Risk Management of the LEP Patient and Effective Language Access Plans for 2012: Problems and Solutions to Reach Compliance With The Joint Commission Standards Presented by: Armando Ezquerra Hasbun, Director of Programs, LSA Shiva Bidar-Sielaff, CCHI Commissioner

LSA Company Overview About LSA Founded in 1991 by Laura K.T. Schriver Horsham, PA headquarters A network of more than 5,000 Independently Contracted global Linguists Recently named to Common Sense Advisory’s list of “Top Global Language Services Providers” for the second consecutive year Over 200 language offerings 100% privately owned Certified Diversity Enterprise (WMBE)

LSA Company Overview LSA is proud to offer a full range of language translation services and language interpreter services:

Webinar Objectives Discuss the current regulatory requirements governing Language Access Plans for LEP populations in healthcare settings Learn more about the problems healthcare providers and administrators typically encounter when implementing an effective Language Access Plan Review the recommended options, strategies and solutions to meet Joint Commission Standards, with the ultimate goal of achieving optimal outcomes for all Understand the importance of using certified and credentialed medical interpreters when caring for an LEP patient, and what certification and credentialing means to The Joint Commission You are invited to share your experiences, in terms of challenges and successes, at the end of the Webinar during the Q&A session.

The Joint Commission (TJC) The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report. The declared mission of the organization is: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”

Key Guidelines Regarding Equal Language Access Standards PC : The hospital effectively communicates with patients when providing care, treatment and services. EP 1: The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care. EP 2: The hospital communicates with the patient during the provision of care, treatment and services in a manner that meets the patient’s oral and written communication needs. Title VI of the Civil Rights Act of 1964 prohibits discrimination based on “national origin,” which includes language. The Americans with Disabilities Act of 1990 Section 504 of the Rehabilitation Act of 1973

How Are Health Care Providers Responding? Some of the larger providers are at the vanguard, and are setting an example on how to successfully achieve equal language access; on the other hand, the majority of smaller providers are finding themselves in one of the positions listed below: Rushing to try and meet compliance deadlines Trying to make sense of guidelines that are not explicit Struggling for funding that has not been budgeted for At a loss as to how well their language needs are being met Having to design, document and perfect their response

The Language Access Plan The first step to achieving equal language access is to create, develop, apply and continuously supervise your institution’s Language Access Plan A Language Access Plan is the roadmap that is created to reflect: The linguistic needs of the community your institution serves Your arrangements for meeting those needs Your system for the provision of interpretation services: Staff face-to-face interpreters Per-diem face-to-face interpreters contracted directly Per-diem face-to-face interpreters from agencies Remote interpreters from provider pools Remote telephonic interpreters from language services providers Remote VRI interpreters from language services providers

Language Access Plan on Interpretation HR : It is not appropriate to rely on untrained individuals as the primary source for bridging communication barriers during medical encounters with individuals who are deaf or speak a language other than English. Requirement HR , EP1 requires hospitals to define staff qualifications specific to job responsibilities. Note 4 in EP 1 requires hospitals to specifically ensure that individuals who provide interpreting and translation services in the hospital have defined qualifications and competencies.

Language Access Plan on the Use of Untrained Interpreters Untrained individuals – including family members, friends, other patients and / or untrained bilingual staff – should not be used to provide language access services during medical encounters. Standard HR : The hospital defines staff qualifications “Qualifications for language interpreters and translators may be met through language proficiency assessment, education, training and experience.”

Problems and Possibilities Lack of Institutional Support My institution doesn’t budget for contracting language services My institution doesn’t have policies in place regarding the proper use of interpreters My institution relies on bilinguals and doesn’t see the need to do it any other way Lack of Trained Interpreters Our in-house team has never been trained Our bilingual personnel has not been tested We cannot possibly provide interpreters: In all the languages that show up In all the medical subspecialties needed At all hours of the day and night We cannot be sure how our team performs

Problems and Possibilities Multiple Solutions but No Accountability How can we test for language skills? How can we determine interpreting ability? We can’t tell how well an interpreter performs Conflicts of interest and ethical dilemmas Correct language but much misunderstanding Can we rely on “Certified” interpreters? Trained, Qualified, Certified? The 40-hour specialized training course The ‘Training the Trainer’ course The National Certification options available Health Care Interpreter Qualification Continued Education and Remote Learning English and Languages of Limited Diffusion

Problems and Possibilities Opposition From All Sides: A Shift in Perception and Attitude Is Needed Providers see the process as cumbersome; causes delays Bilingual providers use their own language skills Patients rely on their own family and friends Dual-role employees have extra duties and no pay differential Remote interpreting has major limitations Technophobes tend to under use available services

Problems and Possibilities Understanding Professional Interpreters Knowledge, skills and ability Training, testing and acquisition of credentials Applied ethics Protocol and common standards of practice Protocol and best practices Linguistic limitations – consulting the dictionary Roles and what an Interpreter cannot do A typical day in the life of a healthcare Interpreter

Problems and Possibilities Sources of Recurrent Problems Sudden re-scheduling and cancellations Reported times and billing reconciliation How to manage the INFORMED CONSENT FORM Errors, inaccuracies and incomplete interpretation The interpreter takes over control of the session Side conversations in the foreign language Cannot hear well; disconnections The interpreter is argumentative or impolite

How LSA Can Help LSA supports you in your mission by: Helping providers assess their bilingual dual-role staff Providing training courses to help make interpreters qualified to sit in for the certification examination Offering continuing education educational sessions on specialized topics for your interpreter corps Training your providers on how to work with interpreters Delivering a full range of services to help providers achieve their goals of better outcomes, while meeting all specifications of a Language Access Plan; LSA’s full suite of services includes: Translation & Localization Video Remote Interpreting Interpreting by Telephone Face-to-Face Interpreting American Sign Language Intercultural Consulting

Healthcare Interpreter Certification A Piece of the Compliance Puzzle: Healthcare Interpreter Certification Shiva Bidar-Sielaff CCHI Commissioner

Why is Credentialing Important? No federal regulations for the healthcare interpreting profession exist Very few state regulations exist Major organizations understand importance of competent interpreters: Office for Civil Rights Office of Minority Health The Joint Commission

New Joint Commission Standards The patient-centered communication standards, approved in December 2009 and released in January 2010, became effective on July 1 st, 2012: HR , EP 1: Individuals providing interpreting or translation services have defined qualifications or competencies Qualifications for language interpreters may be met through Assessment (AHI and CHI tests) Education (U.S. High School or equivalent) Training (Minimum of 40 hours & Continuing Education) Experience

Certification Commission for Healthcare Interpreters CCHI (Certification Commission for Healthcare Interpreters) – “One Voice” One set of industry-formed standards Assurance of competency Professional certification program Involving Interpreters Employees and independent contractors Users of interpreter services Bringing together the necessary stakeholders through a non-profit organization

Why CCHI Credentials? The AHI TM and CHI TM examinations follow the blueprint created by the Job Task Analysis (JTA) Exams were developed according to NCCA Standards, under direct oversight of CCHI CCHI exams have been psychometrically validated Over 1,250 applicants since testing began 509 interpreters nationwide have already earned their CCHI credentials – 165 AHI TM and 344 CHI TM

Test Development Supporters Note: The participation by supporters does not constitute ultimate endorsement of CCHI’s certification program.

CCHI Current Credentials Associate Healthcare Interpreter TM Credential (AHI TM ) Available to all interpreters except Spanish-, Arabic- and Mandarin- speaking interpreters Certified Healthcare Interpreter TM Certification (CHI TM ) Currently available to Spanish-, Arabic- and Mandarin-speaking interpreters

What Is the Associate Healthcare Interpreter TM (AHI TM ) Credential? Available to interpreters in ALL languages Entry point into professional certification Two-hour, computer-based, 100 question, multiple choice exam in English Tests the basics of health care interpreting Preliminary results are immediate at test center Credential awarded upon successful completion of the written examination (except for Interpreters who are eligible for CHI TM )

The AHI TM Examination Managing an Interpreting Encounter30% - 35% Healthcare Terminology22% - 25% Interacting With Other Healthcare Professionals20% - 24% Preparing for an Interpreting Encounter16% - 20% Demonstrating Cultural Responsiveness 3% - 6%

What is the Certified Healthcare Interpreter TM (CHI TM ) Certification? Currently available in Spanish, Arabic and Mandarin; other languages will continue to be developed Tests the basics of health care interpreting plus interpreting skills and abilities AHI TM examination + computer-based oral performance examination (takes one hour to complete) = Certification

The CHI TM Examination Knowledge required of health care interpreters (same as AHI TM credential) Interpreting in a health care environment: accurately and completely within a cultural and environmental context: Interpret consecutively75 – 80% Interpret simultaneously 10 – 15% Sight translate and translate healthcare documents10 – 15%

Fees Application:$30 (non-refundable) AHI TM :$175 CHI TM :$250 $455 total for Spanish-, Mandarin- and Arabic-speaking interpreters $205 for all other interpreters All fees are non-refundable This is for one examination administration

Credential / Certification Maintenance CHI TM certification and AHI TM credential are valid for four years Maintenance Requirements 32 hours total Continuing Education = 16 hours (classroom or contact) in years 1 & 2, 16 hours in years 3 & 4 40 hours of work experience = 20 hours in years 1 & 2, 20 hours in years 3 & 4

CCHI Certification Commission for Healthcare Interpreters

Thank You! Armando Ezquerra Hasbun Director of Programs, LSA Shiva Bidar-Sielaff CCHI Commissioner

Translation and Localization Face-to-Face Interpreting Video Remote Interpreting (VRI) American Sign Language (ASL)Intercultural Consulting Q&A Session