Principles for Cultural Broker Programs in Health Care
care organizations should carefully consider the values and
principles that frame their approach to the provision of
services and supports and that govern their participation
in community engagement. A major value of cultural and linguistic
competence involves extending the concept of self-determination
beyond the individual to the community (Cross et al, 1989;
Goode, 2001). Communities have the inherent ability to recognize
their own problems, including the health of their members,
and to intervene appropriately on their own behalf (Goode,
2001). The NCCC adopted the following principles for community
engagement (Brown, Perry, & Goode, 2003) based on this value:
determine their own needs.
members are full partners in decision-making.
should economically benefit from collaboration.
should benefit from the transfer of knowledge and skills.
that govern community engagement are commensurate with those
of cultural brokering. Similarly, the following principles
are essential to developing and sustaining effective cultural
AND LINGUISTIC COMPETENCE GUIDE CONNECTIONS WITH COMMUNITY
When patients at La Clinica Latina at the Ohio State University Medical Center
first see clinic co-director Cregg Ashcraft, M.D., they see a non-Hispanic male
physician and assume he doesn’t speak Spanish. Ashcraft, who grew up in
Mexico, and later practiced there and in many Latin American countries, says
his bilingual skills are essential to providing primary and preventive health
care to a Latino population that is mostly undocumented and low income. He requires
that Spanish-speaking clinicians provide the array of services offered by this
clinic. Many of the providers and staff represent the patients’ diverse
countries of origin. This diversity acknowledges group differences among the
Latino population. Ashcraft says his language skills and experience guide his
effort to “ understand as best as I can the situation that people are in.” Ashcraft
has assumed the role of cultural broker,both as a physician in his clinical practice
and as an administrator influencing policy supporting the use of cultural brokers.
brokering honors and respects cultural differences
is a high degree of diversity within any given community.
This diversity may not be readily apparent to individuals
and organizations that seek to provide services to these
communities. Cultural broker programs must be attentive
to how community members identify themselves. Self-identity
is influenced by historical, social, economic, generational,
and other cultural factors.
is essential that health care organizations:
and respond to cultural differences within communities,
including those whose members speak the same language;
the strengths of bicultural and multicultural practitioners
and staff; and
knowledgeable of group differences including how individuals
and respecting diverse characteristics and the complexity of these dynamics
in providing culturally and linguistically
competent service delivery.