FEDERAL LEVEL

Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance. The Act provides the legal foundation and rationale for developing culturally competent programs and organizations. To assist federal agencies that provide financial assistance, the wide variety of recipients that receive such assistance, and the actual and potential beneficiaries of programs receiving federal assistance, the U.S. Department of Justice has published a Title VI Legal Manual. The Title VI Legal Manual sets out Title VI legal principles and standards. Additionally, the Department has published an Investigation Procedures Manual to give practical advice on how to investigate Title VI complaints. Also available on the Federal Coordination and Compliance Website are a host of other materials that may be helpful to those interested in ensuring effective enforcement of Title VI.

The National Standards for Culturally and Linguistically Appropriate Services (CLAS)  in Health and Health Care were developed by the Office of Minority Health, U.S. Dept. of Health and Human Services, and are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for health and health care organizations to provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.  This website contains a tremendous wealth of valuable information, including the full text of all 15 CLAS Standards, and is well worth exploring for anyone interested in increasing their understanding of cultural and linguistic competence.

Executive Order 13166: Improving Access to Services for Persons with Limited English Proficiency. The Executive Order requires Federal agencies to examine the services they provide, identify any need for services to those with limited English proficiency (LEP), and develop and implement a system to provide those services so LEP persons can have meaningful access to them.  The Executive Order also requires that the Federal agencies work to ensure that recipients of Federal financial assistance provide meaningful access to their LEP applicants and beneficiaries.

Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons.  This Guidance sets forth the compliance standards that recipients of Federal financial assistance must follow to ensure that their programs and activities normally provided in English are accessible to limited English proficient persons and thus do not discriminate on the basis of national origin in violation of Title VI's prohibition against national origin discrimination.

STATE LEVEL

PHYSICIAN EDUCATION: In 2005 the NJ State Legislature enacted a law requiring the New Jersey Board of Medical Examiners in consultation with the Commission on Higher Education to prescribe requirements, by regulation, for physician training in cultural competency.  The regulations relating to cultural competency training were adopted in their final form on April 7, 2008.  The legislation requires that all medical schools in New Jersey provide instruction to their current and future students in cultural competency. This instruction is required as a condition of receiving a diploma from a college of medicine in New Jersey. New Jersey medical schools are also required to provide cultural competency CME instruction for licensed physicians who were not required to and did not receive cultural competency training in their medical school curriculum. The required curriculum in cultural competency training has become more prevalent in medical schools since 2005. The curriculum required cannot be assumed to be included in medical, osteopathic and podiatric schools operating outside of New Jersey.

LAW ENFORCEMENT: In 2016, Governor Chris Christie signed a bill requiring police officers in NJ to undergo cultural competence/diversity training. The bill requires the state Department of Law and Public Safety to develop cultural diversity training materials and an online tutorial for local police chiefs, who are themselves required to draft a "cultural diversity action plan." The attorney general’s directive implementing the legislation and creating a Continuing Education Institute may be found here.  A related news article can be found here.

NON-GOVERNMENTAL

The National Center for Cultural Competence (NCCC) has been in existence since 1995 and is a component of the Georgetown University Center for Child and Human Development. Housed within the department of pediatrics of the Georgetown University Medical Center, the Center is funded in part from the Maternal and Child Health Bureau, Health Resources and Services Administration of the U.S. Department of Health and Human Services. The NCCC defines the following framework for organizations hoping to improve their level of cultural competence:

Cultural competence requires that organizations:

• have a defined set of values and principles, and demonstrate behaviors, attitudes, policies and structures that enable them to work effectively cross-culturally.
• have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve.
• incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.

Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum. (adapted from Cross et al., 1989)