VII. Communicating With Limited English Speakers in Health and Mental Health Care Settings

Effective communication in a multicultural environment requires linguistic competency. There are numerous definitions of linguistic competence, as noted in Section B4 of this module. Goode and Jones (2003, revised 2004) developed a broad definition of linguistic competence, summarized as follows:

The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic competency requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity.

The most sensitive, inquiry-based approach to patients from culturally and linguistically diverse groups is useless if providers and patients cannot communicate effectively. The rapid growth of the population of patients with limited English proficiency has challenged the health and mental health care systems. Although the federal government and many states have statutory requirements to assure language access, health and mental health care systems lag far behind in (1) recruiting and retaining a multilingual workforce, (2) building the infrastructure, (3) developing and executing policy and procedures, and (4) allocating the necessary resources for linguistic competency.

Numerous studies have documented the negative impact of language barriers on health and mental health care outcomes (Carrasquillo, Orav, Brennan, & Burstin,1999; Karter, Ferrara, Darbinian, Ackerson, & Selby, 2000; Muzyk, Muzyk, & Barnett, 2004; Newcomb & Carmona, 2004; Ngo-Metzger et al., 2003; Westberg & Sorensen, 2005). The data from these studies indicate that individuals with limited English proficiency, for whom no language services are offered, are less satisfied with services, have worse health outcomes, are less likely to return for needed services, and are less likely to understand medications. Further, the potential for medical errors with such patients is increased.

There is a growing realization that linguistic competency is integral to quality of care and that an increasing number of initiatives are focusing on best and evidence-based practices in this area. See the Resources section.