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Better communication, BetterCare: Where to start?
Jelena Pasalic,BS
TB & Refugee Health ProgramJanae Duncan, BS
Center for Multicultural Health
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Overview of the issues:
Today, over 11% of the U.S. population(31 million people) is foreign born.
One child in five is an immigrant or animmigrants child.
47 million U.S.residents over the age of
four speak a language other thanEnglish at home (18% of thepopulation).
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1/3 of the foreign born population of theU.S. arrived in the decade between
1990-2000 New arrivals show a great diversity of
culture and languages.
More than 380 languages are nowspoken in the U.S.
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Common Foreign Languages in
the U.S. Spanish
Chinese
French
German
Tagalog Vietnamese
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Common Foreign Languages in
the U.S. (continue) Korean
Russian
Arabic and
Japanese
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Studies show that patients
speaking limited English: Receive less than optimal health care
Receive less preventive care
They are at increased risk of experiencingmedical errors
Have fewer physician visits
They are less likely to return for follow-upvisits
They are less satisfied with their health care
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What Can Organizations Do?
Increase access to care
Improve quality of care, health
outcomes, and health status
Increase patient satisfaction
Enhance or ensure appropriateresource utilization
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Increase Access to Care
Providing linguistically and culturallyappropriate trained medical interpreters
at the time of service.(Title VI of the Civil Rights Act of 1964)
Increase racial and ethnic diversity
among professionals.
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Quality of Care
The provision of linguistically andculturally appropriate trained medical
interpreters can improve quality of care. Many LEP patients receive poor
medical diagnosis and inappropriate
services, as a result of the failure ofmedical staff to speak/provide medicalinterpreter.
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Patient Satisfaction
Appropriate language assistanceservice (LAS) implementation can
improve patient satisfaction. LEP patients have higher satisfaction
with their health care providers when
quality language services wereavailable to them.
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Resource Utilization
The implementation of LAS can enhanceappropriate resource utilization.
Physicians have performed more frequentand more expensive testing when a bilingualphysician or professional interpreter was notavailable.
The lack of interpretation services hasresulted in more frequent hospitaladmissions.
The duration of patient visit has increased
when LAS were not in place.
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Title VI of the Civil Right Act of
1964Title VI of the Civil Right Act of 1964 states: No
person in the United States shall, on groundof race, color, or national origin, be excludedfrom participation in, be denied the benefitsof, or be subjected to discrimination underany program or activity receiving Federalfinancial assistance.
To avoid discrimination based on nationalorigin, Title VI and its implementingregulations require recipients of Federalfinancial assistance to take reasonable steps
to provide meaningful access to LEP persons.
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Title VI of the Civil Right Act of
1964The purpose of this Act is to improve the
health of racial and ethnic minority
populations through the development ofeffective health policies and programsthat help to eliminate disparities in
health.
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Who must comply with Title VI
requirements?All public and private entities receivingDepartment of Health and Human Servicesfederal financial assistance are coveredentities.
State, county and local health and welfareagencies
Hospitals and nursing homes Managed care organizations
Head Start programs
Contractors/vendors
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Who Can You Use As An
Interpreter? Trained bi-lingual staff
On-staff interpreters
Contract interpreters
Telephone interpreters
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Who Should Not Serve as a
Health Interpreter: Patients family and friends
Children under 18 y.o.
Other patients and visitors
Volunteers
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Professional Interpreters!
What can they do for me? Reduce liability, help ensure appropriate
utilization, increase client compliance
and satisfaction with services Provide a quality service
- accuracy and completeness
- trained to handle difficult situations
- code of ethics
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Professional Interpreters!
What can they do for me?Assure effective communication by
facilitating the communication between
both the client and provider. Effective use of time during the clinical
encounter.
Improved outcomes for the client.
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Bridging the Gap
Bridging the Gap is a 40-hourbasic/intermediate training course for
medical interpreters. The training was originally developed by
the Cross Cultural Health Care Program
(CCHCP) in 1995 in Seattle,Washington.
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Goal of the Bridging the Gap
Understand the work and role ofmedical interpreters
Professional criteria to deal with anydifficult situation
Concrete skills dealing with
interpretation, culture/cultural sensitivity,advocacy
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Bridging the Gap
Basic interpreting skills(role, ethics,conduit and clarifier interpreting,
intervening, managing the flow of thesession).
Information on health care (introduction
to the health care system, how doctorsthink, anatomy, basic medicalprocedures).
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Bridging the Gap
continued Culture in interpreting (self-awareness,
basic characteristics of specific cultures,
traditional health care in specificcommunities, culture-brokering).
Communication skills for advocacy(listening skills, communication styles,
appropriate advocacy). Professional development
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Interpretation Services
Where to start? Disseminate information to front line staff who
may need to utilize interpreter services indaily interactions.
Build awareness regarding laws, guidancesand why an interpreter should be used.
Identify the considerations for choosing an
interpreting option (provider, interpreter andLEP).
Recognize key factors in successful vs.unsuccessful interpretative encounters.
Identify your questions
C l l A f W ki i h l
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Cultural Aspects of Working with people
from different cultures Lifelong experience
Be familiar with the normative cultural valuesof your clients
Avoid stereotyping
Work with Trained Language Interpreters Try to assign same-sex health care
providers/Interpreters
Be familiar with folk illnesses
Work with family and community leaders Consider the priorities for the patient
Learn about the beliefs and practices of the
patient populations you serve
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Tips for providers working with
untrained Interpreters: Make introduction among all participants.
Make appropriate positioning.
Speak directly to the client and use first person.
Speak at a moderate pace and at normal volume,pause often
Avoid using technical vocabulary, symbolic speech.
Consecutive interpreting.
Ask the interpreter to be Conduit/Interpreteverything what is said, exactly what is said: addnothing, omit nothing and change nothing.
Document the use of an interpreter by name, in the
client chart
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What if an interpreter is not
available?
Who yagonna call?
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Use Telephone Interpretation
Services When
You receive a call
You make a call
You are face-to-face
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Telephone Interpretation Companies
Language LineServices
1-800-752-6096
Propio LanguageServices LLC
1-888-804-2044
Institute for CulturalCompetency
1-800-654-6231
Pentskiff
(801)484-4089
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How does it work?
Dial toll free #
State name of your company, billing
code and language needed You are connected with an interpreter
It is that simple!
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How much does it cost?
Public
@ $4.00 per minute
charged to creditcard
Contract
@ $1.00 per minute
with a minimum of20 minutes a month-Possibility of a jointcontract
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What does a it include?
24/7 service 365 days a year
Billing code
Training kit
Rapid toll free access
Billing options
Volume discounts
Detailed summary reports
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Telephone Interpretation
is an Option for
Fast
Reliable
Professional
Language Access Services
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Interpretation and Translation
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How do I choose a
translation agency?
Have a clear idea of what you want fromthe agency and choose one that meets
your needs
Communicate in order to better
COMMUNICATE
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What can I expect from a
translation agency?
Credibility
Quality translating
High quality customer service
Good business practices
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Take time up front to ask questions
When you contact a prospectivelanguage agency, you will want to ask
about a wide range of issues in order togauge the likely quality of services
See handout
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General Translation
Recommendations
Translate meaning and NOT word forword
At least TWO translators per document Evaluate English version for readability,
figures of speech, acronyms and
technical terms Establish a method to ensure quality
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Translation Process
Pre-translation
Review existing materials
Develop a project timeline
Select a translator
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Translation Process
Translation
Assign subject matter experts to work
with the translators Staff and translators meet to review
document and discuss terminology
First translator prepares a draft Second translator proofreads draft and
makes edits
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Translation Process
Translation continued
Two translators discuss issues and negotiate
changes Throughout the process translators should
consult staff with questions
Assemble native speakers or focus groups toevaluate the accuracy and culturalappropriateness of translated materials
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Sources and Resources
The California EndowmentHow to Choose and Use a Language Agency: A
Guide for Health and Social Service ProvidersWho Wish to Contract With Language Agencies
California State Personnel Board
Recommendations and Resources for theTranslation of Written Documents, April 2003
Center for Multicultural Health Technical Assistancehttp://www.health.utah.gov/cmh/udoh/Request.pdf
I it th t h lth
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Is it necessary that health care
providers offer linguistically
competent care, and if so, why?Such care is indeed necessary
because providing quality and safe
health care in our pluralistic societycannot be done without erasinglanguage barriers. In other words:
This is who we are and these are the
patients we serve.
Language Access in Health Care Statement of Principles: Explanatory Guide,NHeLP October 2006