Acculturation means the process of adopting the cultural traits or social patterns of a group other than one’s own. In regard to immigrant groups, acculturation is the process of incorporating values, beliefs and behaviors from the dominant culture into the immigrants’ cultural worldview.
Assimilation means the process of taking on the cultural traits and characteristics of another distinct group; absorption of a new or different culture into the main cultural body; to make like; to cause to resemble.
Bicultural means the ability to understand and function effectively in two cultural environments. An individual who is bicultural is not necessarily culturally competent.
Bilingual means the ability to effectively speak two languages.
CLAS Standards means a set of 15 Culturally and Linguistically Appropriate Services by the Office of Minority Health, U.S. Department of Health and Human Services. They are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the United States.
Comparability of access or benefits means meaningfully equal access and benefits across all populations served, including any adaptations necessary to achieve equality.
Cultural broker or Culturally-informed consultant means a person serving in a non-clinical or non-professional capacity who is recognized by the client’s cultural or linguistic community as one who has knowledge of a particular culture or language and its definition of health, mental health, and family dysfunction and who is used by service providers and organizations to assist in providing culturally and linguistically-appropriate service. The term should not be confused with a professional consultation between a mainstream provider and a culturally-specific provider. There are no established criteria for certifying when an individual is culturally informed, but the organization may establish a test to determine a consultant’s usefulness in facilitating positive client outcomes. An organization that uses cultural consultants to facilitate face-to-face client encounters may use feedback from clients and families.
Cultural competence or Culturally competent (Individual) means the capability and will of a provider or service delivery organization to respond to the unique needs of an individual client, which arise from the client’s culture and to use the client’s cultural strengths as a tool in the healing or helping process. In this document, culturally competent indicates the ability to work across multiple cultures and is, therefore, distinct from culturally specific which refers to capability with one particular culture. For example, an African American psychologist may be competent to provide culturally-specific services to African American clients but would not be culturally competent unless she has demonstrated success in treating clients of at least one other culture.
Cultural competence (organizational) means: (1) the attainment of knowledge regarding beliefs and values (e.g., related to health, mental health, or child rearing), and disease incidence and prevalence; (2) the ability to communicate effectively for the thorough and accurate exchange of information, perception, instruction, and preferences with regard to the client’s presenting condition and related history; and (3) skills and behaviors that will enable practitioners and systems to provide appropriate service for the diverse populations. The word culture is used to imply the integrated pattern of human behavior that includes thoughts, communication, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group. For the organization or service delivery system, cultural competence means the ability to provide equal access and quality of services to individuals from each cultural and linguistic population served, based on an understanding of each population’s distinct needs. For the individual professional, cultural competence additionally means the ability to use the client’s culture as a resource or tool to aid in the service or treatment process and to aid in addressing human needs. Such ability will depend, in part, upon knowledge of specific cultures, skills in cross-cultural and culturally-specific clinical practices, and proficiency in clients’ languages. (National Center for Cultural Competence)
Cultural consultation means advice from an individual knowledgeable about a particular group’s culture but not necessarily knowledgeable in the professional field or discipline.
Culturally competent provider means a service professional who understands, and can utilize to the client’s benefit, the client’s culture either because he or she is of the same cultural or ethnic group or because the provider has developed the knowledge and skills through training and personal growth to provide high-quality service to diverse clients. The term can be used in a practical sense to indicate success in achieving positive outcomes for clients. At this time, DHS has not adopted criteria to certify or measure cultural competence.
Culturally-specific intervention means interventions or treatments that are common to or are especially effective with a specific population or services provided by practitioners who are characteristically found within a particular population. Expectations of high service quality remain.
Culturally-specific provider means one who is characteristically found or proven especially effective within a particular cultural and linguistic population.
Culture means (a) the integrated pattern of socially transmitted human behavior that includes thoughts, communication, actions, customs, beliefs, values, and institutions, and all other products of human work or thought, characteristic of a particular community or population. (b) Cultural defines the preferred ways for meeting needs. (c) Culture is created by people as a dynamic adaptive mechanism, continuously changing to allow a more effective adaptation to new circumstances. (d) Culture is a set of guidelines, both explicit and implicit, which individuals inherit as members of a particular society, and which tells them how to view the world, how to experience it emotionally, and how to behave in relation to other people, to supernatural forces and gods, and to the natural environment." (e) Culture also involves the historical circumstances leading to a group’s economic, social, and political status in the social structure. (f) Culture involves the circumstances and experiences associated with developing certain beliefs, norms, and values. (National Center for Cultural Competence) Culture provides the “big story.” This story, repeated from generation to generation, provides both individuals and the group with their reason for being. If the story is not passed on by families to children, the children will make up compensatory–and typically less satisfying–stories out of deep-felt, if unconscious, necessity (MN Department of Human Services). is more about behavior than biology. Emphasizing culture when discussing how human services workers develop cultural competency—and removing race from that discussion—helps to focus on the behaviors, attitudes, and practices needed in order to effectively serve diverse cultural communities.
Cultural is the most broad and overarching fabric of the social environment. It may include racial, ethnic, religious, or social communities or populations. Race is separate from culture.
Culture-bound behaviors or culture-bound syndrome means culture-specific behaviors, conditions, and diseases that affect a person’s health and well-being. For example, in some cultures, a person can become ill and suffer “soul loss” because another person has cursed them. In some cultures, women breast-feed babies until they are two or three years old while in others, women learn that bottle feeding is more appropriate. In some cultures, a person who sees a vision can be a gifted healer while, in others, she may be labeled schizophrenic. In some cultures, young women are circumcised when they reach puberty; in others, baby boys are circumcised (MN Department of Human Services).
Disparities are Differences in health status among distinct segments of the population including differences that occur by gender, race or ethnicity, education or income, disability, or living in various geographic localities (VDH Office of Minority Health and Health Equity).
Diverse populations means distinct groups including, but not limited to, racial and ethnic minorities, persons of color, American Indians, gay, lesbian, bisexual, and transgender cultures, deaf culture, disabilities culture, economic class cultures, and immigrants.
Diverse staff means organization workers who are representative of the demographic characteristics of the service area. The concept focuses on recruitment and retention. It is distinct from the concept of “culturally competent staff,” which focuses on issues of education and training to achieve greater skills and knowledge. The diversity of an organization’s staff is a necessary, but not sufficient, condition for providing culturally and linguistically appropriate services.
Dynamics of Difference means the interpersonal interactions that occur in a cross-cultural encounter. When one culture interacts with the population of another, both may misjudge the other’s actions based on learned expectations. Each party brings to the relationship unique histories with the other group and the influence of the current political relationship between the two groups. Both will bring culturally-prescribed patterns of communication, etiquette, and problem solving. Both may bring stereotypes or underlying feeling about serving—or being served by—someone who is “different.” Such tension is part of the cross-cultural encounter. Both professionals and clients should be vigilant against misinterpretation and misjudgment.
Ethnic means designating basic groups or divisions of human beings as distinguished by customs, a common language, a common history, a common religion, or other such characteristics.
Ethnographic interview means a meeting with a person of another culture in order to begin understanding his or her worldview, beliefs and life situation. It is a way to examine the patterned interactions and significant symbols of specific cultural groups to identify cultural rules that direct behaviors and the meaning people ascribe to such behaviors. Ethnographic interviewing helps a person understand another culture while avoiding stereotyping. An ethnographic interviewer is in control of the structure of the event, while the interviewee is in control of the cultural content of the event. The interviewer is the learner and the interviewee is the teacher.
Healer means an individual who has demonstrated success in healing or preventing health or mental health problems or conditions using practices that are based in, and recognized by, the culture of the client, and who is acknowledged by peers as a competent practitioner, whether or not licensed or certified by law.
Health Equity is when all people have "the opportunity to 'attain their full health potential' and no one is 'disadvantaged from achieving this potential because of their social position or other socially determined circumstance'" (VDH Office of Minority Health and Health Equity).
Health Inequity is a difference or disparity in health outcomes that is systematic, avoidable, and unjust (Center for Disease Control).
Interpreter means an individual trained and/or certified in facilitating oral, written, or manual communication between two or more people of different languages. For the purpose of these Guidelines, a qualified interpreter possesses in-depth knowledge, not only of the language, but also of cultural values, beliefs, and verbal and non-verbal expressions. A technically proficient interpreter who is lacking specific cultural knowledge can work in conjunction with a culturally informed consultant (also known as a cultural broker).
Limited English proficiency (LEP) or persons with LEP, means individuals who cannot speak, read, write or understand the English language at a level that permits them to interact effectively with healthcare providers and social service agencies. (Note: This may not be easy to identify. Some people may know enough English to manage basic life skills but may not speak, read, or comprehend English well enough to understand in a meaningful way some of the more complicated concepts they may encounter in the health and human services systems.)
Meaningful access means the ability to use services and benefits comparable to those enjoyed by members of the mainstream cultures. It is achieved by eliminating communication barriers and ensuring that the client or potential client can communicate effectively. An organization must ensure that the LEP person:
• is given adequate information
• is able to understand the services and benefits available
• is able to receive services for which he or she is eligible
• can effectively communicate the relevant circumstances of his or her situation to the service provider and
• receives language assistance at no cost.
According to the Office of Civil Rights (OCR) Guidance: “The type of language assistance an (organization) provides to ensure meaningful access will depend on a variety of factors, including the size of the (organization), the size of the eligible LEP population it serves, the nature of the program or service, the objectives of the program, the total resources available to the (organization), the frequency with which particular languages are encountered, and the frequency with which LEP persons come into contact with the program. There is no ‘one size fits all’ solution for Title VI compliance with respect to LEP persons. OCR will make its assessment of the language assistance needed to ensure meaningful access on a case by case basis.”
OCR Guidance means the federal language assistance requirements as defined in Title VI of the Civil Rights Act of 1964; Policy Guidance On The Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency, published by the Office of Civil Rights, Federal Register, Vol. 65, No. 169, August 30, 2000, pp. 52762 through 52774.
Organization means both the entity that determines access to services and the entity that performs services. For example, it would include both a county social services agency and its contracted vendors and service providers. Additionally, it would include both a managed care organization (or health maintenance organization–HMO) and its network of physicians and other clinical professionals.
Persons eligible to be served or likely to be directly affected means clients and applicants in a program’s approved geographic service area who are eligible for services or benefits. OCR will address this standard on a case-by-case basis.
Preferred language means the self-identified language, which the client prefers to use in a service or clinical encounter. The preferred language need not be the client’s native or primary language if the client indicates sufficient proficiency in English and prefers to use English.
This term is not used in the OCR Guidance which, instead, uses the term “primary language.” The term “preferred” originated in public comments to the CLAS standards as having “the advantage of implying that the client, rather than the organization’s staff, makes the decision about which language is noted in the management information system (MIS) and patient record.” (See CLAS Standards, General Discussion of Standard 10.)
Race means any of the different varieties of human beings as distinguished by physical characteristics; one among the group of populations constituting humanity, where differences are biological in nature and are transmitted genetically. The term is inaccurate when applied to national, religious, geographic, linguistic, or cultural groups.
Safe Harbor means criteria established in the OCR Guidance that assures an organization that it has complied with the federal obligation to provide translated written materials for persons with limited-English proficiency. However, the Safe Harbor provisions are not mandatory and do not establish numerical thresholds. OCR will review a number of other factors in determining compliance. See OCR Guidance, pages 52762 and 52767.
Social Determinants of Health- Most people recognize that health and wellness are connected to many variables. The CDC defines the social determinants of health as the complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world.
Title VI of the Civil Rights Act of 1964 means federal law found at 42 U.S.C. 2000 d et. seq. and its implementing legislation at 45 CFR Part 80.
Unduly burdensome means the level of cost or time beyond which the translation of documents will not be required by the federal government. The Office of Civil Rights (U.S. Department of Health and Human Services) will determine the extent of an organization’s obligation to provide written translations of documents on a case by case basis. According to the OCR Guidance: “OCR recognizes that recipient/covered entities in a number of areas, such as many large cities, regularly serve LEP persons from many different areas of the world who speak dozens and sometimes over 100 different languages. It would be unduly burdensome to demand that recipient/covered entities in these circumstances translate all written materials into dozens, if not more than 100 languages.”