Dental Initiative
Topic of Interest #2

A Definition of Linguistic Competence
Historically, Federal statutes and regulations prohibited discrimination based on race, color, or national origin, including the ability to speak limited English. As a result, health care organizations have typically focused on the provision of interpretation and translation services in response to legislative mandates. Best practice in the provision of quality health care to diverse populations has evolved beyond simply the provision of language access to organizational capacity for linguistic competence.

There are varied definitions of linguistic competence. These definitions represent diverse perspectives, interests and needs. The following definition of linguistic competence was developed by the National Center for Cultural Competence. It encompasses a broad spectrum of constituency groups that could require language assistance from an organization or agency.

Linguistic competence - the capacity of an organization and its personnel to effectively communicate with persons of limited English proficiency, those who are illiterate or have low literacy skills, and individuals with disabilities. This may include, but is not limited to, bilingual/bicultural staff and other organizational capacity such as telecommunication systems, sign or foreign language interpretation services, alternative formats, and translation of legally binding documents (e.g. consent forms, confidentiality and patient rights statements, release of information), signage and health education materials. The organization must have policy, structures, practices, procedures and dedicated resources to support this capacity (Goode & Jones, 8/00).

This month's EPA Topic of Interest cites two rationale for the provision of linguistically competent services in primary health care which are: (1) to effectively serve linguistically diverse populations, and (2) to comply with statutory requirements regarding equal access to persons with limited English proficiency (LEP).

Changes in Demographics
Over the past decade, the percentage of individuals from diverse ethnic, racial and cultural backgrounds in the United States has increased dramatically. The 2000 Census data revealed that:

• approximately one-third of the U.S. population is from racially, ethnically and culturally diverse groups, up from one-fourth of the population in 1990.
• 24.4 million or just over 10% of the U.S. population is foreign-born.
• the majority of foreign-born population (51%) is of Hispanic origin.

According to 1999 data from the U.S. Census Bureau, there are over 300 languages spoken in the U.S. These demographics present a challenge to the health care delivery system. For more information on the current demographic data see: http://www.census.gov/populatio/www/socdemo/foreign.html

For specific information on immigrants admitted by country of origin and intended residence, age, gender, occupation and other demographic data, please refer to the Statistical Yearbook at http://www.ins.gov.

Statutory Requirements
There are federal laws and regulations that mandate language access. The following are some selected examples of statutory requirements:

• Title VI of the Civil Rights Act of 1964 - prohibits discrimination against persons with limited English proficiency based on their national origin.
• Office of Civil Rights Guidance Memorandum- focuses on language barriers and outlines factors for OCR staff to consider in determining whether or not a program receiving financial assistance is taking steps to overcome language barriers. It also emphasizes flexibility in choosing options for language assistance. For more information on this policy guidance see, http://www.hhs.gov/ocr/lep/.
• Department of Justice Coordination of Enforcement of Nondiscrimination in Federally Assisted Programs - provides that " where a significant number or proportion of the population eligible to be served or, that needs service or information in a language other than English, the recipient shall take reasonable steps to provide information in appropriate languages. This requirement applies with regards to written material of the type which is ordinarily distributed to the public."
• Medicaid - regulations require that Medicaid providers and participating agencies, including long-term care facilities, render culturally and linguistically appropriate services.
• Medicare - encourages providers to make bilingual services available whenever the services are necessary.
• Americans With Disabilities Act of 1990 - civil rights legislation for people with disabilities.

For more information on selected laws and regulations that mandate linguistic competence, see Policy Brief 2 .

Recruitment & Retention
Nationally, there is a need to increase diversity in dental education programs, both faculty and scholars. Universities and colleges should make concerted efforts to recruit and retain faculty and scholars with an interest in and commitment to providing services to underserved and vulnerable populations, including those from linguistically diverse groups.

Professional Development
Ensure that faculty and staff are provided with ongoing professional development activities and opportunities to enhance their skills and knowledge of best practices related to linguistic competence. Professional development activities should assist dental faculty to understand, articulate and advance the role of cultural and linguistic competence in teaching models, clinical skills, critical inquiry and research, and advocacy for underserved populations.

Education and Training
Institutions of higher learning must prepare scholars/professionals to provide services to individuals with a variety of communication needs. This can be accomplished by the infusion of cultural and linguistic competence throughout the curricula, including service learning.

Identifying Language Needs
Universities and colleges should identify the language needs in their designated service delivery area. This information can be used to enhance outreach activities and service delivery and build community partnerships to effectively address current and emergent language trends.

Strategies for Increasing Linguistic Competence at the Service Delivery Level
Organizational policies, structures and procedures should be developed and implemented to eliminate language barriers. The following are some suggestions:

• Policies and procedures to support ongoing professional development and inservice training on cultural and linguistic health care practices.
• Develop policies and procedures regarding use of interpreter and translation services and providing information in formats that meet the literacy needs of the population served.
• Contract with or have ready access to personnel who are proficient in the skilled in the provision of medical interpretation and translation services.
• Allocate resources for telecommunication suppliers that can provide interpretation services via telephone.
• Develop an outreach plan that increases community awareness of the organizational capacity to address diverse language needs in the service area.
• Evaluate the quality, appropriateness and consumer satisfaction with the array of translation and interpretation services provided.

Strategies for Increasing Linguistic Competence at the Provider Level
The following are some suggestions for providing linguistically competent services:

• Recognize the dynamics of cross-cultural communication in interactions with population served.
• Recognize the role and value of using medical and sign language interpreters in clinical encounters.
• Learn how to work effectively with interpreters.
• Learn and use key words and/or colloquialisms in the patient's language of origin to enhance assessment, treatment and other interventions.
• Enroll in foreign and/or sign language courses.
• Ensure that all information is provided in formats that meet the literacy needs of the population served.

Additional Resources

Medical Interpretation Training Programs and other resources from Cross-Cultural Health Care http://www.xculture.org/new/ask/detail.cfm?QID=4&list=4%2C6

http://www.xculture.org/resource/resources/category.cfm?Category=5

Economic Benefit of Providing Medical Interpreters http://www.hispanichealth.org/lep3b.html

Communication is a Quality of Care Issue http://www.hispanichealth.org/lep3.html

Strategies to Provide Services to LEP Patients http://www.hispanichealth.org/lep3a.html

CLAS Standards http://www.omhrc.gov/clas/indexfinal.htm