Language Access in Health Care

Right Thing To Do Contra Costa Health Services is committed to cultural and linguistic competence in the provision of medical care, and believes that effective communication with patients is essential to quality care, access to care, and assuring a patient’s adherence to treatment plans, all of which are important to the delivery of quality health care with successful outcomes. Our patients come from linguistically and ethnically varied backgrounds that reflect the broad diversity of Contra Costa County’s population.

The “Truth” Daily occurrence of unaddressed language barriers in the US is an open secret Survey of providers at our Hospital and HC - Admittedly “nonproficient” speakers are using their ‘pretend’ language often or everyday. Many providers ‘just get by’ without interpretation. Many admit to “avoiding communication” with LEP patients.

Excuses? Ad hoc interpreters “good enough” Professional interpreters slow things down Equipment caused barriers Patients didn’t ask for/don’t want interpreters ?HIPAA Provider with “good enough” language skills “This is America, we speak English”

Quality Professional healthcare interpreters decrease important errors/encounter in terms of omission, false fluency, substitution, edtiorialization, addition Ad hoc interpreters are significantly more likely to make important errors

Benefits of Language Services Improved quality patient care and better health outcomes Improved patient flow for limited English proficient patients Improved patient satisfaction Compliance with federal & state regulations

Regulations Federal government - Title VI (CLAS standards) - Americans with Disabilities Act (ADA) State laws (more that any other state) Joint Commission Malpractice law - “standard of care:” adequate steps to be certain that he fully understands [the patient’s] complaints

Title VI Civil Rights Act of 1964 Federal Aid recipients Oral and written language assistance to Limited English Proficiency (LEP) people “No person in the US shall, on the 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.” 42 U.S.C. § 2000d “National origin” includes individuals with LEP

Americans with Disabilities Act (ADA) Deaf or Hard of Hearing – Federal Aid recipients – Equal service to Deaf persons – Remove barriers that prevent Deaf persons from participating in care

Joint Commission National Patient Safety Goals - Goal #13 – Encourage patient’s active involvement in their own care as a patient safety strategy

Malpractice Case An adolescent Latino boy is found by an EMS crew with altered mental status. A caregiver uses the term "intoxicado" to describe the boy's condition. She intended to convey that the patient has been "nauseated." Healthcare personnel, without the aid of an interpreter, presume that the boy is "intoxicated." Immediate imaging of the patient's brain is not performed and the correct diagnosis of a ruptured aneurysm with intra-cranial hemorrhage is delayed. The outcome is irreversible brain damage and quadriplegia. The family is awarded $71 million.

In person interpretation available – CMIs Health Care Interpreter Network (HCIN) Refugee program staff Contracted Interpreters for on-site and phone interpretation Translation vendor for written documents

CCHS part of a network of safety net hospitals and health systems. Calls (phone/video) routed to our interpreters first Then to other network partners Then to Language Line – client ID and cost center (audio only) HCIN

Contra Costa Health Services Health Care Interpreter Network HCIN INTERPRETER Any Language, Any Time TO REQUEST AN INTERPRETER DIAL: (9) LANGUAGE DIRECTORY 01 - Spanish 11 - Tagalog 02 - American Sign 12 - Tongan 03 - Cantonese 13 - Russian 04 - Mandarin 14 - Armenian 05 - Vietnamese 15- Farsi 06 - Korean 16 - Hindi/Dari 07 - Hmong 17 - Punjabi 08 - Cambodian 18 - Arabic 09 - Lao 19 - Mixteco 10 - Mien 20 - Thai For all other languages - 00  Report equipment problems to: (9)  In the event of a system failure call (800) for your contracted language service provider. Requests for interpreters not provided by HCIN automatically roll over to Language Line Services. Your Language Line ID is Client ID: Cost Center: 6386 POLYCOM VIDEO INSTRUCTIONS  Plug power cord into outlet  Plug computer cable into HCIN data port  Press Power button on front of unit—wait 45 seconds  Dial ext 8360 using the remote  Press the Call Button  When you hear the welcome message, press the number of the desired language (see directory below)  To adjust volume press  To hang up the call press  Turn power button off LANGUAGE DIRECTORY 01 - Spanish 11 - Tagalog 02 - American Sign ** 12 - Tongan 03 - Cantonese 13 - Russian 04 - Mandarin 14 - Armenian 05 - Vietnamese 15 - Farsi/Dari 06 - Korean 16 - Hindi 07 - Hmong 17 - Punjabi 08 - Cambodian 18 - Arabic 09 - Lao 19 - Mixteco 10 - Mien 20 - Thai ** After the announcement press 1 For all other languages - 00 Report equipment problems to: In the event of a system failure call (800) for your contracted language service provider Requests for interpreters not provided by HCIN automatically roll over to Language Line Services. Your Language Line Client ID: Your Cost Center: 6352 Contra Costa Health Services Health Care Interpreter Network POLYCOM VIDEO INSTRUCTIONS  Plug power cord into outlet  Plug computer cable into HCIN data port  Press Power button on front of unit—wait 45 seconds  Dial ext 8360 using the remote  Press the Call Button  When you hear the welcome message, press the number of the desired language (see directory below)  To adjust volume press  To hang up the call press  Turn power button off LANGUAGE DIRECTORY 01 - Spanish 11 - Tagalog 02 - American Sign ** 12 - Tongan 03 - Cantonese 13 - Russian 04 - Mandarin 14 - Armenian 05 - Vietnamese 15 - Farsi/Dari 06 - Korean 16 - Hindi 07 - Hmong 17 - Punjabi 08 - Cambodian 18 - Arabic 09 - Lao 19 - Mixteco 10 - Mien 20 - Thai ** After the announcement press 1 For all other languages - 00 Report equipment problems to: In the event of a system failure call (800) for your contracted language service provider Requests for interpreters not provided by HCIN automatically roll over to Language Line Services. Your Language Line Client ID: Your Cost Center: 6352 Contra Costa Health Services Health Care Interpreter Network Contra Costa Health Services Health Care Interpreter Network POLYCOM VIDEO INSTRUCTIONS  Plug power cord into outlet  Plug computer cable into HCIN data port  Press Power button on front of unit—wait 45 seconds  Dial ext 8360 using the remote  Press the Call Button  When you hear the welcome message, press the number of the desired language (see directory below)  To adjust volume press  To hang up the call press  Turn power button off 01 - Spanish 11 - Tagalog 02 - American Sign ** 12 - Tongan 03 - Cantonese 13 - Russian 04 - Mandarin 14 - Armenian 05 - Vietnamese 15 - Farsi/Dari 06 - Korean 16 - Hindi 07 - Hmong 17 - Punjabi 08 - Cambodian 18 - Arabic 09 - Lao 19 - Mixteco 10 - Mien 20 - Thai ** After the announcement press 1 For all other languages - 00 Requests for interpreters not provided by HCIN automatically roll over to Language Line Services. Your Language Line Client ID: Your Cost Center: 6352 Report equipment problems to: In the event of a system failure call (800) for your contracted language service provider

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