OVERVIEW
On October 4, 2005, the State of California passed Assembly Bill 1195 (AB 1195), which mandates the integration of activities that address Cultural and Linguistic Competency (CLC) into all Continuing Medical Education (CME) curricula offered for physicians in the state.
In 2006, IMQ was awarded a two year grant by the California Endowment to develop a program that provides technical assistance and other resources to CME providers to effectively integrate CLC into the planning, development, and implementation of CME courses and materials offered to California physicians. During this time IMQ disseminated information about the legislation and created an arsenal of resources to assist providers. Workshops were offered throughout the state to help CME providers interpret the law and integrate CLC topics within CME activities. IMQ also provided direct individualized technical assistance to CME providers. IMQ created a webpage to serve as a clearinghouse for CLC information.
In August of 2008, IMQ was awarded a second grant from the California Endowment to expand and refine its existing CLC Program, and also to begin to reach out directly physicians throughout the state.
One of the current foci is on improving CLC technical assistance to further enhance successful integration of CLC into diverse CME programs with a hope to prevent, reduce, and eliminate health disparities. In collaboration with other departments within IMQ, as well as partners outside of IMQ, we continue to refine and expand our web-based CLC resources, seminars, webinars and individualized assistance to offer pertinent information and support both to CME providers and healthcare professionals across the state. CME providers are encouraged to utilize this multi-faceted program as often as needed.
IMQ staff conducts both onsite and web-based training and assessment through workshops and consultations available upon request in most parts of the state. CLC is a process rather than a destination, and providing sustainable, continuous training will strengthen its capacity in broader clinical practice settings as a vehicle to address health disparities. |
CULTURAL AND LINGUISTIC COMPETENCY PROCESS
Health and healthcare disparities are real, they are here in California, and despite efforts are not going away. In a Kaiser Family Foundation Survey (2001) 62% of physicians reported witnessing minority patients receiving poor quality health care. While the data on disparities is growing, the remedies have not kept pace. As stated by Peter Slavin, MD of Massachusetts General Hospital, “we need to get beyond just diagnosing the problem- we need to start treating it”. This is the impetus behind the cultural and linguistic competency initiative. To become culturally proficient, physicians need to engage in an ongoing educational process that includes an awareness of these disparities; an understanding of the influence of their own personal and professional culture on clinical treatment, how cultural differences between the provider and patient affect the delivery of care; and knowing where and how to obtain information that can be used to establish productive therapeutic relationships with patients. Cultural competency is a path of lifelong learning about oneself in relation to others (Hixon,2003).
What is Cultural & Linguistic Competency?
In California health care system, Cultural & Linguistic Competency (CLC) can be interpreted as:
“a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities1.” |
The terms “ATTITUDE, KNOWLEDGE, AND SKILLS” include such practical components as:
- - Linguistic accommodations
- - Information to establish therapeutic relationships
- - Cultural and ethnicity data in diagnosis, treatment, and overall process of clinical care
|
and likewise, “CULTURES, GROUPS, AND COMMUNITIES” can also be based on a wide range of ideas and characteristics including (but are not limited to):
- - Religion/faith/spirituality
- - Nationality
- - Race/Ethnicity
- - Sexuality
- - Gender roles/identities/presentations
- - Age
- - Geographical associations
|
Most often, those who are affected the most by disparities identify with multiple cultural identities. Thus also remember that these aspects of “culture” are not mutually exclusive. Additionally, you may be wondering whether competency is synonymous to sensitivity – the answer is yes and no. It is because competence suggests the ability to complete a task that is not implied by sensitivity, while one can be competent without being sensitive. Therefore, always consider CLC in the context of quality of care and patient health outcomes – it should become apparent that ideally both competence and sensitivity should be present when providing health care.
Medical Leadership Council on Cultural Proficiency’s video.
Medical Leadership Council on Cultural Proficiency (MLC) has developed a video
to promote CLC in healthcare! |
 |
|
NEWS
FROM THE WHITE HOUSE
In a move that will increase the delivery of culturally competent care, President Obama has announced that regulations be developed for every hospital receiving Medicare or Medicaid funds, to allow patients to determine their visitors and to ensure that patients’ advance directives are respected.
“It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy,”
“… participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or disability. The rule-making should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient’s care or treatment.”
For the full announcement, please visit the government website.
EVENTS
UPCOMING IMQ EDUCATIONAL PROGRAMS
We provide a variety of workshops, outreach conferences, and trainings for a wide range of audiences. Please let us know if 1) you cannot find an event near you 2) you would like for us to hold an event at your location 3) you can offer us a space to hold these events (accessible by attendees outside of your organization)!
Thank you!
For CME professionals
Please stay tuned for regular updates!
For physicians
Please stay tuned for regular updates!
|
|
UPCOMING NON-IMQ EDUCATIONAL OPPORTUNITIES
|
| August 18-20, 2010
Marriott Denver South at Park Meadows
Littleton, CO
Academy of Health Equity: Achieving Health Equity in the Era of Healthcare Reform
The overarching theme of the conference is “Achieving Health Equity in the Era of Health Care Reform.” The meeting is critical to developing the knowledge-base for those engaged in health disparity activities by facilitating trans-disciplinary exchanges of the latest research and practical applications by addressing a number of key strategic elements.
For more information and to register, please visit their website. |
| September 8-10, 2010
Crowne Plaza Fallsview
Niagara Falls, Ontario, Canada
1st Annual Decolonizing Indigenous Health Research Conference
The Decolonizing Indigenous Health Research Conference will bring together community members, educators, health workers, researchers, and students to meet and learn from each other about current issues, practice, and research findings related to Indigenous health.
For more information and to register, please visit their website. |
| September 8 (and other successive dates), 2010
Online Training
AskCHIS Online Trainings
Learn how to use AskCHIS without having to leave home! Our NEW two-hour online workshop provides a basic introduction to the free easy-to-use online AskCHIS Web tool. Participants will learn how to search for health data by county, region, or statewide. Upcoming workshops will focus on a range of topics, including health disparities, chronic disease, healthy living, as well as topics participants choose themselves.
For more information and to register, please visit their website. |
| September 11-13, 2010
The Westin
Seattle, WA
Mayo School of Continuous Professional Development: The 8th National Changing Patterns of Cancer in Native Communities – Strength Through Tradition & Science
Our 8th National Changing Cancer Patterns in Native Communities conference will be held September 11-14, 2010. This year’s theme is “Strength Through Tradition and Science.” Our purpose is (1) to provide a forum for community leaders and members, students, researchers, clinicians, service providers, and others to address critical cancer issues among Native people; (2) to present updates on comprehensive cancer control plans in Native communities; (3) to review advances in AIAN cancer research to determine future research priorities and explore the science of translational research; (4) to highlight effective cancer control activities and programs in AIAN communities; (5) to highlight the strengths of AIAN traditions in promoting comprehensive cancer prevention and control, and (6) to publish selected papers presented at the conference so that this information can reach a wider audience. Some of the topics to be included at the conference will include cancer prevention, cancer screening, cultural sensitivity, tobacco issues, policy, structures and systems, comprehensive cancer control programs, palliative care and end-of-life issues, quality of life and survivorship issues, cancer treatment, community partnerships, traditional healing and western medicine, spirituality in cancer, physical activity, diet and nutrition, cancer education, movies and other media.
For more information and to register, please visit their website. |
| September 30 – October 3, 2010
Loews Miami Beach Hotel
Miami, FL
American Association for Cancer Research: The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved
This conference will address all levels of basic, population, clinical, and transdisciplinary research related to cancer. The goals of this conference are to bring together physicians, scientists, health professionals, and health care leaders working in a variety of disciplines to discuss the latest findings in their fields, to foster collaborative interdisciplinary interactions and partnerships, and to stimulate the development of new research in cancer health disparities.
For more information and to register, please visit their website. |
| October 18 – 21, 2010
Renaissance Baltimore Harborplace Hotel
Baltimore, MD
DiversityRx 2010 Seventh National Conference on Quality Health Care for Culturally Diverse Populations
The conference theme is “Improving health care for culturally diverse populations: A new place on the national health agenda,” and we’ll be featuring many prominent speakers from the U.S. Department of Health and Human Services, The Joint Commission, the National Committee for Quality Assurance, the National Quality Forum, and Johns Hopkins.
For more information and to register, please visit their website. |
| November 6-10, 2010
Colorado Convention Center
Denver, CO
American Public Health Association 138th Annual Meeting & Expo: Social Justice
Join us as we explore the link between social justice and public health and the importance of expanding the dialogue to include social determinants of health equity in all policy debates. Ultimately education, transportation and housing policies affect the health of people. The challenge for any government – municipal, regional state and federal – is to introduce health consequences into all discussions of social policies. An important challenge for the public health community is to be at the forefront of this debate. Ten years into the new millennium, this theme celebrates the spirit and practice of public health, and also offers an opportunity to expand our understanding of the many links between social circumstance and health.
For more information and to register, please visit their website. |
| November 10-13, 2010
Marriott Hotel
Philadelphia, PA
4th Annual National Conference on Health Disparities: Reducing Health Disparities Through Strengthening and Sustaining Healthy Communities
This national conference will address questions about non-medical determinants of health, including education levels, health literacy, poverty, public safety, community design, access to care, environmental equality, environmental justice, and personal, government, and corporate responsibility. Conference presenters and participants will discuss solutions, review “programs that work,” and recommend policies to strengthen and enhance the current “medical model” of health care through diverse, multi-disciplinary partnerships and perspectives.
For more information and to register, please visit their website. |
|
|
FAQ
|
|
What is Cultural Competency?
 Cultural Competency means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups and communities.
Please click here to download our CLC in Healthcare 101 brochure. |
|
What is Linguistic Competency?
Linguistic competency means the ability of a physician and surgeon to provide patients who do not speak English or who have limited ability to speak English direct communication in the patient’s primary language.
Please click here to download our CLC in Healthcare 101 brochure. |
|
Does (AB 1195) California Business and Professions Code. Ch. 5, Article 10, 2190.1 (2005) require a certain number of curriculum hours of Continuing Medical Education dedicated to Cultural and Linguistic Competency?
NO. There are not a specific number of hours, but ALL CME activities after July 1, 2006 should include Cultural and Linguistic Competency components in their curriculum.
|
|
Does (AB 1195) California Business and Professions Code. Ch. 5, Article 10, 2190.1 (2005) affect all CME activities?
Technically, no. The following educational activities are exempt:
- • Activities solely dedicated to research unrelated to patient care
- • Other activities that do not contain ANY patient care components
- • Activities offered by providers not located in California
However, these exemptions are being questioned, thus we highly encourage our providers to consider CLC in all CME activities whenever possible. |
|
How do we show compliance with (AB 1195) California Business and Professions Code. Ch. 5, Article 10, 2190.1 (2005)?
IMQ expects each provider to make a commitment and effort to comply with the law. Program planning documentation should show evidence of efforts both to assess the need for CLC education as well as meaningfully address these needs in CME activities.
See page 21 of the Standards Manual for standards of compliance with (AB 1195) California Business and Professions Code. Ch. 5, Article 10, 2190.1 (2005). |
|
Is there a specific list of populations that our organization should target for improving Cultural and Linguistic Competency in CME curriculum?
NO. Studies have shown that many different populations experience significant health disparities and disease burden. Unequal access to care and services as a result of language barriers and/or cultural differences can lead to poorer overall health status. Cultural competence, however, implies the ability to adapt and reinvent according to a changing environment (including demographics, socio-economics, literacy levels, religious beliefs, and acculturation), and the expressed needs of the surrounding community. Therefore, it is each facility/organization’s responsibility to assess the needs of the community/patients, and take appropriate cultural and linguistic considerations in CME curriculum development.
|
|
Will IMQ provide (AB 1195) California Business and Professions Code. Ch. 5, Article 10, 2190.1 (2005) related templates of speaker requirements, policies, or other materials for us to use to comply?
IMQ will provide resources to assist CME providers in drafting policies and other relevant materials specific to identified provider needs. There is no one-size-fits-all solution to complying with AB 1195. In fact, the spirit of AB 1195 promotes variation in how CME providers will target their education strategies.
|
|
How do we effectively incorporate CLC into our CME curricula?
The key, is to always remember the reason WHY there is a need for CLC inclusion in CME programs: it rose from the general concern for growing health disparities and their link to quality of care. Therefore, instead of thinking “what is the minimum requirement to fulfill the AB 1195?” think “how can we improve the health of our minority patients?” “what should our clinicians know about our community members in order to improve the quality of care?” “how can we enhance the overall health outcomes of our patients?” Such paradigm shift should help you think through effective ways to incorporate CLC into your CME programs. Additionally, always consider more than just a single aspect of culture – i.e. consider more than just race or ethnicity – explore hidden demographics such as age, gender, sexuality, religion, geography, etc. Most often, those who are affected the most by the disparities tend to identify with multiple cultural identities. Thus also remember that “culture” is not mutually exclusive.
Please click here to download our CLC in Healthcare 101 brochure. |
|
What are some useful tips for integrating CLC into CME curricula?
In addition to the answer provided above regarding effectively incorporating CLC into CME curricula, here are some additional tips on how to successfully integrate CLC into CME curricula:
- • Thinking in terms of RISKS (are there any patient populations that are disproportionately at risk for this disease/condition?)
- • Considering associated ACCESS/AVAILABILITY issues (are there differences among patients in the level of access they have to this medical procedure/diagnostic technique/treatment/information?)
- • Considering the associated REGULATIONS (are there any regulations – local or otherwise – that either create disparity or reduce disparity associated with this topic?)
|
|
|
