EIIC: Emergency Medical Services for Children | Innovation and Improvement Center

Cultural Competency Toolkit

Cultural and linguistic competence is the ability to interact effectively with people of different cultures. Culture refers to the integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups (U.S. Department. of Health and Human Services, Office of Minority Health Affairs).

In terms of EMSC, providing culturally and linguistically appropriate emergency medical care that is both respectful of and responsive to the cultural and linguistic needs of pediatric patients and their families offers the potential to improve healthcare access, quality, and, ultimately, outcomes.

Healthcare Provider Resources

American Academy of Pediatrics

Community Pediatrics: Culturally Effective Pediatric Care
This section of the American Academy of Pediatrics' (AAP) website articulates the Academy’s position on culturally competent care by stating that "the needs of pediatric population are influenced by factors relating to culture and ethnicity. Pediatricians must acquire the knowledge and practice skills that will allow them to: recognize and address culture and ethnicity, make valid assessments of clinical findings, and provide effective patient management." (Accessed September 2013).

Example Practices

Utah Emergency Medical Services for Children
In 2006, the Utah EMSC Program conducted a needs assessment survey of 668 EMS providers to determine how EMSC could help meet their needs. Survey results were then used to compile the Cultural Competence Needs Assessment Fact Sheet, a document that summarizes the survey results, revealing the need and recommended strategies for the development and integration of culturally and linguistically appropriate resources for EMS healthcare providers. (Revised May 2010).

Database Searches

National Library of Medicine PubMed journal article database
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Family and Caregiver Resources

Family Voices

Diversity and Cultural Competence
This Family Voices webpage includes a variety of culturally focused resources that address building relationships with community liaisons and cultural brokers to reach families of children and youth with special healthcare needs – particularly those from underserved population groups. (Accessed September 2013).

Healthcare Provider Resources

American Academy of Pediatrics (AAP)

Community Pediatrics: Culturally Effective Pediatric Care
This section of the AAP website articulates the Academy’s position on culturally competent care by stating that "the needs of pediatric population are influenced by factors relating to culture and ethnicity. Pediatricians must acquire the knowledge and practice skills that will allow them to: recognize and address culture and ethnicity, make valid assessments of clinical findings, and provide effective patient management." (Accessed September 2013).
Policy Statement: Ensuring Culturally Effective Pediatric Care: Implications for Education and Health Policy
This policy statement defines culturally effective health care and describes its importance for pediatrics and the health of children. The statement also addresses the importance of cultural effectiveness, sensitivity, and competence, especially as related to medical training and education. (Reaffirmed August 2008).
Culturally Effective Care Toolkit
This is a practical, hands-on resource to help practicing pediatricians and their office staff provide culturally effective care to their patients and families. (2011).
Presentation – Culturally Effective Pediatric Care in a Community-based Health Program
This presentation provides an overview of culturally effective pediatric care and highlights the AAP’s online Culturally Effective Care Toolkit. A Healthy Tomorrows grantee discusses their experience creating culturally responsive health education materials and training providers how to manage diverse health literacy levels. (April 2011).
Educational Goals and Objectives for Culturally Effective Pediatric Care for Residents in Pediatrics
AAP’s Committee on Pediatric Education developed this list of goals and objectives in providing culturally effective care for pediatric residents. (2008).

American College of Emergency Physicians

Policy Statement: Cultural Competence and Emergency Care
This policy statement affirms the American College of Emergency Physician’s support for culturally and linguistically appropriate resource utilization in the emergency department as well as cultural awareness amongst emergency care providers. (Revised April 2008).

American Medical Association, Institute of Ethics

Communication Climate Assessment Toolkit
The C-CAT is a new organizational performance assessment toolkit from the Ethical Force Program® at the American Medical Association designed to assist your organization in meeting the needs of a diverse patient population. The C-CAT can help organizations improve communication with all patient populations and many of the questions are specifically focused on common communication problems, such as culture, language and health literacy gaps. (2008).

Association of Maternal & Child Health Programs

Racial and Ethnic Disparities in Health Knowledge Path
This knowledge path directs readers to a selection of current, high-quality resources about preventing, identifying, and eliminating racial and ethnic disparities in health. Health professionals, program administrators, policymakers, and researchers can use this knowledge path to learn more about health disparities, health equity, and removing barriers to care; for program development; and to locate training resources and information to answer specific questions. (Accessed July 2015).
Cultural Competency
An online conference call discussing state involvement to develop culturally competent programs that raise awareness about ASD and engage newly diagnosed families from culturally, linguistically, and geographically diverse communities. Populations of specific concern to the State Demonstration Grantees include Hispanic, Native American, and rural families. (May 2009).

Association of State and Territorial Health Officials

2008 Snapshots: State Activities to Promote Health Equity (Interactive Map)
With support from the U.S. Department of Health and Human Services’ Office of Minority Health, the Association of State and Territorial Health Officials surveyed state and territorial health agencies on racial/ethnic minority health and health disparities. This map of the United States portrays each individual state response. (2008).

Champlain Valley Area Health Education Center

Cultural Competency for Health Care Providers
This resource was designed for health care providers to support the promotion of cultural competency in their practice. It is by no means meant to be comprehensive, but rather to provide a general overview and to offer select resources for further study. (January 2013)
Cultural Competency Page
The Champlain Valley Area Health Education Center cultural competency page provides a variety of resources and training opportunities. (Accessed September 2013)

The Commonwealth Fund

Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective
This research, conducted with support from the Commonwealth Fund, identifies five domains of culturally competent care that can be best assessed from the patient’s perspective, including: (1) patient-provider communication, (2) respect for patient preferences and shared decision making, (3) experiences leading to trust or distrust, (4) experiences of discrimination, and (5) linguistic competency. The report also makes recommendations regarding the implications of cultural competence for healthcare providers and health systems, and identifies areas for further research. (October 2006).
Racial and Ethnic Disparities
This custom search results page provides an exhaustive list of resources related to racial and ethnic disparities in healthcare. (Accessed September 2013)

Hablamos Juntos

Universal Symbols in Healthcare: Best Practices for Sign Systems
Developed by Hablamos Juntos – a project designed to improve communications amongst providers and patients with Limited English Proficiency (LEP) support from the Robert Wood Johnson Foundation – this best practices manual provides instructions for implementing culturally and linguistically appropriate health care signage systems to increase healthcare access for patients with limited English language skills. (2005).
Race, Ethnicity, and Language of Patients: Hospital Practices Regarding Collection of Information to Address Disparities in Health Care
This report addresses the ability of health care organizations to describe their patient populations and assess the size and scope of health care disparities in-house. It focuses on hospitals and their practices concerning the collection of information on patient race and ethnicity. The report also provides information on the extent to which U.S. hospitals currently collect information on the race and ethnicity of their patient populations, as well as how this information is collected, recorded, and used. (January 2006).

Indian Health Service (IHS)

Health Literacy Universal Precautions Toolkit
This page on the IHS website defines health literacy, discusses universal precautions, and showcases the preliminary results of three common health literacy tools, including links to these tools. (Accessed September 2013).
Race, Ethnicity, and Language of Patients: Hospital Practices Regarding Collection of Information to Address Disparities in Health Care
This report addresses the ability of health care organizations to describe their patient populations and assess the size and scope of health care disparities in-house. It focuses on hospitals and their practices concerning the collection of information on patient race and ethnicity. The report also provides information on the extent to which U.S. hospitals currently collect information on the race and ethnicity of their patient populations, as well as how this information is collected, recorded, and used. (January 2006).

National Center for Cultural Competence

A Guide for Advancing Family-Centered and Culturally and Linguistically Competent Care
This guide is derived from the comments, concerns, and discussions generated from participants of the Family-Centered Care and Cultural Competence Meeting convened by the Maternal and Child Health Bureau. The meeting explored ways in which family-centered care and cultural and linguistic competence could be integrated in a more effective manner to support and sustain a community-based system of services that are comprehensive, coordinated, and accessible and that provide the highest quality of care. (2007).
Cultural Competency Health Practitioner Assessment
This healthcare provider self-assessment was developed for the Health Resources and Services Administration’s (HRSA’s ) Bureau of Primary Care to encourage cultural and linguistic competence in efforts to support the elimination of health disparities among racial and ethnic groups. (Accessed July 2015).
And the Journey Continues…Achieving Cultural and Linguistic Competence in Systems Serving Children and Youth with Special Health Care Needs and their Families
Designed to offer insight and lessons learned over a decade, this publication shares the efforts of state and territorial programs in implementing culturally and linguistically competent policies, structures, and practices. (Fall 2007).

National Quality Forum

A Comprehensive Framework and Preferred Policies for Measuring and Reporting Cultural Competency: A Consensus Report
This publication aims to promote culturally competent care, to reduce health disparities, and to make care more patient-centered. It does so by endorsing a comprehensive framework or "road map" for measuring and reporting cultural competency. The report also endorses 45 preferred practices for the provision of culturally competent care. (2009).

U.S. Department of Health and Human Services (HHS)

HHS Action Plan to Reduce Racial and Ethnic Health Disparities
This action plan outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. With the HHS Disparities Action Plan, the Department commits to continuously assessing the impact of all policies and programs on racial and ethnic health disparities. It will promote integrated approaches, evidence-based programs, and best practices to reduce these disparities. (April 2011).

Office of Minority Health (OMH)

The OMH website links to a variety of programs and online resources addressing the topics of linguistic and cultural competence. These include the following:

The Center for Linguistic and Cultural Competence in Health Care
The mission of this congressionally mandated center within OMH is to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care delivery and increase limited English-speaking individuals' access to health care. (April 2007)
State Offices of Minority and Multicultural Health Liaison Map
This interactive map provides users the opportunity to view a list of minority and multicultural health liaisons by state or territory. (July 2008).

Agency for Healthcare Research and Quality (AHRQ)

AHRQ, whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, offers the following online resources:

Health Literacy and Cultural Competency
This webpage links to relevant AHRQ cultural competency resources, including funding opportunities, articles of interest, consumer and patient resources, assessment tools, and explications of AHRQ activities to reduce racial and ethnic disparities in healthcare. (Accessed September 2013).
Health Literacy Universal Precautions Toolkit
This toolkit offers primary care practices a way to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific areas. (April 2010).

Centers for Disease Control and Prevention (CDC)

CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same. CDC increases the health security of our nation. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.

Minority Health Resources
The webpage of the CDC Office of Minority Health and Health Disparities links to minority health resources, including cooperative agreements, regional and state minority health consultants, and stakeholder groups. (December 2010).

Health Resources and Services Administration (HRSA)

Cultural competency resources available online through the HRSA website include:

Culture, Language and Health Literacy
Effective health communication is as important to health care as clinical skill. To improve individual health and build healthy communities, health care providers need to recognize and address the unique culture, language and health literacy of diverse consumers and communities. (Accessed September 2013).
Quality Health Services for Hispanics: The Cultural Competency Component
This primer is designed to help healthcare professionals better understand, and more effectively respond to the growing needs of Hispanics in the United States. It should facilitate greater access to, and utilization of, health and human services for this patient population, as well as provide suggestions for improving one-to-one provider-patient interactions. (2001).

National Institutes of Health (NIH)

The NIH, which houses a National Center on Minority and Health and Health Disparities to promote minority health and efforts to reduce health disparities across NIH Institutes, also provides the following resource through the National Library of Medicine:

Multi-Cultural Resources for Health Information
This comprehensive compendium includes information on cultural competency dictionaries, glossaries, online translation tools, and health resources in multiple languages from professional societies and organizations, governmental entities, state medical centers and university medical schools, and other stakeholder groups. (April 2011).

ProLiteracy Education Network

Lessons Plans for Disaster Planning and Home Safety and Online Courses
ProLiteracy Education Network (EdNet) provides free instructional resources to adult literacy and ESOL instructors, learners, and program staff. Formerly known as Thinkfinity Literacy Network, EdNet was launched by ProLiteracy in 2011. (Accessed September 2013).

Example Practices

Utah Emergency Medical Services for Children
In 2006, the Utah EMSC Program conducted a needs assessment survey of 668 EMS providers to determine how EMSC could help meet their needs. Survey results were then used to compile the Cultural Competence Needs Assessment Fact Sheet, a document that summarizes the survey results, revealing the need and recommended strategies for the development and integration of culturally and linguistically appropriate resources for EMS healthcare providers. (Revised May 2010).
California Primary Care Association (CPCA)
Founded in 1994, CPCA, together with the more than 500 community clinics and health centers it represents, has helped to ensure affordable, quality health care to California’s uninsured, low-income, and minority communities. CPCA’s mission is to promote and facilitate equal access to quality health care for individuals and families through organized primary care clinics and clinic networks that, among other things, seek to maintain cost-effective, affordable medical services, as well as meet the linguistic and cultural needs of California’s diverse population.As part of its efforts to improve language access for LEP patients, CPCA conducted a survey of community clinics and health centers throughout California on policies and procedures for providing care to LEP patients. Based on this information and subsequent surveys and interviews, CPCA produced Providing Health Care to Limited English Proficiency (LEP) Patients: A Manual of Promising Practices. This study report demonstrates how health centers address the needs of their LEP patients and includes detailed profiles of promising practices. (2004).
Dialogue Creates Effective Risk Reduction Training: Promising Practices for Cultural and Linguistic Competence in Addressing Sudden Infant Death Syndrome and Other Infant Death (Spring 2007)

The National Center for Cultural Competence chose this promising practice because it exemplifies key values of culturally and linguistically competent health promotion that include the following:

  • Chooses formats that address audience preferences, literacy levels, and language;
  • Elicits reactions from the intended audience and modifies materials and approaches based on their input; and
  • Results in the reciprocal transfer of knowledge and skills between all collaborators and partners.

Family and Caregiver Resources

EMSC Program Materials

Non-English Language Resources
  • Common Emergencies for Children with Special Health Care Needs (English) (Spanish) (2007).
  • Disaster Preparedness Planning for Children and Youth with Special Healthcare Needs (English) (Spanish) (2007).
  • How to Get Help for A Sick or Injured Child (English) (Spanish) (2007).
  • Urgente! A fact sheet for Spanish speaking parents and caregivers. (2000).
  • What to do Until Help Arrives for a Child Medical Emergency (English) (Spanish) (2006).

Family Voices

Diversity and Cultural Competence
This Family Voices webpage includes a variety of culturally focused resources that address building relationships with community liaisons and cultural brokers to reach families of children and youth with special healthcare needs – particularly those from underserved population groups. (Accessed September 2013).