1. Introduction to Language Services at LAC+USC Medical Center
Andrew Young, DO, FACP, FHM
LAC+USC Service Chief of Medicine
Clinical Associate Professor of Medicine
Department of Medicine
Keck School of Medicine of USC

2. Objectives Language and Health Disparities Laws and Policies
Optimal use of interpreters
How to access interpreters at LAC+USC

3. Language and Health Disparities

4. Language and Health Disparities
Language has been associated with:
Decreased comprehension
Decreased access to care
Decreased medication compliance
Worse health status and outcomes
Trained professional interpreters and bilingual health care providers have been shown to:
Improve communication
Improve patient satisfaction
Improve health outcomes

5. Language and Health Disparities
At LAC+USC Medical Center:
More diverse patient population
The majority of our patients prefer a language other than English

6. Language and Health Disparities

7. Law Policies
ACA 1557

9. Law Policies

10. Law Policies

11. Law Policies

12. Bilingual Bonus Does not mean you’re a certified interpreter
**NOT affected by your use of a LAC+USC interepreter!**

13. Levels of Fluency ILR 0 – Isolated words only
ILR 1 - Can speak about familiar topics, may need repetition
ILR 2 – Can give simple instructions, may use awkward phrasing
ILR 3 – Communicate in most social and professional situations
ILR 4 - Near fluent, difficulty with dialects/slang
ILR 5 – Communicate as native speaker
Interagency Language Roundtable – Historically Federal Gov’t noticed self representation of language skills outpaced observed skills. Commissioned system to score the language and cultural skills of members of the foreign service.
Not validated in clinical setting.
4/5 – unlikely to have problems providing clinical care
0/1 – Should routinely use an interpreter
2/3 – May run in to problems – language skills more likely to be self-perceived as adequate, risk of misunderstanding

15. Levels of Interpreter Services
Ad hoc
Bilingual employees
Phone
Video Machine Interpreters (VMI)
In Person Interpreters

16. When can I interpret for myself?
Brief follow-ups
Going over a checklist or medications
But if the patient does not seem to be understanding or if there is any doubt, use an interpreter!!

17. When should I use an interpreter?
Critical Conversations
End of life discussions
Giving a critical diagnosis
Discussing complex treatment plan
Discharge instructions
Informed Consent
When in doubt—use a higher level

20. Question? Comments?
If you have problems please let me or Language Services know about it.

21. References
508.pdf
programs-and-activities-issue-brief/
language-access/
Flores G, Tomany-Korman SC. “The Lanague Spoken at Home and Disparities in Medical and Dental Health, Access to Care and Use of Services in US Children.” Pediatrics Jun; 121(6): e
Paradise RK, et al. “Reducing the Use of ad hoc Interpreters at a Safety-Net Health Care System.” The Joint Commission Journal on Quality and Patient Safety.
Wisnivesky JP, et al. “The Association Between Language Proficiency and Outcomes of Elderly Patients with Asthma.” Ann Allergy Asthma Immunol Sep; 109(3):

22. Scenarios I speak the language. Should I get an interpreter?
Depending on the situation, yes.
I’m a native speaker. Should I get an interpreter?
Unless you’re comfortable with medical jargon, yes.
There’s a fluent family member in the room.
Depending on conversation, get an official interpreter
Can my med student interpret for me?
Depending on conversation, yes