Why Culturally Proficiency?

Cultural proficiency in regard to delivery of health care services to individuals is more than a mere sign on the wall indicating that a certain language is spoken at this establishment. It refers to a concept with a set of standards that means that the health needs of all individuals, regardless of their ethnicity, are being met and that services are being rendered in a manner that accounts for cultural nuances and language differences. Without these considerations, a patient's needs may go unmet and ultimately act as a barrier to future service access.

Cultural and linguistic proficiency is the ability of health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by patients to the health care encounter.

Understanding Cultural Proficiency
Moving Toward Cultural Proficiency

The following graph illustrates the levels of Cultural Proficiency ranging from Cultural Destructiveness at the lower end, to Cultural Proficiency at the upper end. An organization can move up or down the scale at any given time (bi-directional continuum).

Adapted with permission from: Cross, T.L., Bazron, K.W. Dennis, and M. R. Isaccs. "The Cultural Competence Continuum." Toward a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington D.C.: Child and Adolescent Service System Program (CASSP), Technical Assistance Center, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center, 1989; p. 13.

Understanding Each Level

• Cultural Destructiveness - the dehumanization of specific cultures or individuals signifying an underlying bias toward the superiority of the dominant or majority group. Health care practices on this level intend to ignore issues affecting racial and ethnic minorities and promote policies and standards that have an adverse impact on racial and ethnic minorities.
• Cultural Incapacity - the inability to work with diverse populations. Health care practices on this level do not intend to ignore issues or promote policies and standards that have an adverse impact on racial and ethnic minorities; instead, their practices are based on a lack of understanding and ignorance.
• Cultural Blindness - approaches used by and for the majority are perceived as relevant for all others. Health care practices on this level are adopted for "the greater good" of the profession, which is generally the majority perspective. This level is characterized by inability to examine or even recognize existing biases in approaches to practices, education, and research that perpetuates the continued existence and development of models that support stereotypes of diverse populations and thus further promotes prejudice.
• Cultural Pre-Competence - recognition of potential weaknesses and biases within the health care practices and a decision to take action to address the problem. Although this phase is a positive movement, false "comfort" may set in after making only minimal efforts to be responsive to diverse populations. The efforts may only be peripheral and not sufficient to truly address cultural issues.
• Cultural Competence - a demonstrated commitment to racially and ethnically diverse populations in all aspects of the structure and functions of the organization. The commitment is characterized by a sustained, systematic integration and evaluation at all levels of significant collaboration from diverse populations into the infrastructure of the organization.
• Cultural Proficiency - is demonstrated by the centrality of an organization's commitment to diversity and by its external expertise, leadership, and proactive advocacy in promoting health care for diverse populations.

Progress along the cultural competency continuum requires continually assessment of the organization's ability to address diversity, celebrating successes, learning from mistakes, and identifying opportunities for rediscovery. An important point to remember is that actions taken at one point in time may not be sufficient to address diversity issues at another point in time. Today's changing environment demands that efforts to move toward cultural proficiency are more than the "right" and "good" thing to do - they are the essential component of effective health care.