter that is clinically relevant to different
practice specialties and specific issues encountered
in patient care. The videos are accompanied
by training manuals and resource materials that
make it easy for the educator to adapt them
to specific training situations. For about $2,000,
an educational institution can create a good
library of these excellent training tools. The
following is a list of easily accessed video
and training material.
1. Videos from Fanlight Productions. fanlight@fanlight.com
Telephone 800-937-4113. Fanlight is distributing
a series of videos, excellent for use in teaching
cultural competency to health care professionals.
Most are clinically accurate and case-based.
All have cultural competence themes. The Fanlight
Website offers a list and detailed descriptions.
All may be rented or purchased. Here’s
a sample:
“The Angry Heart: The Impact of Racism
on Heart Disease Among African Americans”
By Jay Fedigan. The cost to buy the video is
$199 and it is 57 minutes long.
“Community Voices Exploring Cross-Cultural
Care through Cancer” By Jennie Greene,
MS, and Kim Newell, MD, for the Harvard Center
for Cancer Prevention, Produced at the Harvard
School for Public Health. The cost to buy it
is $249, and it is 69 minutes long.
“The Culture of Emotions. A Cultural
Competence and Diversity Training Program.”
Scientific advisors: Francis G. Lu, M.D., and
Juan E. Mezzich, M.D., Ph.D.; Producer: Harriet
Koskoff. The cost to buy it is $249, and it
is 58 minutes long.
“Worlds Apart” By Maren Grainger-Monsen,
M.D. Trigger tapes raise awareness of cultural
barriers that affect patient/provider communication.
The cost to buy it is $369, and it is 48 minutes
long.
“Grief in America” By Bert Atkinson,
with narration by Anthony Edwards. The cost
to buy it is $245, and it is 55 minutes long.
2. “The Bilingual Medical Interview.”
Boston City Hospital. Prepared by The Faculty
and Staff of the Primary Care Training Programs
in Internal Medicine and Pediatrics at Boston
City Hospital. The Boston University School
of Medicine and Office of Interpreter Services,
Department of Health and Hospitals, Boston,
MA and The Boston Area Health Education Center.
Written and directed by Eric J. Hardt, M.D.
Video Post Production: CF Video/Watertown ©
1987. The length of video is 31:15. It is designed
to improve the skills of the viewer in the bilingual
medical interview. Vignettes and case studies
richly illustrate many aspects of clinician-patient
interpreter interaction and the dos and don’ts
involved.
3. “Communicating Effectively Through
An Interpreter: Barriers to Communication.”
CCHCP – The Cross Cultural Health Care
Program. www.xcultural.org
4. “Female Circumcision/Female Genital
Mutilation: Clinical Management of Circumcised
Women.” The American College of Obstetricians
and Gynecologists, 1999. You can order this
video from the ACOG Bookstore at: http://sales.acog.com/acb23/showdetl.cfm?&DID=6&Product_ID=540&CATID=17.
The cost of video is $125 ($95 for ACOG members)
and it is 69 minutes long.
5. Kaiser Permanente CARE Actors' award-winning
cultural competency and medicine videos and
DVD. Many were created with funding from The
California Endowment. Professional actors and
screenwriters. Contact Gus Gaona (323-259-4776)
at Kaiser Permanente MultiMedia Communication,
825 Colorado Boulevard, Suite 301, Los Angeles,
CA 90041 for order forms. The total cost for
20 vignettes is $105. The brief but dramatic
vignettes are accompanied by support materials
for facilitators and participants. The length
of each trigger video is 8 to 12 minutes. Series
A is Cultural Issues in the Clinical Setting
and contains 5 vignettes. Series B is Beyond
OB and contains 5 vignettes. The Multicultural
Health Series, Part 1, contains four vignettes
and the Multicultural Health Series, Part 2
contains six vignettes. The Multicultural Health
Series 1 & 2 are available on DVD.
Kaiser Permanente also makes five provider's
handbooks on culturally competent care for the
following populations: Latino; African American;
Asian and Pacific Islanders; Gay, Lesbian, Bisexual,
and Transgender; and Individuals with Disabilities.
These books provide background on demographics,
epidemiology, risk factors, health beliefs and
behaviors, and treatment issues. Call 510-271-6653
to obtain these handbooks.
6. Mental Health Interpreting: a Mentored Curriculum.”
Pollard, Robert. Accompanied by a workbook.
Contact: Robert Pollard, Ph.D. (716) 275-3544
or Robert_Pollard@urmc.rochester.edu.
The University of Rochester, School of Medical
and Dentistry. The video was produced in association
with the Monroe County Office of Mental Health
and the Department of Psychiatry at the University
of Rochester Medical Center © 1997-2000
University of Rochester. The length of the video
in minutes is 32:02.
7. “Quality Care for Diverse Populations.”
The American Academy of Family Physicians. This
program is available in two formats to suit
group training and self-learning needs. Both
formats can be ordered either online (www.aafp.org/catalog/)
or over the telephone (at 800-944-0000). The
item number is Cs 723 and the title is Cultural
Competency Videotape.
8. “Through the Eyes of Others”
Tape 1: General Sessions. ROWAY Productions
– 7317 Cahill Road #229, Edina, MN 55439
or call 612-941-9337. Jointly sponsored by the
Hennepin County Medical Society, United Way
of Minneapolis Area, Hennepin County Medical
Center Staff, and the University of Minnesota.
The length of the video is 2:00:35.
9. “Training for Cultural Competence
in the HIV Epidemic.” Presented by the
Hawaii Area AIDS Education and Training Center,
University of Hawaii, John A. Burns School of
Medicine. Funded in part by grant No. 5-T01
MH19263-02 from the National Institute of Mental
Health. The length of the video is 45:45.
10. CD-ROM: 2000 Ohio Department of Health
and Medical college of Ohio. Cultural Competence
in Breast Cancer Care. Vertigo Productions LTD,
3634 Denise Drive, Toledo, OH 43614. Phone 877-385-6211,
fax 419-385-7170.
V. Useful Websites
The following Websites, particularly those
run by foundations and the Centers of Excellence,
are a source of current information on issues
related to cultural competence and diversity.
Many have on-going newsletters and alerts. They
consistently produce new statistical and educational
material that will be useful in keeping curricula
current and focused on emerging and important
issues in patient care and public policy. Many
have bibliographies or are linked to bibliographies.
1. The
California Endowment
2. California
Health care Foundation
3. The Commonwealth
Fund
One East 75th Street, New York, NY, 10021
Phone 212-606-3800; fax 212-606-3500
4. Chinese American
Medical Society Home Page
5. Cultural
Competence Activities in the Bureau of Primary
Health Care
6. The Cross Cultural
Health Care Program. Language issues, training,
interpretation.
7. New
York State Citizens’ Coalition for Children,
Inc.
8. Directory of Resources
in Cultural Diversity and Cultural Competence
9. Diversity
Rx Home Page
10. EatEthnic Home
Page
11. EthnoMed
– Ethnic Medicine Guide
12. The Henry
J. Kaiser Family Foundation
13. Hablamos
Juntos Resource Center: Models, Approaches,
and Tools
14. Kaiser Permanente
National Linguistic & Cultural Programs
15. Institute
for Diversity in Health Management
16. Manhattan Cross-Cultural Group. Physician
educators in cross-cultural medicine. Contact:
Tessa
Misiaszek by email
17. McGill
University Department of Psychiatry, Division
of Transcultural Psychiatry
18. The National
Alliance for Hispanic Health
19. National
Council on Interpreting in Health Care (NCIHC)
20. National
Hispanic Medical Association Home Page
21. National Asian
Women’s Health Organization
22. National
Center for Cultural Competence/Georgetown University
23. North East Consortium on Cross-Cultural
Medical Education and Practice
Contact:
Ed Poliandro by email
24. Office
of Minority Health - Cultural Competence Works.
25. Office
of Minority Health Resource Center
The Health Resources and Services Administration
(HRSA) provides publications and resources on
minority health issues.
26. Office
of Minority Health. Culture and Health Website
provides tools, teaching modules, and concept
papers.
27. The
Park Ridge Center for the Study of Health, Faith
and Ethics
28. Perspectives
of Difference. Teaching Diversity and Cross-Cultural
Competence in Health care: A Trainer's Guide
29. Society
for Medical Anthropology
30. Stanford
Geriatric Education Center Cross-Cultural Geriatric
Medicine
c/o VAPAHCS, 3801 Miranda Avenue, Room A-236,
(182B-SGEC), Palo Alto, CA 94304, or call (650)
494-3986.
31. Transcultural Nursing
Society Home Page
VI. Selected Centers of Excellence
Many of the following Centers of Excellence
have developed training and evaluation tools,
materials on interpretation and other useful
material that could be incorporated into curricula
for health care professionals.
1. Center
for Cross-Cultural Health (CCCH)
2. Center
for Healthy Families and Cultural Diversity
Located at: Department of Family Medicine, University
of Medicine and Dentistry of New Jersey- Robert
Wood Johnson Medical School, 1 Robert Wood Johnson
Place, New Brunswick, NJ 08903
3.
Center for Research on Ethnicity, Culture and
Health (CRECH)
University of Michigan, School of Public Health
4. Center
for Immigrant Health/New York University School
of Medicine
5. Center
for Multicultural and Community Affairs/Mount
Sinai School of Medicine
6. Center
for Multicultural and Minority Health/New York
Weill Cornell Medical Center
7. Center
for Multicultural Health, University of New
South Wales, Sydney, Australia
8. Multicultural
Training and Research Institute, Temple Department
of Social Work
9. University
of Michigan Health System Program for Multicultural
Health
10. University
of Wisconsin Center for the Study of Race &
Ethnicity in Medicine
VII. Bibliographies
The number of bibliographies focused
on cultural competence in the health professions
and cross-cultural medicine has expanded exponentially,
and is too numerous to capture here. However,
these excellent bibliographies should be a good
start and will lead to others. Many are broken
down by medical specialty, specific medical
issues, or population groups. When seeking to
integrate cross-cultural information into lecture
materials on specific subject matter, appropriate
materials can often be found in these resources.
1. 1999 Andrews, M.M. How to Search for Information
on Transcultural Nursing and Health Subjects:
Internet and CD-ROM Resources. Journal of Transcultural
Nursing, 10(1): 69-74.
2. CultureMed
3. Lu, F.G. Annotated Bibliography on Cultural
Psychiatry and Related Topics. Contact Francis
G. Lu, M.D., at francis.lu@sfdph.org.4. 2002
McCarty, L.J. et al. Cross-Cultural Health Education:
Materials on the World Wide Web. Journal of
Transcultural Nursing, 13(1): 54-60.
5. Physicians for Human Rights. The Right to
Equal Treatment: An Annotated Bibliography on
Studies on Racial and Ethnic Disparities in
Health care, Their Causes and Related Issues.
An excellent resource on health disparities
by specialty.
www.phrusa.org/research/domestic/race/race_report/bibliography.html
6. Transcultural
and Multicultural Health Links.
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