Implementation of Culturally and Linguistically Competent Policies by State Title V Children with Special Health Care Needs (CSHCN) Programs
- 151 Downloads
Objective This descriptive study was intended to identify actual actions, steps and processes of Children with Special Health Care Needs (CSHCN) programs to develop, implement, sustain and assess culturally and linguistically competent policies, structures and practices. Methods An online 52-item mixed format survey of Maternal and Child Health (MCH) CSHCN directors was conducted. In April 2003 and May 2004, 59 directors were solicited to participate in the survey and 42 (86%) responded. Standard quantitative and qualitative analyses of the data were conducted to address key questions linked to the study’s overall objective. Results Findings indicated that almost all respondents are implementing some actions to provide culturally and linguistically competent services including adapting service practices, addressing workforce diversity, providing language access, engaging communities and including requirements in contracts. These individual actions were less often supported by processes such as self-assessment and creating an ongoing structure to systematically address cultural and linguistic competence. Programs are challenged to implement cultural and linguistic competence by state agency organization and budget restrictions. Conclusions The results of the study indicate a continued need for support within state MCH CSHCN programs in order to maintain or enhance the systematic incorporation of culturally and linguistically competent efforts.
KeywordsCultural and linguistic competency Children with Special Health Care Needs US State Title V programs Federal Maternal and Child Health Bureau
Eileen Miller, BS, the staff of the National Center for Cultural Competence and the State CSHCN Directors, without all of whom this study would have not been possible. This study was funded through Cooperative Agreement #U93-MC-00145 from the Maternal and Child Health program (Title V, Social Security Act), HRSA, DHHS.
- 1.Sullivan, L. W. (2004). Missing persons: Minorities in the health professions. Sullivan Commission.Google Scholar
- 2.Institute of Medicine. (2004). In the Nation’s compelling interest: Ensuring diversity in the healthcare workforce. Washington: National Academies Press.Google Scholar
- 3.National Healthcare Disparities Report. (2003). Full Report. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/qual/nhdr03/fullreport/.
- 4.Several Authors. (2003). Cultural competence: Special theme articles. Academic Medicine, 78(6), 547–653.Google Scholar
- 5.President’s New Freedom Commission on Mental Health. (2003). President’s New Freedom Initiative Final Report. Rockville, MD: U.S. Department of Health Resources and Services Administration, DHHS.Google Scholar
- 6.Association of University Centers on Disabilities Network Diversity Survey. (2004). AUCD Network Diversity Survey.Google Scholar
- 7.U.S. Census Bureau. American Community Survey. Accessed December 18, 2007 from http://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=ACS&_submenuId=datasets_2&_lang=en.
- 8.U.S.Census Bureau. Language Spoken at Home. Accessed December 19, 2007 from http://factfinder.census.gov/servlet/STTable?_bm=y&-geo_id=01000US&-qr_name=ACS_2006_EST_G00_S1601&-ds_name=ACS_2006_EST_G00_.
- 9.US Census Bureau. American Fact Finder. Accessed December 18, 2007 from http://factfinder.census.gov/home/saff/main.html?_lang=en.
- 10.Day, J. C. (1996). Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050 (Vol. P25). Washington: U.S. Census Bureau, United States Government Printing Office.Google Scholar
- 11.Cohen, E., & Goode, T. D. (2003, revised). Policy brief 1: Rationale for cultural competence in primary care. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development.Google Scholar
- 12.Institute of Medicine Board on Health Sciences Policy. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Institute of Medicine.Google Scholar
- 14.Kaiser Family Foundation. Racial and ethnic disparities in women’s health coverage and access to care. http://www.kff.org/womenshealth/7018.cfm. Accessed November 3, 2004.
- 21.Siegel, C., Haugland, G., & Chambers, E. D. (2003). Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery. Administration and Policy in Mental Health, 31(2), 141–170. doi: 10.1023/B:APIH.0000003019.97009.15.PubMedCrossRefGoogle Scholar
- 27.Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O., I. I. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Report, 118(4), 293–302.Google Scholar
- 28.Bero, L. A., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D., & Thomson, M. A. (1998). Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. British Medical Journal, 317(7156), 465–468.PubMedGoogle Scholar
- 29.Child and Adolescent Health Measurement Initiative. National Survey of Children with Special Health Care Needs. http://cahmi.org/pages/Home.aspx. Accessed November 4, 2007.
- 30.Maternal and Child Health Bureau. Maternal and Child Health Bureau Strategic Plan: FY 2003–2007. ftp://ftp.hrsa.gov//mchb/stratplan03-07.pdf. Accessed November 4, 2004.
- 31.Cohen, E., & Goode, T. D. (1999). Policy brief 1: Rationale for cultural competence in primary care. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development.Google Scholar
- 32.Dunne, C., Goode, T., & Sockalingham, S. (2003). Planning for cultural and linguistic competence in state Title V programs serving children and youth with special health care needs and their families. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development.Google Scholar
- 33.Version, S.P.S.S. (2002). 11.0 [computer program]. Version. Chicago.Google Scholar
- 34.Strauss, A. L. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press.Google Scholar
- 35.Miles, M., & Huberman, M. (1994). Qualitative analysis: An expanded sourcebook (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar
- 36.Kirk, J., & Miller, M. L. (1985). Reliability and validity in qualitative research. Newbury Park: Sage Publications.Google Scholar