Another component of family-centered care is cultural competency. According to the EMS-C program, “cultural competence includes possessing the appropriate knowledge, skills, and capacity to provide emergency services to children in a manner that demonstrates respect, sensitivity, and understanding of the unique cultural differences within, among, and between groups” (EMS-C National Resource Center, 1999).
Only a few studies have been able to draw a direct link between cultural competence and health care improvement, although expert opinion strongly suggests a connection among cultural competence, quality of care, and reduced racial and ethnic disparities (Betancourt et al., 2002). These studies are not specific to pediatric patients, but cultural competency is an important issue for the emergency care system in general, not just services for children, particularly because the racial/ethnic distribution of emergency care providers is not well matched to the racial/ethnic distribution of the population, and is even less well matched to the population that uses emergency services most frequently. This disparity can only be expected to increase as the U.S. population continues to diversify at a much faster rate than most health professions and occupations (Heron and Haley, 2001; Cone et al., 2003).
One of the biggest challenges for emergency care providers is language barriers. Professional interpreters are often not available in the field or at an ED. Indeed, interpreters are frequently not used in the ED, even when thought necessary by a patient or provider (Baker et al., 1996). When providers cannot obtain adequate information from a patient interview, they tend to use more resources, such as laboratory and radiographic investigations. One study of language barriers in a pediatric ED revealed that a physician–family language barrier was associated with a higher rate of resource utilization for diagnostic studies and increased ED visit times (Hampers et al., 1999).
One special concern is the use of children as interpreters for their own care or the care of their parents/guardians when they speak English but their parents/guardians do not. Use of children as medical interpreters is common practice in many areas with large immigrant populations (Burke, 2005); often, however, the information that needs to be interpreted is beyond children’s comprehension and may be inappropriate for them (Yee, 2005). Children assuming this role take on a heavy emotional responsibility. Additionally, use of an untrained interpreter can lead to medical errors. In one study, the error rate was highest for the youngest interpreter, an 11-year-old (Flores et al., 2003). Some states have regulations that prevent children from serving as medical interpreters for their parents/guardians, but these rules may not apply in emergency situations. The traditional subordinate role of children can be reversed when they are used as interpreters, and in some