Support for Culturally and Linguistically Appropriate Services in Health and Mental Health Care

  • Date: Jan 01 2001
  • Policy Number: 200120

Key Words: Mental Health

The American Public Health Association,

Recognizing that the rapidly growing foreign-born population exceeds 28 million individuals representing over 10% of the population;1

Recognizing that English is not the primary language of the majority of the foreign-born population or some of their children;1

Acknowledging that limited English proficient (LEP) individuals are often unable to obtain basic information regarding health and access to health care due to the lack of translated materials and that even if LEP individuals are able to access health care, they may not receive appropriate, timely and quality care due to linguistic barriers such as lack of trained medical interpreters or bilingual providers;3,5-24

Understanding, therefore, that quality health care provided to LEP individuals must be linguistically and culturally appropriate;

Understanding that many health care providers do not have clear grasp of the needs of and their obligation to provide meaningful access to LEP individuals;2,3,25-27

And noting that emotional and psychological states are culturally influenced and there is an increased need for health and mental health professionals who speak the language of the client populations, and are knowledgeable about the culture of the client populations served.

Recognizing that Executive Order 13166 mandates 1) each Federal agency to examine the services it provides, and develop and implement a system by which LEP individuals can meaningfully access its services and 2) each Federal agency to ensure that recipients of Federal financial assistance provide meaningful access to their LEP applicants and beneficiaries;4

Recognizing that the Office for Civil Rights has issued a Policy Guidance on LEP individuals related to the Title VI of the Civil Rights Act of 1964 that does not impose new requirements but 1) clarifies the responsibilities of providers of health and social services who receive Federal financial assistance from HHS to provide meaningful access to their services, free of charge, 2) clarifies providers’ obligation to ensure that eligible LEP individuals have meaningful access, and 3) highlight examples of policies and practices that OCR would find compliant and violative of Title VI;2

Recognizing that OMH has published its final report on the Culturally and Linguistically Appropriate Services (CLAS) standards as a set of comprehensive nationally recognized standards of cultural and linguistic competence in health care services delivery;3

Noting that APHA policy 9009: A Call to Reject “English Only” Legislation urged states which have enacted English-only legislation to make provisions so that translation, and culturally and linguistically relevant materials are provided;5

Recognizing that we, as a nation, have moved away from enacting English-only legislation to actively addressing the linguistic and cultural barriers to health care facing our immigrant communities;

Concluding that the above policy tools should be used to ensure quality health care for all residents of United State, therefore,

  1. Expresses endorsement of the Executive Order 13166, OCR Policy Guidance and OMH CLAS standards;
  2. Urges each executive department to issue a guidance mandated by EO 13166;
  3. Urges states and health care providers and institutions to work with the federal agencies for adequate implementation of these measures.


  1. Lollock, L. The Foreign-Born Population in the United States: March 2000, Current Population Reports, P20-534, Washington D.C: U.S. Census Bureau. 2001.
  2. Office for Civil Rights, US Department of Health and Human Services: Title VI of the Civil Rights Act of 1964; Policy Guidance on the Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency. Federal Register. August 30, 2000; Vol. 65, No. 169: 52762-52774.
  3. Office of Minority Health, US Department of Health and Human Services: National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care. Federal Register: December 22, 2000; Vol. 65, No. 247: 80865-80879. www.omhrc.gov/clas. 
  4. The White House: Executive Order 13166—Improving Access to Services for Persons with Limited English Proficiency. August 11, 2000.
  5. APHA. Policy Statement No. 9099: A Call to Reject “English Only” Legislation. APHA Public Policy Statements, 1948 to present, cumulative. Washington, DC: APHA, Current volume.
  6. Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG. Language barriers in medicine in the United States. JAMA 1995;273(9):724-728.
  7. Betancourt J, Jacobs E. Language Barriers to Informed Consent and Confidentiality: The Impact on Women’s Health. JAMWA 2000;55(5):294-295.
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  17. Hu DJ, Covell RM. Health care usage by Hispanic outpatients as a function of primary language. West J Med. 1986;144(4):490-493.
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  19. Perez-Stable EJ: Issues in Latino health care-medical staff conference. West J Med 1987;146:213-218.
  20. Wells KB, Hough RL, Golding JM, et al. Which Mexican Americans underutilize health services? Am J Psychiatry. 1987;144:918-922.
  21. Berkanovic E. The effect of inadequate language translation on Hispanic’s response to health surveys. Am J Public Health 1980;70:1273-1278.
  22. Martinez D, Leone EA, Sternbach J. Language as a barrier in health care. In: Elias Olivares L, Leone EA, Cisneros R, Gutirrez J (eds). Spanish language use and public life in the US. New York: Mouton, 1985.
  23. Hendrickson WD, Rusell IJ, Prihoda TJ, Jacobson JM, Rogan A, Bishop GD. An approach to developing a valid Spanish language translation of a health-status questionnaire. Med Care 1989;27(10):959-966.
  24. Hendrickson WD, Rusell IJ, Prihoda TJ, Jacobson JM, Rogan A, Bishop GD, Castillo R. Development of an initial validation of a dual-language English Spanish format for the Arthritis Impact Measurement Scales. Arthritis Rheum 1989;32(9):153-1159.
  25. Schmidt RE, Ahart A, Shur G. Limited English proficient as a barrier to health & social services. Washington, DC: Macro International; 1995.
  26. Ginsberg C, Martin D, Andrulis D, et al. Interpretation and translation services in health care: a survey of US public and private teaching hospitals. Washington, DC: National Public Health and Hospital Institute: 1995.
  27. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275:783-788.

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