Meeting and Exceeding Language and Communication Mandates Todd Blickenstaff Hablamos Juntos Gisela Prieto Caliente Communications June 2-3, 2003 Cultural Competency Standards for NJ HIV/AIDS Service Providers: Princeton, NJ

What are the barriers between provider & patient? Culture Education Language Physical and Communication impairments How can these barriers be reduced?

What are the consequences of language barriers? Increased chance for medical error Lack of patient trust in provider Lower patient satisfaction Lower patient outcomes

The Civil Rights mandate explained Title VI of the 1964 Civil Rights Act Prohibits discrimination by federally funded entities based on race, color, and national origin “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity receiving Federal financial assistance.”

Title VI of the 1964 Civil Rights Act Prohibited practices under Title VI – Denying a benefit or opportunity to participate – Providing different services or benefits – Providing services or benefits in a different manner or in a segregated environment – Restricting privileges – Using policies or procedures that have the effect of discriminating

HHS Title VI Regulations Requires recipients of federal financial assistance to provide meaningful access to LEP Persons To ensure meaningful access, language assistance should result in: – Accurate and effective communication – At no cost to the LEP person 45 CFR Part 80.3(b)(2)

Executive Order Signed August 2000 by President Clinton Improving Access to Services for Persons with Limited English Proficiency – designed to better enforce and implement Title VI – requires federal agencies to meet the same standards as federal financial assistance recipients in providing meaningful access for LEP individuals to federally conducted programs Equates language with national origin

Federal Goals Take reasonable steps to ensure meaningful access to programs and activities by LEP persons. To ensure that Federally-assisted programs aimed at the American public do not leave some behind simply because they face challenges communicating in English. To identify constructive methods to reduce the costs of LEP requirements on small businesses, small local governments, or small non-profits that receive Federal financial assistance. To establish criteria for evaluating and monitoring programs at all levels.

HHS LEP Policy Guidance Explains Title VI and “meaningful access” Provides detailed information about complying with the law Outlines a model plan that identifies promising practices

DOJ Revised LEP Guidelines Issued June 2002 July memo from DOJ instructing federal agencies to use the DOJ LEP guidance as a model for republication of recipient LEP guidance HHS and other federal agencies in the process of conforming to DOJ revised guidance HHS has issued guidance and taken public input These guidelines are in effect now, pending release of revised guidelines.

Who is covered? All public or private agencies that receive financial assistance from any of 30 Federal agencies (directly or indirectly) through a grant, contract or subcontract. “Covered entity” examples: – State, county, local welfare agencies – Hospitals and clinics – Managed care organizations – Nursing homes – Mental health centers – Senior Citizen Centers – Head Start Programs

What language services are you obligated to provide? Depends on four factors: 1. # or proportion of LEP individuals 2. Frequency of contact with the program (how often an interpreter is needed) 3. Nature and importance of the program 4. Resources available and costs

Three ways of providing language services 1. Oral Interpretation- requires proficiency in English and another language, knowledge of specialized terms, understanding of ethics – Dedicated – Dual Role – Contract – Telephonic – Volunteers – Minors

Can family and friends interpret? – Only if offered professional interpreter – Confidentiality and Privacy issues – Conflict of interest – Minors – What the law says- – Bottom line- using friends and family as interpreters is discouraged

Three ways of providing language services 2. Written Translation Consent and complaint forms Notices about eligibility, changes in benefits Application for services, intake forms Notice of free language services What should be available, and in what languages? Cultural Adaptation and cross-cultural communication Methods and Guidelines for Translation

Three ways of providing language services 3. Signage In patient’s language May include pictograms, symbols, etc. Consideration of literacy levels CLAS Standards Language in DOJ guidance

Infrastructure needed to provide services in required languages Bilingual staff interpreters – Dual role – Dedicated Translators Signage Alliances w/organizations or academic institutions that can provide TA/staffing re: language/culture needs

Cultural Competence Recognize the importance of home remedies in some cultures Offer language options for your patients Provide educational brochure in multiple languages Hire staff that represent your patients population Assure that members' of your staff are culturally competent Understand patient health needs and local resources Partner with local agencies and organizations that have subject matter expertise in cultural competence and health disparities

Linguistically appropriate services Establish procedures for communication with LEP speakers at all hours of operation Use open-ended questions to learn cultural beliefs, expectations, and practices that may affect patient health Create an environment that helps patients from diverse, cultural backgrounds feel more comfortable Use 'trained medical interpreters'

For more information… Todd Blickenstaff Gisela Prieto