N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 1 A New Approach to Language Access Advocacy: Collaboration & Research with Health Care Providers

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 2 Overview About NYLPI Our Language Access Advocacy The Role of Research

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 3 NYLPI’s Mission New York Lawyers for the Public Interest (NYLPI) is a nonprofit, civil rights law firm that strives for social justice. In partnership with member law firms, corporate law departments, and other organizations, NYLPI helps underrepresented people develop legal strategies to serve their vision for themselves and their communities.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 4 NYLPI’s Programs The Access to Healthcare Program works to ensure access to quality health care for people in medically underserved communities or facing barriers due to limited English proficiency or racial and ethnic discrimination. The Disability Law Center protects and promotes the civil rights of people with disabilities. The Environmental Justice Project provides organizing and legal assistance to low-income neighborhoods and communities of color that bear an unfair burden of environmental threats. The Pro Bono Clearinghouse provides community groups and nonprofit organizations with free legal assistance by drawing on hundreds of volunteer attorneys from New York’s most prestigious law firms and corporate law departments.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 5 LANGUAGE ACCESS ADVOCACY AT NYLPI

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 6 Advocacy from the “Outside In” Education & outreach Partner with community-based groups to survey LEP patients’ access to local hospitals Meetings and negotiation with hospital administrators to improve language access policies Filing administrative complaints, if necessary Lobbying & law reform

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 7 Advocacy from the “Inside Out” Involves research and collaboration with health care providers to understand what they know (and don’t know) about LEP patients’ rights as well as their subjective attitudes toward LEP communities. Goal is to shape the design and implementation of language access policies, and to improve provider education & training.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 8 WHY FOCUS ON THE PROVIDER?

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 9 Theory vs. Practice Gap between hospital administrators and frontline caregivers in terms of: –Knowledge about legal obligations –Communication about language assistance services available –Perceptions about how accessible services are Very little documentation of these implementation failures Direct impact on quality of care to LEP patient: Understanding provider perspective may lead to more patient-centered care

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 10 Existing Literature BURBANO O’LEARY 2003 Surveyed 59 residents at an urban, university-affiliated children’s hospital about their treatment of LEP patients. Focus on Spanish-language access 40 residents non-proficient in Spanish Method of Interpretation Service % of Nonproficient Residents Who Believe Method is “Often” or “Always” Effective in Improving Communication Hospital-based interpreter100 Telephonic interpretation service80 Patient friend or family member55 TOCHER & LARSON 1999 Time-motion study about physicians actual time spent with LEP patients and their perception of time spent. Found no statistically significant difference in time spent between LEP and non-LEP patients But physicians perceived that they spent more time; that LEP patients more challenging.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 11 Our Study Survey of Emergency Medicine residents at a large teaching hospital in the Bronx Focus on residents’: –Knowledge of communication assistance services available through the hospital –Knowledge of LEP laws & regulations –Attitudes toward LEP patients Hypothesis: Residents less familiar with available communication assistance services and/or LEP laws more likely to have negative attitudes toward treatment of LEP patients.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 12 Implications for Research Language Access Literature Health Disparities Literature Institute of Medicine: “Additional research is needed on provider decision-making, heuristics employed in diagnostic evaluation, and how patients’ race, ethnicity, gender, and social class may influence these decisions.” Better understanding of provider constraints and “implementation failures.” Individual vs. Institutional Biases: Failure to properly implement language access policies may alienate patient and provider, entrenching negative attitudes by both.

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 13 Implications for Advocacy More informed negotiations with hospitals for improved language access policies Influencing provider education Possible provider-community collaboration Innovative policy options and systemic reform Community organizations and advocates demonstrating for better language assistance policies

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 14 For more information Please contact: Nisha Agarwal New York Lawyers for the Public Interest, Inc. Phone:

N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 15 THANK YOU!