Linguistic Competence and Implicit/Explicit Bias Crosswalk. Linguistically Competent Practice Implicit & Explicit Bias

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1 Linguistic Competence and Implicit/Explicit Bias Crosswalk Component of Linguistic Competence: Provide language interpretation and translation services. Beliefs That Reflect - I don t like treating patients with LEP, because Comply with Title VI, Section 601, of the Civil Rights Act, to ensure meaningful access for patients with limited English proficiency. This it takes too long when I federal statute applies to those health care organizations and practices receiving federal funding (i.e., Medicaid, the State Children s Health have to use an interpreter. Insurance Program [SCHIP], or other sources). - This is the best I can do. I speak enough of the language to get by. They never complain anyway. Participate in training on how to work with interpreters. Support the implementation of the National Standards for Culturally and Linguistically Appropriate Services in your health care setting. - Since my practice does not get reimbursed for providing these services, I will not address the language access needs of my patients. - This is an unfunded mandate, so I prefer not to deal with patients who need these services. - These patients should bring their own interpreter. - The telephone interpreter service is just not convenient, and I don t want to take the time to use it. - As a health care provider, it really should not be my responsibility to get interpreters for my patients. My job is to deliver health care. Provide information to patients with limited English proficiency, and their families, on their rights under Title VI. Assess the quality of and patient satisfaction with interpretation and translation services. Commit to never use children or adolescents as the official interpreter in health care encounters. Educate yourself and other practitioners about the adverse consequences to the health and safety of patients when interpretation services are not provided. Advocate for state legislation to reimburse for interpreter services through Medicaid and/or SCHIP programs. Currently, only 13 states and the District of Columbia offer reimbursement through these sources. Request translated prescription labeling for patients with limited English proficiency. Advocate through medical/health professional associations for such labeling if it is not offered in your state or service area. Seek and share knowledge about providing care to populations with limited English proficiency and their families with colleagues or other professionals.

2 Component of Linguistic Competence: Address literacy. - Most people who live in the United States can read. Know the signs to look for that indicate patients may have low literacy or are not literate. - If patients cannot read, they won t be able to understand information about their health and health care. - Problems reading English are mostly limited to immigrants and refugees. - My primary responsibility is to deliver health care. If patients cannot read, they should go to literacy classes. It is not my problem. - It would embarrass my patients if I ask them if they can read or how well do they read. Use evidenced- based tools to assess patient literacy. See resource section for these tools. Document your patients literacy level in the medical record. Recognize that limitations in English proficiency are in no way a reflection of a patient s level of intellectual functioning. Recognize that patients limited ability to read, speak, and understand English has no bearing on their ability to read, speak, and understand in their language of origin. Encourage your patients to have trusted individuals accompany them for appointments to assist with reading. Allow your patients to audiotape visits so that they can listen again at home and share information with their families. Provide patient educational materials that are in Plain Language and in easy- to- read formats. See resource section for these materials. Use diagrams, photos, illustrations, and electronic devices to share information with your patients. Seek and share knowledge about literacy and its impact on health and mental health care with colleagues and other professionals.

3 Component of Linguistic Competence: Address health literacy. - Patients who are articulate and/or have a good job should have no problems Acknowledge that a significant proportion of the U.S. population has problems with health literacy. with health literacy. Assume individual responsibility for simplifying the complex language of medicine. - Some patients just don t want to follow through on treatment plans no matter how many times I tell them what is needed. Use evidence- based tools to assess health literacy. See resource section of a list of these tools. Use assessment results and evidence- based tools designed to address health literacy to meet the needs of and be responsive to your patients. - Health literacy has little or nothing to do with quality care. I am not willing to assume yet another burden in my practice. Seek and share knowledge about health literacy with colleagues and other professionals. - I can t water down everything I say. I send them to my nurse if they can t understand. That s what nurses are for.

4 Component of Linguistic Competence: Respond to the communication needs of individuals with disabilities. - People with intellectual disabilities simply do not have the capacity to understand health and medical issues. Recognize and respond to the diverse capacity among people with intellectual disabilities to understand and process information, including health information. Document patients ability to communicate about their health and to make decisions in the medical record. - I just talk to the parents or caregivers of patients with cognitive limitations. It is easier that way. - Since the stroke, his speech is so difficult to understand. He should have someone with him during appointments with me. Talk directly to patients using easy- to- understand language and terminology. Ensure compliance with federal statutes that ban discrimination against individuals with disabilities in health care. Seek and share knowledge about providing care to patient populations who have disabilities (cognitive, physical, sensory) with colleagues and other professionals. - It really should not be my responsibility to provide accommodations for blind patients. - I refer patients like these to other practitioners. It takes too much time during appointments to communicate with them.

5 Component of Linguistic Competence: Respond to the communication needs of individuals who are deaf or hard of hearing. I refer these patients to other practitioners who know how to treat those who are deaf or hard of hearing. These patients should bring their own sign language interpreters. Can I trust the sign language interpreter to accurately convey what I am saying? I will be liable if the interpreter makes a mistake. Be knowledgeable of federal or other statutes that ensure that health care is accessible for to patients who are deaf or hard of hearing. Arrange for sign language interpreters for patients who need and/or request this accommodation. Learn about the professional and ethical responsibilities of sign language interpreters. Meet with sign language interpreters to discuss approaches before seeing patients who need this service. Allow sufficient time for patient appointments and consultations when sign language interpreters are present. Ensure compliance with federal statutes that ban discrimination against individuals with disabilities, including those who are deaf, in health care. Seek and share knowledge about providing care to patient populations who are deaf or hard of hearing with colleagues and other professionals.

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