Language Access Services Strategies for Effective Language Access for the AAPI community Valerie Huang, MA, CHI, Language Services Program Manager
Objectives Define language access and the role it plays in overall patient safety, satisfaction and quality of care from the AAPI perspective Have an overview of the legal requirements for providing access to programs and services for individuals who are limited English proficient (LEP) Learn about the challenge healthcare providers and administrators typically encounter when implementing an effective Language Access Plan Review the recommended options, strategies for effective language service program for the AAPI community, with the ultimate goal of achieving optimal outcomes for all 2
Critical Issues Facing Asian Americans and Pacific Islanders- Whitehouse Initiative on Asian American and Pacific islanders
Language Diversity and English Proficiency Among AAPIs Asian American population in the United States has the highest proportion of residents who speak a language other than English at home Among Asian languages spoken at home, Chinese is the most prevalent (2.7 million speakers, with about 472,000 and 454,000 specifying Mandarin and Cantonese, respectively), followed by Tagalog (1.6 million), Vietnamese (1.4 million), and Korean (1.1 million) The linguistic diversity of South Asian immigrants is also evident, with about 2.8 million speakers of South Asian languages Asian Americans also have the highest rates of limited English proficiency at 35 percent, defined by the Census Bureau as those who do not speak English very well
Barriers to Healthcare Among AAPI Language and culture Health literacy Health insurance Immigrant Status Even with Insurance, Language Barriers could undermine Asian Americans access to care
Many AAPI patients come with family members or friend who can interpret for them. Isn t this enough to communicate with them in the clinical setting? 7
Reasons Why We Shouldn t Use A Lack of impartiality Family Interpreter Medical understanding Impropriety or discomfort with personal issues Stress on relationships Inaccurate interpretations have serious Consequences
Federal Landscape For Language Rights In Health Care 9
Title VI of the 1964 Civil Rights Act No person in the United State shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal finanical assistance. Translation: if your institution receives Federal funding of any kind ( e.g. Medicaid, Medicare, research grant etc.), you must provide language access services. Working with Interpreters 10
Executive Order 13166 and DOJ LEP Guidance In August 2000, Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, was issued Directs agencies to draft Title VI guidance specially tailored to its recipients that is consistent with the LEP Guidance issued by the Department of Justice Requires that recipients of Federal funds follow the Title VI compliance standards provided in the DOJ s LEP Guidance 11
National CLAS Standards The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations Principal Standard (1) Governance, Leadership, and Workforce(2-4) Communication and language Assistance (5-8) Engagement, Continuous Improvement, and Accountability ( 9-15) https://www.thinkculturalhealth.hhs.gov/assets/pdfs/enhancednationalclasstandards.pdf
National CLAS Standards Offer Communication and Language Assistance 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area
Affordable Care Act Section 1557 Communication with Individuals with Limited English Proficiency Language assistance services must be provided in a timely manner Minor children, family members, or friends can no longer be relied upon as medical interpreters or to facilitate communication - only exceptions: in emergency situations Bilingual staff must be trained and tested to serve as medical interpreters and must be able to demonstrate their proficiency in doing so Limited English proficient individuals can decline the services of an interpreter, but providers may still use language services to assist their communication with a patient 14
What is the difference between a healthcare interpreter and a bilingual employee? A bilingual individual is a person who has some degree of proficiency in two languages A bilingual employee may provide direct services in both languages but, without additional training, is not qualified to serve as an interpreter Professional interpreter An individual with appropriate training and experience who is able to interpret with consistency and accuracy and who adheres to a code of professional ethics 15
Common Causes of Adverse Events for LEP and Culturally Diverse Patients Uses of family member/ friends or nonqualified staff as interpreters Use of basic language skills to get by Cultural beliefs and traditions affecting patent cares e.g. minimizing reports of pain deferring to authority figures 16
Consideration for Providing Language Access Services in Your Agency Understand how LEP individuals interact with your agency Identification and assessment of AAPI LEP community Procuring language services Training of staff on policies and procedures Provide notice of language assistance services Monitoring, evaluating and update the language access policy, plan and procedure
Right to Interpreter Services Language Access Plan To address initiation's responsibilities as a f federal financial funds relating to the needs of individuals with limited English language skills. The plan has been prepared in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000 et seq.; 45 CFR 80, and its implementing regulations, which state that no person shall be subjected to discrimination on the basis of race, color or national origin. Patient/Family Care Policy Limited English Proficient (LEP) and Deaf/ Hard of Hearing (D/HOH) individuals and their guardians are to be afforded meaningful participation in their health care processes equal to their hearing and English speaking counterparts. Inform Patients and families availability of language Services
Identification of LEP Factors used to determine the title VI obligation to ensure meaningful access to LEP persons Patient / family languages are identified when an appointment is being scheduled or when the patients are being admitted to the hospital If the patient/ caregiver requires an interpreter because s/he speaks a language other than English, the language is noted in the header of the computerized medical record
Identifying Patient s Preferred Language Determine whether an interpreter's services are needed at time of scheduling appointment- via phone or in person Identify the patient's preferred language for discussing health care, involve patients and families in the care process Assuring proper documentation of the LEP patient encounter 20
Interpreter vs. Translator Interpreter Render a message orally, or in signed language, from one language into another Translator Render written text from one language to another in writing. writing and editing skills. A reader does not have the opportunity to seek clarification Note: An interpreter is not usually a qualified translator 21
Certified VS. Qualified Interpreters Qualified interpreter Linguistic proficiency in source and target languages Medical Terminology Bilingual-Knowledge of dialectic variations Complete 40-60 interpreter training program Certified interpreter Qualified interpreter Certified by a professional organization or government entity through rigorous testing based on appropriate and consistent criteria. 22
Provided Translated Written Documents Remain Compliant What documents should be translated? Notices of free language assistance Notices of eligibility criteria for services Informed consent documents Intake forms that have clinical consequences Discharge instructions Complaint forms Professional translation services Quality assurance process Easy access for staff
Challenge healthcare providers and administrators typically encounter when implementing an effective Language Access Funding Education Talent management Accountability Quality improvement Access Plan
Access Overcoming the Barriers Improving the Utilization of Language Services by Asian Americans and Pacific Islanders Promote the accessibility of language services Improve language access through technology Promote the language services as free. This is the strongest motivation for All AAPI LEPs to actually use the service Funding How can provides work with advocates and policy makers to improve language access funding? Is legislative or administrative action needed?
Overcoming the Barriers Improving the Utilization of Language Services by Asian Americans and Pacific Islanders Education Community engagement and empowerment Language assistance resources Diffusing linguistic and cultural competence Talent management Increasing the availability of qualified Interpreters Retention Leveraging bilingual staff Compete for healthcare interpreter professionals
Overcoming the Barriers Accountability Drivers for Change Linguistic diversity in the health care workforce Work force development-prepare for the future Professional certificate programs Quality improvement Improve primary language data collect Quality improvement processes -efficiency and quality of language services
Everyone Matters One Team Approach Collaborations with office of Health Equity and Diversity and Inclusion Clinical staff orientation and In-services by Interpreter services Guiding staff in providing the appropriate type of interpreter service Including Interpreter on the care team
Patient Family Centered Care Provide timely services: reduce wait time for patient, families and providers by utilizing remote interpreting services Designate one of the care team members to coordinate interpreter requests Evaluate and validate the need for extended services ( sign and initial on the interpreter verification form) Ensure no service interruption: contact IS immediately for any hardware/software issues Interpreter Services
Interpreter Resources at NCH NCH provides interpreter services to patients and families with limited English proficiency and to patients who are deaf or hard of hearing 24 hours per day, 7 days per week at all campus locations. Resources available for the provision of services to LEP families: Administrative team: Program manager, Staffing coordinator, Schedulers One site / Face to Face Staff interpreters : Spanish, Somali, Nepali, Arabic and French Agency interpreters ( all languages) Remote Interpreter Services (Phone/Video) All languages Video Relay Services American Sign Language Ohio Relay Service 7-1-1 or 1-800-750-0750 Interpreter Services
Quality Assurance for Interpretation and Translation Qualified/certified interpreters language competency and interpreter skill assessment upon hire All interpreters complete medical interpreter education (40 hours+) Ensuring ongoing, periodic training and assessment of staff Interpreter s competency is reviewed annually
Direct Dial interpreter Services for patients and families Interpreter Services
Resources and Assistance Needed Funding Technical assistance Availability of trained interpreter in all languages Resource for medical interpreter continued education Scheduling-technology to support volume, manage complexity and diversity of requests Professional healthcare interpreter certificate
References Whitehouse Initiative on Asian American and Pacific Islanders https://www.whitehouse.gov/administration/eop/aapi/about Responding to the Language Challenge: Kaiser Permanente s Approach The Permanente Journal/ Summer 2009/ Volume 13 No. 3 National Standards for Culturally and Linguistically Appropriate Services in Health Care http://minorityhealth.hhs.gov/ Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals https:// www.jointcommission.org https://www.jointcommission.org/topics/health_equity.aspx Limited English Proficiency a federal interagency website https://www.lep.gov/ Language Access Planning and Technical Assistance Tool Migration policy institute Department of Justice Language Access Plan https://www.justice.gov/sites/default/files/open/legacy/2012/05/07/language-accessplan.pdf