Better communication, Better Care: Where to start?” Jelena Pasalic,BS TB & Refugee Health Program Janae Duncan, BS Center for Multicultural Health

Overview of the issues: Today, over 11% of the U.S. population (31 million people) is foreign born. One child in five is an immigrant or an immigrant’s child. 47 million U.S.residents over the age of four speak a language other than English at home (18% of the population).

1/3 of the foreign born population of the U.S. arrived in the decade between New arrivals show a great diversity of culture and languages. More than 380 languages are now spoken in the U.S.

Common Foreign Languages in the U.S. Spanish Chinese French German Tagalog Vietnamese

Common Foreign Languages in the U.S. (continue…) Korean Russian Arabic and Japanese

Studies show that patients speaking limited English: Receive less than optimal health care Receive less preventive care They are at increased risk of experiencing medical errors Have fewer physician visits They are less likely to return for follow-up visits They are less satisfied with their health care

What Can Organizations Do? Increase access to care Improve quality of care, health outcomes, and health status Increase patient satisfaction Enhance or ensure appropriate resource utilization

Increase Access to Care Providing linguistically and culturally appropriate trained medical interpreters at the time of service. (Title VI of the Civil Rights Act of 1964) Increase racial and ethnic diversity among professionals.

Quality of Care The provision of linguistically and culturally appropriate trained medical interpreters can improve quality of care. Many LEP patients receive poor medical diagnosis and inappropriate services, as a result of the failure of medical staff to speak/provide medical interpreter.

Patient Satisfaction Appropriate language assistance service (LAS) implementation can improve patient satisfaction. LEP patients have higher satisfaction with their health care providers when quality language services were available to them.

Resource Utilization The implementation of LAS can enhance appropriate resource utilization. Physicians have performed more frequent and more expensive testing when a bilingual physician or professional interpreter was not available. The lack of interpretation services has resulted in more frequent hospital admissions. The duration of patient visit has increased when LAS were not in place.

Title VI of the Civil Right Act of 1964 Title VI of the Civil Right Act of 1964 states: “No person in the United States shall, on 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 financial assistance. To avoid discrimination based on national origin, Title VI and its implementing regulations require recipients of Federal financial assistance to take reasonable steps to provide meaningful access to LEP persons.

Title VI of the Civil Right Act of 1964 The purpose of this Act is to improve the health of racial and ethnic minority populations through the development of effective health policies and programs that help to eliminate disparities in health.

Who must comply with Title VI requirements? All public and private entities receiving Department of Health and Human Services federal financial assistance are “covered entities”. State, county and local health and welfare agencies Hospitals and nursing homes Managed care organizations Head Start programs Contractors/vendors

Who Can You Use As An Interpreter? Trained bi-lingual staff On-staff interpreters Contract interpreters Telephone interpreters

Who Should Not Serve as a Health Interpreter: Patient’s family and friends Children under 18 y.o. Other patients and visitors Volunteers

Professional Interpreters! What can they do for me? Reduce liability, help ensure appropriate utilization, increase client compliance and satisfaction with services Provide a quality service - accuracy and completeness - trained to handle difficult situations - code of ethics

Professional Interpreters! What can they do for me? Assure effective communication by facilitating the communication between both the client and provider. Effective use of time during the clinical encounter. Improved outcomes for the client.

Bridging the Gap Bridging the Gap is a 40-hour basic/intermediate training course for medical interpreters. The training was originally developed by the Cross Cultural Health Care Program (CCHCP) in 1995 in Seattle, Washington.

Goal of the “Bridging the Gap” Understand the work and role of medical interpreters Professional criteria to deal with any difficult situation Concrete skills dealing with interpretation, culture/cultural sensitivity, advocacy

Bridging the Gap Basic interpreting skills(role, ethics, conduit and clarifier interpreting, intervening, managing the flow of the session). Information on health care (introduction to the health care system, how doctors think, anatomy, basic medical procedures).

Bridging the Gap continued… Culture in interpreting (self-awareness, basic characteristics of specific cultures, traditional health care in specific communities, culture-brokering). Communication skills for advocacy (listening skills, communication styles, appropriate advocacy). Professional development

Interpretation Services Where to start? Disseminate information to front line staff who may need to utilize interpreter services in daily interactions. Build awareness regarding laws, guidances and why an interpreter should be used. Identify the considerations for choosing an interpreting option (provider, interpreter and LEP). Recognize key factors in successful vs. unsuccessful interpretative encounters. Identify your questions

Cultural Aspects of Working with people from different cultures Lifelong experience Be familiar with the normative cultural values of your clients Avoid stereotyping Work with Trained Language Interpreters Try to assign same-sex health care providers/Interpreters Be familiar with folk illnesses Work with family and community leaders Consider the priorities for the patient Learn about the beliefs and practices of the patient populations you serve

Tips for providers working with untrained Interpreters: Make introduction among all participants. Make appropriate positioning. Speak directly to the client and use first person. Speak at a moderate pace and at normal volume, pause often Avoid using technical vocabulary, symbolic speech. Consecutive interpreting. Ask the interpreter to be “Conduit”/Interpret everything what is said, exactly what is said: add nothing, omit nothing and change nothing. Document the use of an interpreter by name, in the client chart

What if an interpreter is not available? “Who ya gonna call?”

Use Telephone Interpretation Services When… You receive a call You make a call You are face-to-face

Telephone Interpretation Companies Language Line Services Propio Language Services LLC Institute for Cultural Competency Pentskiff (801)

How does it work? Dial toll free # State name of your company, billing code and language needed You are connected with an interpreter It is that simple!

How much does it cost? $4.00 per minute charged to credit card $1.00 per minute with a minimum of 20 minutes a month- Possibility of a joint contract

What does a it include? 24/7 service 365 days a year Billing code Training kit Rapid toll free access Billing options Volume discounts Detailed summary reports

Telephone Interpretation is an Option for… Fast Reliable Professional Language Access Services

Interpretation and Translation

How do I choose a translation agency? Have a clear idea of what you want from the agency and choose one that meets your needs Communicate in order to better COMMUNICATE

What can I expect from a translation agency? Credibility Quality translating High quality customer service Good business practices

Take time up front to ask questions When you contact a prospective language agency, you will want to ask about a wide range of issues in order to gauge the likely quality of services See handout

General Translation Recommendations Translate meaning and NOT word for word At least TWO translators per document Evaluate English version for readability, figures of speech, acronyms and technical terms Establish a method to ensure quality

Translation Process Pre-translation Review existing materials Develop a project timeline Select a translator

Translation Process Translation Assign subject matter experts to work with the translators Staff and translators meet to review document and discuss terminology First translator prepares a draft Second translator proofreads draft and makes edits

Translation Process Translation continued Two translators discuss issues and negotiate changes Throughout the process translators should consult staff with questions Assemble native speakers or focus groups to evaluate the accuracy and cultural appropriateness of translated materials

Sources and Resources The California Endowment How to Choose and Use a Language Agency: A Guide for Health and Social Service Providers Who Wish to Contract With Language Agencies California State Personnel Board Recommendations and Resources for the Translation of Written Documents, April 2003 Center for Multicultural Health Technical Assistance

“Is it necessary that health care providers offer linguistically competent care, and if so, why? …Such care is indeed necessary because providing quality and safe health care in our pluralistic society cannot be done without erasing language barriers. In other words: ‘This is who we are and these are the patients we serve.’” Language Access in Health Care Statement of Principles: Explanatory Guide, NHeLP October 2006