Health Care Navigation & Resources Kheir Mugwaneza, Immigrant Health, Center for Inclusion Health. AHN Alicia Moore, Senior Project Manager, Executive Nursing. AHN

Agenda Introduction Why It Matters Current State: AHN Policy and Interpretive Services Additional Community Resources Call to Action 2

Current Laws and Regulations Introduction AHN Summary Establishing a strategy to assist limited English proficiency patients Stratus Video Remote (VRI)/Phone (OPI) Interpretation implementation Interpretive service standardization and expansion Services included: Video Phone In-person Document Translation Inclusive of inpatient and Allegheny Clinic facilities Improved staff/provider education on diverse patient needs Current Laws and Regulations Title VI of the Civil Rights Act, 1964 Executive Order 13166 Title III of the Americans with Disabilities Act, 1990 3

Current Laws and Regulations: Title VI Services that are more limited in scope or lower in quality Unreasonable delays in the delivery of services Limiting participation in a program or activity Providing services that are not as effective Examples of practices which may violate Title VI: Any organization or individual that receives Federal financial assistance, either directly or indirectly, through a grant, contract or subcontract, is covered by Title VI. Example of covered entities: Hospitals Health service providers Nursing homes 4

Why It Matters Clear communication Mutual understanding Instructions Potential litigation Healthcare Barriers Treatment/diagnosis misunderstanding Fewer visits Delay in preventative services Exacerbation of chronic condition Longer hospital stays Poor patient satisfaction rates Fiscal impact 5

Accessing AHN Interpretation Resources Review of Network Policy Current Services Provided Obtaining Interpretive/Translation Services Defining the Strategy Ahead 6

Policy Overview – Introduction Policy Statement Effective patient-provider communication is necessary for quality and patient safety. Research shows that patients with communication problems are at an increased risk of experiencing preventable adverse events, and that patients with Limited English Proficiency (LEP) are more likely to experience adverse events than English speaking patients. Patients may have hearing or visual needs, speak or read a language other than English, experience difficulty understanding health information, or are unable to speak due to their medical condition or treatment. Additionally, some communication needs may change during the course of care. Goal: To ensure provision of the most effective communication between the patient and his/her provider in a manner that meets the patient's needs. The key to deciding what aid or service is needed to communicate effectively is to consider the nature, length, complexity, and content of the communication, as well as, the person's preferred method(s) of communication. AHN entities are encouraged to consult with the person with a disability to determine what aid or service is appropriate. Codifies AHN’s commitment to patient centered care through effective communication Outlines best practices for effective communication and obtaining interpretive and/or translation services Applies to AHN hospitals, Surgery Centers, Allegheny Clinic facilities 7

Policy Overview – Summary Any patient and/or companion who is limited English proficient or deaf or hard of hearing must be offered interpreter services or auxiliary aids free of charge at point of contact Family, friends and non-qualified employees may not be used as interpreters unless a qualified interpreter is declined by the patient and the former is requested Minor children should never be used as interpreters; they may be used for non-critical communication In emergency situations, it is appropriate to provide any necessary medical treatments and use best efforts to provide the most effective communication possible until the interpreter arrives  initial point of contact includes (registration, emergency department, outpatient or inpatient area). 8

Policy Overview – Summary Examples of critical points where qualified interpreter is required: Admission for inpatient care (Patient Rights, Advance Directive, Admission Assessment) Informed consent Treatment and procedure explanations and results Discharge As deemed necessary by caregivers to provide information to the patient or to receive information from the patient Full policy available on PolicyStat: Communication: Auxiliary Aids and Language Assistance Services/Interpreters 9

*Video Remote Interpretation Current Resources *Video Remote Interpretation Phone Interpretation In-person Interpretation TDD/TTY Devices Document Translation 10

Obtaining Interpretation/Translation Services* Contact House/Hospital Operations Administrator or Unit Manager Can coordinate the delivery/pick-up of interpretation devices such as I-Pads or phones Note site-specific variations in who to contact HOA’s are first point of contact on off-shifts Call/Email Stratus Video for Document Translation Requests for translation at AHN must be submitted directly from the facility to the Document Translation Coordinator Iris Dittmaier idittmaier@stratusvideo.com 727-500-1534 Ext. 565 Requests may also be submitted online https://www.stratusvideo.com/stratus-word/ Coordinate Directly with Community Providers Includes: Center for Hearing and Deaf Services (HDS) TransPerfect Truspoint Reference Hospital or Facility Flow Chart When Needed Available as addendum to policy on PolicyStat Flow charts available for all applicable faciltities Includes directions for I-Pad/phone use Contact Variations: Nursing Administration (WPH); Patient Access staff (WXF); Patient Relations/LC (SVH); or Case Management/Social Work 11

Strategy Moving Forward Education Resources Policy/Process Partnership Standardized and improved education around culturally and linguistically appropriate care Expansion of high quality, contracted service providers to support the network (In-person, Video/Phone, Document Translation) Improved aids for language identification and service requests Review of current system processes to improve clarity on documentation requirements, procedures for identifying appropriate interpretation modality with patient Strengthen medical, nursing, ancillary services collaboration and coordination regarding communication aid/services 12

Social Service Providers Additional Resources Online Resources Social Service Providers Practical Guide to Culturally Competent Care: http://www.thinkculturalhealth.hhs.gov HSS Office of Minority Health: http://www/omhrc.gov Federal Interagency Working Group on LEP: http://www.lep.gov National Consortium for Multicultural Education for Health Professionals: http://culturalmeded.standford.edu Refugee Resettlement Agencies: AJAPO; JFCS; NAMSC Latino Immigrants: Casa San Jose, Latino Community Center, Latino Family Center ISAC (Immigrant Services and Connections): 412-742-4200 13

Additional Resources Think Cultural Health Resources Office of Minority Health Resource Center Resources Education (Nurses, Physicians, Administrators) Culturally and linguistically competent nursing care, including a self-awareness tool and strategies for delivering . Patient-centered care. Communication and language assistance, including how to work effectively with an interpreter. Organizational CLAS-related activities, including strategic planning, staff training, and community partnerships. 14

Join AHN Immigrant Health Quarterly Meetings Call to Action Join AHN Immigrant Health Quarterly Meetings Be a champion at your facilities Plan events and activities to raise awareness April: National Minority Health Month June: Immigrant Heritage Month 15

Questions ? 16