1. Health Access: Overcoming Barriers Mireya Munoz Program Manager, ALAS para tu Salud Health Justice Network 11/09/2010 This presentation is possible thanks to funding from This presentation is possible thanks to funding from The California Endowment, Office of Aides Programs and Policy (OAPP), Susan G. Komen-LA Affiliate

2. Interpretation, Translation, Testing and Training “We Speak Your Language for a Healthier Community” Language Division  Translation  Interpretation  Interpreter training  Translator training  Continuing Education  Program evaluation Advocacy Division  Consumer education  Provider education  LEP advocacy 6 FTEs, 2 NAPCA Volunteers, and 90+ interpreters - Arabic, Armenian, Cambodian (Khmer), Chinese (Cantonese, Mandarin, Teo-Chew, and Taiwanese), Farsi, Indonesian, Japanese, Korean, Russian, Spanish, Tagalog,Thai, and Vietnamese Service area : Los Angeles County with limited services in Orange, San Bernardino and Riverside Counties

3. Barriers to Culturally and Linguistically Appropriate Health Care

6. Togafitiga o le kanesa i vaila’au (Samoan) Nababasa mo ba ito? (Tagalog) (Korean) (Khmer) (Chinese) (Vietnamese)

7. Who is currently interpreting in health care settings?

11. Unqualified Interpreters  Research shows that 23% to 53% of the words are interpreted incorrectly by unqualified interpreters  They omit, add, or change the information, and render errors that can distort or affect a patients’ care (e.g.. Diabetes vs. Hepatitis)  Misunderstandings related to medication, diagnosis or other instructions  Patients and providers do not have the ability to judge the clarity or accuracy of the interpretation © Connecting Worlds, PALS for Health 2002

12. How the Language Barrier Affects the Patient  Delay in receiving medical care  Denial of benefits or services needed  Receive inappropriate benefits or services  Have to use family members or strangers in order to communicate with their doctor. Ira Pollack, Regional Manager, Region IX Ira Pollack, Regional Manager, Region IX Title VI and the Provision of Services to Persons With Limited English Proficiency Title VI and the Provision of Services to Persons With Limited English Proficiency

13. Why Family Members And Friends May Not Be The Best Interpreters Their knowledge of English may not be good enough Their knowledge of English may not be good enough Many individuals, especially children, lack fluidity in their native language Many individuals, especially children, lack fluidity in their native language If they don’t work in the medical field, they may not be familiar with medical terminology or important concepts If they don’t work in the medical field, they may not be familiar with medical terminology or important concepts …Appendix, Arthritis, Chemotherapy, Hemroid, Thyroid, Ultrasound, Virus… …Appendix, Arthritis, Chemotherapy, Hemroid, Thyroid, Ultrasound, Virus…

14. Why Family Members And Friends May Not Be The Best Interpreters They are not trained and often omit or misinterpret important information. They are not trained and often omit or misinterpret important information. They are not obligated to keep your information confidential. They are not obligated to keep your information confidential. There are sensitive information that you do not want your friends and family to know. There are sensitive information that you do not want your friends and family to know. There are time when they may have their own opinions or goals, which can confuse the doctor. There are time when they may have their own opinions or goals, which can confuse the doctor.

15. Challenges Patients Face  Lack of knowledge about their linguistic rights  Lack of knowledge about the health care system  Difference between emergency and preventative care  Cultural factors: questioning of authority figures (health providers) is inappropriate  Fear of receiving poor quality care or reprisals  Lack of access to qualified interpreters

16. Challenges Patients Face  Lack of reimbursement  Lack of resources to quality interpreting services  Lack of knowledge in the area of health care interpreting resources  Lack of tools to evaluate the linguistic proficiency of bilingual staff  Lack of resources for training interpreters

17. Health Access: Trained Health Care Interpreters

18.  Improves communication between patient and provider  Empowers patients to care for themselves  Increase adherence to medication and treatment instructions  Reduces the use of expensive and unnecessary exams unnecessary exams  Reduces the number of cancelled appointments Having a Trained Health Care Interpreter

19. Trained Health Care Interpreters Trained Health Care Interpreters Proficiency/fluency in English and Proficiency/fluency in English and source language is verified Are familiar with medical Are familiar with medical terminologies in both languages Have been train to retain and Have been train to retain and interpret what the patient and doctor say with accuracy and in totality Must adhere to ethical rules, including confidentiality Must adhere to ethical rules, including confidentiality

20. Using Trained Interpreters Remember to speak directly to the doctor or patient, not the interpreter Remember to speak directly to the doctor or patient, not the interpreter Speak in short sentences and pause so that the interpreter can completely and accurately Speak in short sentences and pause so that the interpreter can completely and accurately Try not to interrupt or speak over the interpreter Try not to interrupt or speak over the interpreter Do ask interpreter for cultural clarification Do ask interpreter for cultural clarification Do not ask interpreter for medical advice Do not ask interpreter for medical advice

21. Patient’s Rights

22. Federal Language Access Law  Title VI of the Civils Rights Act of 1964: Prohibits discrimination based on race, color or national origin (which includes language)  Who should abide by these laws? - Any agency or program that receives federal funding - Any agency or program that receives federal funding - State, county, and local health agencies - State, county, and local health agencies - Hospitals and health clinics - Hospitals and health clinics - Health plans - Health plans - Mental health centers - Mental health centers

23. State Laws Kopp Act Ensures the availability of interpreting services at acute care facilities Ensures the availability of interpreting services at acute care facilities Hospitals have to post interpreter service signs in different language Hospitals have to post interpreter service signs in different language Notify all employees about the requirement to provide interpreters to all patients that need them Notify all employees about the requirement to provide interpreters to all patients that need themDymally-Alatorre Applies to all state-funded agency or program Applies to all state-funded agency or program Employment of enough bilingual employees Employment of enough bilingual employees Translation of written materials Translation of written materials Senate Bill 853-(Escutia) – Effective January of 2009  All managed health plans must have language access  Health care plans will take necessary measures to ensure that all members have access to interpretation services and translation of vital documents

24. What This Means For All Patients… What This Means For All Patients… All Patients with Limited English Proficiency :  Have a right to a qualified interpreter  Have the right to receive vital documents in their preferred language  Should never be asked to bring their own interpreter  Should never be charged for interpreting services  Should not suffer unreasonable delay in receiving care due to limited English proficiency  Should always be treated with respect

25. Health Access:

26. How To Get An Interpreter When you call to make a medical appointment, ask for your preferred language to be noted in your chart and ask for an interpreter When you call to make a medical appointment, ask for your preferred language to be noted in your chart and ask for an interpreter Contact your insurance company’s Patient Relations Department, or health care agency’s Language, Interpreter or Diversity Department Contact your insurance company’s Patient Relations Department, or health care agency’s Language, Interpreter or Diversity Department If you don’t get an interpreter, file a complaint (Patient Relations, Ombudsman, Office for Civil Rights) If you don’t get an interpreter, file a complaint (Patient Relations, Ombudsman, Office for Civil Rights) If you still don’t get an interpreter, call PALS or ALAS If you still don’t get an interpreter, call PALS or ALAS

29. I Speak Card (Front) I Speak Spanish I need a Spanish speaking interpreter for my medical appointment. Please, make a note on my medical file of my language and need for an interpreter. Thanks!

30. I Speak Card (Back) Important things to remember before and after your appointment:  When scheduling your appointment, ask for an interpreter.  Ask your doctor to note your language on your medical file.  Write down any questions for your doctor before your appointment.  Ask your questions at the beginning of your appointment.  Ask for an interpreter when making your next appointment. SSG/PALS for Health (213)553-1818. OMH Bilingual Bicultural Service Demonstration Grant

31. How to Contact Us: PALS for Health/ALAS para tu Salud (213)-627-4850 or (213) 553-1818 www.palsforhealth.org

32. Thank You!