Notes About Terminology
“Cultural competence” and “A framework which emphasizes the importance of maintaining an open attitude and curiosity about each individual and their circumstances; provider and staff self-awareness of their own biases; and a commitment to engage in ongoing self-reflection..” This toolkit uses “cultural competence” to refer to: increased understanding of individuals and families and their experiences; positive, affirming attitudes towards them; the skills to develop the provider-patient trust necessary for excellent health care, and the sustained provider and organizational behaviors that demonstrate continuous improvement. This is distinguished from clinical competence: a separate set of knowledge, attitudes, skills, and behaviors needed to deliver responsible and equitable diagnosis, treatment of symptoms and disease states, and preventive care.
The authors use the term “cultural competence” due to the widespread use of this terminology in the regulations governing health care training and medical education. – for instance, by the U.S. Department of Health and Human Services1E.g., Department of Health and Human Services Office of Minority Health, NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH AND HEALTH CARE: A BLUEPRINT FOR ADVANCING AND SUSTAINING CLAS POLICY AND PRACTICE (April 2013), https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedCLASStandardsBlueprint.pdf.., Association of American Medical Colleges2AAMC, IMPLEMENTING CURRICULAR AND INSTITUTIONAL CLIMATE CHANGES TO IMPROVE HEALTH CARE FOR INDIVIDUALS WHO ARE LGBT, GENDER NONCONFORMING, OR BORN WITH DSD, supra n.1., and National Quality Forum3National Quality Forum, A COMPREHENSIVE FRAMEWORK AND PREFERRED PRACTICES FOR MEASURING AND REPORTING CULTURAL COMPETENCY (April 2009), http://www.qualityforum.org/projects/cultural_competency.aspx.. However, we embrace the “A framework which emphasizes the importance of maintaining an open attitude and curiosity about each individual and their circumstances; provider and staff self-awareness of their own biases; and a commitment to engage in ongoing self-reflection.” framework, which emphasizes the importance of maintaining an open attitude and curiosity about each individual and their circumstances, provider and staff self-awareness of their own biases, and a commitment to engage in ongoing self-reflection.4E.g., Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998; 9(2):117-125. In addition, true cultural competence requires providers and staff to appreciate the individual and intersectional differences that arise within communities with respect to race, ethnicity, gender, social circumstance, country of origin, religion, and other identity factors, and tailor their care appropriately. When a health provider assumes cultural competence to be a simple matter of mastering knowledge about characteristics shared by people, it may mislead the provider into thinking they know more than they actually do, and blind them to critical facts about their patient, undermining the provider-patient relationship and resulting in suboptimal care. Over-emphasis on provider “competence” also can blind a provider to racial, ethnic and cultural dynamics in the provider-patient relationship and reinforce racial, ethnic and cultural hierarchies.
In short, the authors of this toolkit have chosen to adhere to the language of “competence” – because of its general acceptance in health care professions and in the literature, and to emphasize that the knowledge, attitudes and skills emphasized here – including the skill of cross-cultural communication – are not optional or dispensable. However, the “humility” framework is equally important for good care.
Use of “LGBTQIA”. The authors of this toolkit recognize that words matter and that the terminology used for self-identification of individuals and populations with minority sexual orientations, gender identities, gender expressions, and The biological process through which chromosomes, gonads, hormones, internal sex organs, and genitals change from conception through adolescence. continues to evolve. For example, some individuals may not be comfortable with the word “An umbrella term to describe individuals who do not identify as straight and/or cisgender. Also a slur used to refer to someone who is not straight and/or cisgender. Due to its historical use as a derogatory term, and how it is still used as a slur in many communities, it is not embraced or used by all LGBTQ people. The term “queer” can often be use interchangeably with LGBTQ (e.g., “queer people” instead of “LGBTQ people”).” while others may self-identify primarily as An umbrella term to describe individuals who do not identify as straight and/or cisgender. Also a slur used to refer to someone who is not straight and/or cisgender. Due to its historical use as a derogatory term, and how it is still used as a slur in many communities, it is not embraced or used by all LGBTQ people. The term “queer” can often be use interchangeably with LGBTQ (e.g., “queer people” instead of “LGBTQ people”).. In addition, some individuals may prefer to use the term “attractional” or “affectional” orientation instead of the term “sexual” orientation to describe their identities. Others may use “A term sometimes used by some members of the African American or Black community to express a non-straight sexual orientation without relying on terms and symbols of European descent.,” “A gender identity label often used by people who do not identify with the binary of man/woman. Also an umbrella term for many gender non-conforming or non-binary identities (e.g., agender, bigender, genderfluid).” or “nonbinary” to define themselves. Diverse sub-populations within the community have their own preferred terms. For example, within the An underground subculture consisting of mainly Black and Latine members of the LGBTQI+ community who represent their Houses by ‘walking’ or competing in categories to earn recognition and awards within their community. ‘Houses’ are chosen families that individuals compete with and often live with (see Family). Walk categories are often representations and performances of the barriers that Queer and Trans People of Color (QTPOC) face in accessing formal employment, housing, and public services, e.g., passing as cisgender, performing masculine and feminine stereotypes, and conspicuous wealth. there are such terms as “A term is used within the Ballroom scene (see House/Ballroom culture) to refer to a trans and femme-presenting woman.” and “A term is used within the Ballroom scene (see House/Ballroom culture) to refer to gay/bi/same-gender-loving cisgender men.,” which recognize a diversity of gender identities and gender expressions. While recognizing that any terminology used will not be inclusive of all, this toolkit will use the terms The type of sexual, romantic, emotional/spiritual attraction one has the capacity to feel for some others, generally labeled based on the gender relationship between the person and the people they are attracted to., The internal perception of one’s gender, and how they label themselves, based on how much they align or don’t align with what they understand their options for gender to be., and The external display of one’s gender, through a combination of clothing, grooming, demeanor, social behavior, and other factors. Gender expression varies depending on culture, context, and historical period. Also referred to as “gender presentation.” (SOGIE), and The biological process through which chromosomes, gonads, hormones, internal sex organs, and genitals change from conception through adolescence., to refer to broad domains of identity. This toolkit uses A woman who is primarily attracted romantically, erotically, and/or emotionally to other women. Women and non-binary people may use this term to describe themselves., Experiencing attraction solely (or primarily) to some members of the same gender. Can be used to refer to people of any gender who are attracted to other people of the same gender. Also an umbrella term used to refer to the queer community as a whole, or as an individual identity label for anyone who is not straight., A person who experiences attraction to some people of their gender and another gender. Bisexual attraction does not have to be equally split, or indicate a level of interest that is the same across the genders an individual may be attracted to. Often used interchangeably with “pansexual”., A gender description for someone who has transitioned (or is transitioning) from living as one gender to another. Also an umbrella term for anyone whose sex assigned at birth and gender identity do not correspond in the expected way (e.g., someone who was assigned male at birth, but does not identify as a man)., An umbrella term to describe individuals who do not identify as straight and/or cisgender. Also a slur used to refer to someone who is not straight and/or cisgender. Due to its historical use as a derogatory term, and how it is still used as a slur in many communities, it is not embraced or used by all LGBTQ people. The term “queer” can often be use interchangeably with LGBTQ (e.g., “queer people” instead of “LGBTQ people”)., intersex, and Experiencing little or no sexual attraction to others and/or a lack of interest in sexual relationships/behavior. Asexuality exists on a continuum from people who experience no sexual attraction or have no desire for sex, to those who experience low levels, or sexual attraction only under specific conditions. Sometimes abbreviated to “ace.” spectrum to broadly refer to people with these diverse identities, while aware that there are more specific cultural, linguistic, and other self-identifications that, while not specifically named, are intended to be included. It is important for providers and staff to recognize the full range of sexual, attractional and gender identities and expressions, rather than make assumptions about their patients, and cultural competence/humility trainings should convey this message.5Some researchers and policymakers have begun to refer to “sexual and gender minorities” when discussing individuals and communities. This term has the advantage of being inclusive and avoiding specific labels that some individuals and communities do not recognize as appropriate for their experience. However, the term is regarded by many as excessively clinical, and as failing to acknowledge the distinct cultures and histories of communities and their differences from the histories and experiences of communities defined by race or ethnicity.
Additionally, the authors of these guidelines are acutely aware of the important historic, social, and political context for this work to improve health, as part of a larger movement towards health equity. Every person has multiple aspects of their identity in addition to their The type of sexual, romantic, emotional/spiritual attraction one has the capacity to feel for some others, generally labeled based on the gender relationship between the person and the people they are attracted to., The internal perception of one’s gender, and how they label themselves, based on how much they align or don’t align with what they understand their options for gender to be., The external display of one’s gender, through a combination of clothing, grooming, demeanor, social behavior, and other factors. Gender expression varies depending on culture, context, and historical period. Also referred to as “gender presentation.”, and The biological process through which chromosomes, gonads, hormones, internal sex organs, and genitals change from conception through adolescence.. This toolkit is not intended to, and could not, adequately address the disparities and inequities based on sex, age, race, ethnicity, language, socioeconomic status, disability, national origin, immigration status, geographic location, and other factors. Any training on cultural competence should include discussion of these multiple lived experiences, with their compounding and cumulative impacts on access to services and health outcomes.
“A term referring to providers and other staff who undergo trainings, in order to underscore the goal of continuous learning rather than a one-time communication of a defined set of facts.” vs. “trainees”. This toolkit uses ‘A term referring to providers and other staff who undergo trainings, in order to underscore the goal of continuous learning rather than a one-time communication of a defined set of facts.” rather than “trainees” to refer to providers and other staff who undergo trainings, in order to underscore the goal of continuous learning rather than a one-time communication of a defined set of facts. We also encourage the use of best practices in A theory of learning that differentiates the routinely paternalistic approach to instruction for child learners from self-directed and self-motivated approaches taken when instructing adult learners. Adult learning values the expertise and knowledge of the learner and builds on existing experiences to develop new skills. The educator as facilitator should recognize and validate existing expertise in learners and use the learner’s experiences as grounds for discussion. Instead of disseminating knowledge to learners in a lecture, the facilitator is one of many resources available to learners and provides additional resources. to optimize the effectiveness and impact of the trainings.