Transcript Document

An Introduction to Culture and
the Importance of Language
Gloria Grijalva, MS
Interpreter Services Manager
Bridging the Gap Trainer
Kaweah Delta Health Care District
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Introduction

If there is no harmony internally; it will be
reflected externally.
Respect
Language
Laws
Beliefs
Kaweah
Delta
Culture
Data
Health
Service
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Ice breaker Exercise
(Ejercicio de rompehielos)
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Name/Department
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What is the next holiday you will
celebrate?
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What generation are you?
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Course Objectives
Define culture and understand the
importance of language
 Identify Legislative, Regulatory and
Accreditation Mandates in health care
 Respond to demographic changes
 Improve the quality of service and
outcomes.
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What is culture?
(Your definition)
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Cultural Competency

“To be culturally competent doesn’t mean
you are an authority in the value and
beliefs of every culture. What it means is
that you hold a deep respect for cultural
differences and are eager to learn, and
willing to accept, that there are many ways
of viewing the world.”
• -Okokon O. Udo, PhD
• Integrative Health and Wellness
• Northwestern Health Sciences University
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Definition of Terms (Handout)
Acculturation
Assimilation
Culture
Cultural
Brokering
Cultural
Awareness
Cultural
Competence
Cultural
Sensitivity
Ethnic
Ethnicity
Linguistic
Competence
Review Handout Race
Together
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Six Compelling Reasons for Achieving
Organizational Cultural Competence:
1.
2.
3.
4.
5.
6.
To meet legislative, regulatory & accreditation
mandates.
To respond to demographic changes.
To address health disparities.
To understand the impact of individual and
organizational culture
To improve the quality of service & outcomes.
To enhance the workplace environment.
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Understanding Cultural Diversity
Individual culture is multifaceted and encompasses:
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Personality, unique style
Internal factors – gender, race, age, sexual
orientation
External influences – society, experiences
Where individuals grow up or live now, religious
affiliation
Organizational influences – seniority, level
within organization, work location
Levels of acculturation
Minority or majority status
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Identifying Visible and Invisible
Cultural Diversity
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Visible
List Examples
(Group work to flip
chart or board)
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Invisible
List Examples
(Group work to flip
chart or board)
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Visible and invisible diversity
encompasses issues related to:
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Race
Color
Class
Age
Experience
Ability
Gender
Ethnicity
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Education
Language
Religion
Politics
Sexual Orientation
Gender Identity
Socio-economic
Status
Resident Status
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Diversity
 “Many
people see diversity as a
lightning rod for conflict.”

Discuss – what does that mean to you?
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Conflict is…
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A perceived or actual incompatibility of
interests, goals, values, and/or resources.
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Diversity
Challenges arise because of differences in
perceptions, norms, expectations and
behaviors.
 The goal is to enhance the communication
and collaboration skills of all team
members who come to the workplace with
a diversity of perspectives and world
views.
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Elements of Cultural
Competence
Awareness of one’s own culture
 Awareness and acceptance of difference
 Understanding the dynamics of difference
 Development of cultural knowledge
 Celebration of diversity
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(Bottle of Wine Handout)
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The table below compares the
concepts of race, culture and ethnicity
Concept
Primary
Characteristic
Race
Inherent,
Genetic –
Biological,
Descent
Physical, Natural
Behavioral
Expression of
preferred
lifestyle
Identity, MultiEthnicity/
Ethnic Group faceted,
‘Political’
Culture
Origin
Associated
Perceptions
Permanent
Upbringing –
Learned
Capable of being
Changed,
Optional
Socially
constructed
Internal or
external
Situational,
Negotiated
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The Legal side of Language and
Culture
Is anyone watching us?
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National Standards for Culturally and
Linguistically Appropriate Services (CLAS)
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•
History
Set of 14 different operational standards
developed by the OMH/DHHS and
published in March 2001. (See handout)
Purpose
To contribute to the elimination of racial
and ethnic health disparities and improve
the health of all Americans
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14 National Recommended
Standards
Created to inform, guide and facilitate
implementation of CLAS
Culturally Competent Care
 Language Access Services
 Organizational Supports for Cultural
Competence
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The Joint Commission
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The Joint commission works to continuously improve the
safety and quality of care provided to the public through
the provision of healthcare accreditation and related
services that support performance improvement in health
care organizations. An independent, not-for-profit
organization, The Joint Commission evaluates and
accredits nearly 15,000 healthcare organizations and
programs in the United States.
New guidelines for hospitals available in 2010 for
implementation in 2011.
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Hospitals, Language, and Culture:
A Snapshot of the Nation
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A report from the Joint Commission and funded
by The California Endowment says that
linguistically and culturally appropriate care is
lacking in many hospitals, and that an
increasingly diverse American population
requires broad new strategies to address their
needs. The study analyzed 60 hospitals across
the country in their efforts to offer culturally
competent care. The report makes
recommendations to hospitals and policymakers
and shares best practices for health care for
diverse populations.
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Title VI of the Civil Rights Act of 1964
According to this federal regulation, all health care
providers receiving federal financial assistance from the
U.S. Department of Health and Human Services are
prohibited from conducting any of their programs,
activities, and services in a manner that subjects any
person or class of persons to discrimination on the
grounds of race color or national origin. A frequent cause
of discrimination on the basis of national origin in health
care settings which often leads to a violation of the Title
VI regulation is the use of ineffective methods of
communication between English-speaking health care
providers and persons, who, because of their national
origin have limited proficiency in using English.
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California Policy
State efforts to promote cultural and
linguistic Competency
• Legislation
• AB 1195 (Coto)
•
Regulation
• Department of Managed Health Care (DMHC)
implementation of SB 853
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Policy Issues – Providers
AB 1195
Even if the provider is language capable
and does not need an interpreter, cultural
competency must be assured.
 Misunderstandings can also result from
racial or socioeconomic differences
 Providers must continually educate
themselves to identify areas of possible
miscommunication
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AB 1195
Requires providers to complete continuing
education courses in cultural competency.
 Based on recommendations from the DHS
& DCA Task Force on Culturally and
Linguistically Appropriate Physicians and
Dentists.
 One-time, 16 credit hours requirement
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Policy Issues – Health Plans
SB853 – Effective Jan. ‘06
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Health plans must provide language services for
communication between enrollees and plan
administrative staff
Health plans must share responsibility with
providers for ensuring culturally and
linguistically appropriate services
Health plans must have information systems
capable of identifying language needs and
measuring quality by language, race, ethnicity
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SB 853 Provisions
Needs Assessment
 Interpretation Services
 Written Translation
 Quality Assurance
 Cultural Competency Reporting
 Audit and Reporting
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Kaweah Delta Health Care
District – Policy #: AP.122
Interpreter Services
Available in KDNet
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DEMOGRAPHICS
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Changing Demographics in the United
States
Demographics have moved beyond black and white – to a
complex mosaic of races and ethnicities
 - 35 million Hispanics
 - 34.5 million Blacks
 - 10.5 million Asian Americans
 - 4 million Native Americans
Most significant trend is the record growth of Hispanic
Americans
Persons with physical and mental impairments are the
largest single “minority” (approx. 49 million).
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(The Village of 100 people Activity Handout)
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Tulare County
Kaweah Delta Health Care
District
Languages Identified by Patients
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1. Achinese (Acehnese)
2. Afrikaans,
3. Arabic
4. Armenian
5. Bengali
6. Bosnian
7. Cambodian
8. Cantonese
9. Chinese
10. Dutch
11. Egyptian
12. Farsi
13. French
14. German
15. Hindi
16. Hmong
17. Illocano
18. Iloko
19. Iroquoian
20. Italian
21. Japanese
22. Kannada
23. Korean
24. Lahu
25. Lao
26. Mandarin
27. Mien
28. Mixteco
29. Persian
30. Philippine
31. Polish
32. Portuguese
33. Punjabi
34. Romanian
35. Russian
36. Spanish
37. Tagalog
38. Tamil
39. Thai
40. Tongan
41. Turkish
42. Urdu
43. Vietnamese
44. American Sign Language
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KDHCD Top 3 Languages
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Spanish
Lahu
Lao
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Spanish
Lao
Lahu
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What are Yours????
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Language Needs
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Lahu
Interpreters needed
Language Line does
not have
Panational has one
Solution –
Test our staff
8 have been tested
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Mixteco
Interpreters needed
Often mistaken for
Spanish speakers
Language Line has
Panational has
limited use
No internal staff
identified
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Indigenous Communities from
Mexico
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Mixteco
Indigenous language from Oaxaca, Mexico
 Is not a derivative of Spanish
 If they speak Spanish, usually a second
language
 Large settlement in Farmersville
 Many are farm workers
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Diet and Health
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Diet and Health
For thousands of years indigenous
people have possessed the
knowledge of how to balance their
diet (in quantity and quality) to
preserve their health.
•They gained this knowledge
throughout the years, primarily
through oral traditions that have
been passed on from generation to
generation.
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Diet & Health
•According to the indigenous
traditions, FOOD is the first
resource that a human being has to
preserve their health.
•A healthy body is the one that
maintains a balance between HOT
and COLD qualities.
•Illness results when an excess of
either destroys this equilibrium.
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HOT - COLD Conception
•According to indigenous beliefs, the
human body, the plants, animals and
minerals possess the quality of being Hot
or Cold.
•Human bodily conditions and stages of
life are also classified as Hot or Cold. Exs:
–Pregnancy, Menstruation are
classified as Hot
–Post-Partum State is classified as
Cold
–At birth humans are Cold, they
reached their maximum heat in
Adulthood and gradually loses this
heat as he/she grow older.
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HOT - COLD Conception
•To restore the equilibrium between
Hot/Cold the opposite quality must be
applied.
•Special diet, herbal remedies, sweat baths,
massages are all used to absorb or
introduce hot or cold into the body. Exs:
–Diarrhea: Is caused by excess Cold.
It is curable by consuming boiled
water, teas (guayaba, estafiate) &
tostadas.
–Constipation: Is caused by excess of
Hot. It is curable by consuming
“regular” water, soft tortillas.
–In post-partum, women shall use
Temazcal and consume Hot Foods:
chicken broth, grilled beef, tostadas,
boiled water.
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HOT - COLD Conception
•Indigenous people categorize foods
according to their Hot and Cold qualities.
•Hot and Cold qualities are related to the
food’s place of origin (cold or hot lands),
to the part of the plant used, and to the
stage of development of the plant/animal.
Ex.:
–The upper parts of the plants (leaves)
are considered hotter than the inferior
parts (roots).
•Plants and animals can transfer their
hot/cold qualities to the dishes they are
used in. Ex.:
–Sugar & chile add hotness to a meal.
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Indigenous Medicine:
A Traditional Approach to Health
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What is Indigenous Medicine?
– Culturally and empirically
based
– Passed from generation to
generation
– A cumulative knowledge
of illnesses and its cures
– Holistic approach to health
– Encompasses the use of
different resources:
-Natural Elements: Herbs,
minerals, animals
-Religion
-Spirituality
-Magic
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Etiology of Indigenous Medicine
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Illness, Health Maintenance,
Religion and Social Relations are
interwoven.
Illness is caused by outside
agents (supernatural, human or
non human) that disturbed the
physical, spiritual or cosmic
balance
Illnesses are attributed to:
– Evil spirits, sorcery and
violation of taboos
– Strong Emotions
– Excess of hot and cold
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Indigenous Medicine – Common Beliefs
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Traditional Medicine
Approaches:
– Herbolaria: Use of
medicinal plants/herbs.
– Midwives: Treatment
during pregnancy.
– Hueseros: Treatment for
bone problems
– Sobadores: Treatment for
muscle pain / sprains
– Shamans: Spiritual realm
of supra-natural conditions
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Traditional Healers
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Religious leaders seen as
community PROTECTORS.
ROLE: Using divinatory and
prophetic skills, healers
discover the CAUSE of the
illness and provide
appropriate treatment.
DIAGNOSIS METHODS:
Baraja, Pulsing, Visionary
Powers
TREATMENT PRACTICES:
Healing ceremonies that
involve use of medicinal
plants, prayers and ritual
ceremonies.
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Types of Healers
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Domestic Level
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–
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•
•
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Mothers, Aunts
Grandmothers
Professional healers:
Parteras
Hierberos
Sobadores
Hueseros
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Lahu
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Lahu (Mussur)
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Earliest documentation known locates them in
Southwestern China
Laos to Thailand
Salt Lake City to Tulare County
Groups:
–
–
–
–
Yellow, - Largest in Tulare County
Black,
Red,
White
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Lahu Health Problems
Diabetes
 High Blood Pressure
 Cancer
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– Colon
– Respiratory - Smoking is a Problem
– Stomach
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Laotian Populations
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Lahu is majority of the minority
– Approximately 1,500 in Visalia
– Tulare County 1,700
Mien, approximately 1,100 in Visalia
 Hmong, approximately 800 in Visalia
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– Approximately 1,800 in Tulare County
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Lao, approximately 400 in Visalia
– Approximately 1,200 in Tulare County
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An Asian View of Cultural
Difference
(Handout)
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CULTURAL & LINGUISTIC
TOOLS
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KDHCD TOOL KIT
Interpreters (6)
Part-Time (2)
Per Diem (3)
Language
Resource
Assistants/Pins
Cultural &
Linguistic
Advisory Board
Hands on
Communication
(ASL)
Health Care
Interpreter
Network (HCIN)
1/18/10
COS HCICP
Internship
Interpreter
Services Policy
AP.122
Waiver of
Interpreter
Services Form
Signage
Spanish
Vidatak EZ
Boards
Spanish test
New KDHCD
applicants
Pacific
Interpreters
Panational
Wristbands
Lt. Blue
SDL Trados
Technologies
software
KDCentral
Intranet info
Interpreter Dept.
Other languages
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Health Care Interpreter
Network (HCIN)
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A collaborative of California hospitals and
health care systems using the latest
technology to share trained health care
health care interpreters. Hospital
videoconferencing devices and telephones
connect within seconds to interpreters on
the HCIN system using a hosted
video/voice call center service.
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HCIN Members
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Arrowhead RMC
Children Hospital Central
California
Fresno Regional Medical
Center
Contra Costa Health Services
Harbor-UCLA MC
Kern Medical Center
Martin Luther King MultiService Ambulatory Care
Center
Natividad Medical Center
Northern Inyo Hospital
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Olive View – UCLA Medical
Center
Rancho Los Amigos National
Rehab Center
Riverside County Regional
Medical Center
San Joaquin General Hospital
San Joaquin County
Behavioral Health Services
San Mateo Medical Center
Ventura County Medical
Center
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Summary

“Linguistically and culturally appropriate
care has a direct impact on quality and
safety and is a growing issue that is not
going to go away.”
– Says Paul M. Schyve, M.D., senior vicepresident,
– The Joint Commission
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Thank you!

Thank you so much for your attendance!

Have a wonderful day!
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Information Source
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Cultural Competence in Health & Human
Services;The Cross Cultural Health Care Program
“Concepts of Diversity: race culture and
ethnicity”; The University of Warwick
California Pan-Ethnic Health Network, Cultural
and Linguistic Access: Legislation and
Regulations 2005; Martin Martinez, MPP, Policy
Director
Lewis, Paul and Elaine, (1984). Peoples of the
Golden Triangle. New York: Thames and Hudson
Inc.
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Additional Resources
Asian American Coalition, Paul Chao,
Executive Director
 Bridging the Cultural Divide in Health
Care Settings, The Essential Role of
Cultural Broker Programs, Retrieved
January 21, 2008, from the World Wide
Web://.georgetown.edu/research/gucchd/nc
cc/documents/cultural_broker_guide_Engli
sh

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Additional Resources
Continued.
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Office of Minority Health, U.S. Department of
Health and Human Services, (2000). National
Standards for Culturally and Linguistically
appropriate Services (CLAS) in Health Care.
Federal Register, 65(247), 80865-80879.
http://www.omhrc.gov/clas/finalcultural1a.htm
U.S. Census Bureau, American FactFinder.
Characteristics of People by Language Spoken at
Home, retrieved 1/10/08;
http://factfinder.census.gov/servletSTTable
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Continued Resources
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Christina L. Cordero, Ph.D., MPH; Division of
Standards and Survey Methods, The Joint
Commission; Hospitals, Language, and Culture:
A Snapshot of the Nation; November 7, 2007
Hospitals, Language, and Culture, Project
Update; October 2007; Juan Lopez: One Limited
English Proficient Man’s Experience at 60
Hospitals
Music retrieved January 22, 2008; Martha
Toledo teca huiini’; berelele; xunaxi xtinne’
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