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Promising Practices in Healthcare. Language Access Advocacy Project California 2004. Promising Practices in Health Care. Purpose of Presentation: To provide highlights of existing promising practices in the provision and financing of language services in health care Overview of Presentation

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promising practices in healthcare

Promising Practices in Healthcare

Language Access Advocacy Project California 2004

promising practices in health care
Promising Practices in Health Care
  • Purpose of Presentation: To provide highlights of existing promising practices in the provision and financing of language services in health care
  • Overview of Presentation
    • Policies and Procedures
    • Needs Assessment
    • Delivery System
    • Training and Competency
    • Workforce
    • Monitoring and Evaluation
    • Use of Technology
    • Financing and Reimbursement
    • Ongoing Challenges
policies and procedures
Policies and Procedures
  • Promising policies and procedures include elements that:
    • Publicize patient rights and availability of services
    • Identify and assess language needs
    • Assure proper documentation
    • Provide timely telephone communication
    • Ensure systematic data collection
promising policies and procedures sequoia community health foundation
Promising Policies and Procedures:Sequoia Community Health Foundation
  • Community clinic serving primarily farmworkers in southern Fresno County
  • Has a written policy on access to interpretation services
  • Includes specific procedures on how to access language line services
  • Incorporates written instructions in the personnel policies manual
  • Includes training for staff on policy and procedures in orientation process
needs assessments
Needs Assessments
  • Promising needs assessments include:
    • An assessment of community language needs
    • An internal assessment of institutional needs
promising needs assessment la cl nica de la raza
Promising Needs Assessment: La Clínica de la Raza
  • Community clinic serving primarily Latino patients in East Oakland
  • La Clínica de la Raza conducted a Cultural Competence Assessment Survey
    • Assessed staff views regarding cultural competency
    • Was included as a component of the organization’s quality assurance oversight plan
    • Yielded results that illustrate a strong recognition among staff of the importance of culture
    • Identified needs
      • Materials and signs in different languages & cultures
      • Training and information about non-Latino cultures
promising needs assessment l a care
Promising Needs Assessment: L.A. Care
  • Health maintenance organization serving Medi-Cal, Healthy Families, and CaliforniaKids enrollees in Los Angeles County
  • As part of its assessment, LA Care conducted a survey of providers to identify needs and challenges
    • 92% felt language and cultural issues are important in delivering health care
    • Over three-quarters would use translated materials or interpreters if made available to them
    • 50% would like training on how to use interpreters
    • 49% would like staff trained as professional interpreters
delivery systems
Delivery Systems
  • Promising delivery systems include components such as:
    • Coordinator and administrative structure
    • Scheduling and tracking system
    • Models of oral language assistance
    • Guidelines for translation of written materials
promising delivery system asian pacific health care venture
Promising Delivery System: Asian Pacific Health Care Venture
  • Community clinic serving Asians & Pacific Islanders in Los Angeles
  • Components of its delivery system include:
    • Bilingual staff hiring flow chart
      • Job descriptions for bilingual staff
      • Hiring criteria
      • Application process
      • Oral interpretation test
      • Written translation test
    • Translations of vital documents
    • Trainings for Staff
    • Patient satisfaction surveys
promising delivery system asian pacific health care venture1
Promising Delivery System: Asian Pacific Health Care Venture

Source: “A Functional Manual for Providing Linguistically Competent Health Care Services as Developed by a Community Health Center”

promising delivery system golden valley health center
Promising Delivery System: Golden Valley Health Center
  • Community clinic serving Latino and Southeast Asian communities in Merced
  • Cultural Mediators
    • Provide language interpretation for Latino, Hmong and Lao patients
    • Receive 40 hours of training and tests for proficiency
    • Serve as part of the clinical team to transmit cultural understandings and beliefs between clinicians and patients
  • Cultural Competence Training
    • Culture Clinic for residents
    • Training to work effectively with interpreters
promising delivery system alameda alliance for health
Promising Delivery System: Alameda Alliance for Health
  • Nonprofit health plan serving Alameda County
  • Makes arrangements and coordinates interpreter services
  • Pays interpreters directly at both the plan and provider levels
  • Identifies qualified interpreter services
training and competency
Training and Competency
  • Key elements of promising training and competency activities include:
    • Interpreter training
    • Staff/provider training
    • Competency assessment
      • Core skills
      • Core knowledge
      • Code of ethics
promising training and competency asian health services
Promising Training and Competency: Asian Health Services
  • Community clinic primarily serving Asians & Pacific Islanders in Oakland
  • Interpretation and Translation Services
      • Conducted in multiple languages: Cambodian, Cantonese, Farsi, Korean, Mandarin, Spanish, Vietnamese
      • Translation by a primary translator, Editing by a second translator, Formatting of document, Proofreading, & Cultural adaptations of health materials
  • Health Care Interpreting Training
      • 40 hour, 5 week training
      • Covers interpreter skills, roles, and ethics
  • Cross-Cultural Health Care Training
      • Training for health care staff on serving multicultural patients
promising training and competency family healthcare network
Promising Training and Competency: Family HealthCare Network
  • Community clinic serving low-income, underserved individuals in Tulare County
  • Efforts to promote training and competency include:
  • Establishing a strong commitment to hiring bilingual staff from the community
  • Evaluating language proficiency
    • Utilize standardized oral and written tests
    • Bilingual staff shadow bilingual physicians initially to ensure accurate language proficiency
promising training and competency ssg pals for health program
Promising Training and Competency: SSG/PALS for Health Program
  • Community based language access program serving Los Angeles and Orange County.
  • PALS for Health conducts language proficiency assessment in 10 languages
  • 48-hour Health Care Interpreting Training
      • Language proficiency test is a prerequisite to enrollment
      • Skills and knowledge building, standards, role plays, language labs, medical terminology, continuing education and interpreter support.
  • Patient Education
      • Informing LEP patients about language rights
      • Distribution of “I Speak” cards
  • Components of a promising language services program include:
    • Workforce Recruitment
    • Workforce Retention
promising workforce program ca physician corps loan repayment
Promising Workforce Program: CA Physician Corps Loan Repayment
  • Provides loan repayment scholarships for physicians who practice in underserved areas
  • Operated by the CA Office of Statewide Health Planning & Development
  • Focused on primary care physicians
  • Priority consideration given to those who:
    • Come from an economically disadvantaged background
    • Have significant training in cultural/linguistic issues
    • Speak a Medi-Cal threshold language
  • Companion program for dentists to be implemented.
monitoring and evaluation
Monitoring and Evaluation
  • Key elements of monitoring and evaluation include:
    • Patient satisfaction
    • Process variables
    • Outcome and quality measures
promising monitoring and evaluation venice family clinic
Promising Monitoring and Evaluation: Venice Family Clinic
  • Free clinic serving primarily Latino and low-income patients in Los Angeles
  • As part of its monitoring and evaluation efforts, Venice Family Clinic designed a quarterly patient satisfaction survey to obtain input from patients
    • Assists the clinic in monitoring quality of care provided to patients.
    • Includes questions regarding cultural and linguistic services
promising monitoring and evaluation national health services
Promising Monitoring and Evaluation: National Health Services
  • Community clinic serving low-income and farmworker patients in Kern County
  • As part of its monitoring and evaluation activities, National Health Services has created a Language Barrier Log
    • Records Patient’s Name, Arrival Time, Time Seen, Native Language
    • Reviewed as part of the quality assessment program
    • Patients should not wait more than 15 minutes for an interpreter or bilingual staff member
use of technology
Use of Technology
  • Pilot projects are currently exploring and testing the use of new technologies:
    • Remote simultaneous translation
    • Videoconferencing
promising use of technology gouverneur hospital
Promising Use of Technology: Gouverneur Hospital
  • Public hospital primarily serving Chinese and Latino immigrants in New York City
  • Implemented a remote simultaneous medical interpretation pilot
    • Use trained medical interpreters who interpret for providers and patients through wireless headsets
    • Interpreter listens to what is said by one party and transmits an interpretation to the other
    • Provider and patient only hear their own languages
promising use of technology alameda county medical center
Promising Use of Technology: Alameda County Medical Center
  • A system of public health care in Alameda County with 3 hospitals and 4 clinics
  • Alameda County Medical Center is currently piloting a videoconferencing medical interpretation system
  • Provider and patient talk to one another in the exam room while an interpreter in another location interprets via videoconference
medicaid schip financing and reimbursement
Medicaid/SCHIP Financing and Reimbursement
  • August 30, 2000 CMS Letter discusses how states can draw down federal matching funds for language assistance in Medicaid/SCHIP
  • Only 10 states have established direct reimbursement using federal matching funds to pay for language services
  • Four models of reimbursement –
    • contract with language service agencies
    • reimburse providers for hiring interpreters
    • certify interpreters as Medicaid providers
    • provide access to language line
model 1 language service agencies
Model 1 – Language Service Agencies
  • Hawaii, Washington, and Utah contract with interpreter organizations. Providers schedule interpreters who then bill the state.
  • Washington offers testing and certification of its interpreters. For seven prominent languages, the state administers a certification test, and for other languages, the state has a process for qualifying interpreters.
model 2 provider reimbursement
Model 2 – Provider Reimbursement
  • Maine and Minnesota require providers to pay for interpreters and then reimburse providers
  • Providers have discretion on who to hire
  • In Maine, interpreters must sign code of ethics; cannot use family members/friends
  • Considerations
    • state oversight
    • quality of interpreters
    • provider concerns
model 3 payments to interpreters
Model 3 – Payments to Interpreters
  • New Hampshire requires interpreters to become Medicaid providers
  • Interpreters submit bills directly to the state
  • Considerations
    • requirements of becoming a provider
    • low reimbursement rates
model 4 language line
Model 4 – Language Line
  • As of October 10, 2003, Kansas started paying for a telephonic language line which managed care providers can access for Medicaid/SCHIP patients
  • The language line is coordinated through the state’s fiscal agent (EDS) and providers receive a code for access
  • Estimated budget – $275,000 for first year
current state financing
Current State Financing

* $30 for business hours; $40 non-business hours

** Or usual and customary fee, whichever is less.

FFS: Fee-for-service Medicaid enrollees

All: both managed care and fee-for-service Medicaid enrollees

Source: “Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency”

ongoing challenges in health care
Ongoing Challenges in Health Care
  • Financial Reimbursement
    • Medi-Cal and Healthy Families patients
    • Uninsured patients
  • Changing Demographics
    • Diversity of languages
    • Indigenous languages
  • Workforce - Bilingual Providers and Interpreters
    • Recruitment
    • Retention
  • Lack of technical assistance resources and tools to assist in changing operations
ongoing challenges in health care1
Ongoing Challenges in Health Care
  • Trainings for interpreters, providers, and support staff
    • Cost of training
    • Opportunity cost of time away from clinic
  • Access to technology for remote interpretation
    • Rural areas may lack adequate telecommunications infrastructure
  • Confidentiality
    • Especially for rare languages spoken by small communities
  • CPCA’s publication, “Providing Health Care to Limited English Proficient Patients: A Manual of Promising Practices” at
  • AAPCHO’s publication, “A Functional Manual for Providing Linguistically Competent Health Care Services as Developed by a Community Health Center” at
  • NHeLP’s publication “Providing Language Interpretation Services in Health Care Settings: Examples from the Field” at
  • NHeLP and Access Project publication “Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency” at
language access advocacy project contact information
Language Access Advocacy Project Contact Information
  • Asian Pacific American Legal Center

Hemi Kim

213-977-7500 x 215

213-977-7595 Fax

[email protected]

  • Asian & Pacific Islander American Health Forum

Alice Chen and Gem Daus


415-954-9999 Fax

[email protected]

[email protected]

language access advocacy project contact information1
Language Access Advocacy Project Contact Information
  • California Pan-Ethnic Health Network

Ellen Wu and Martin Martinez


510-832-1175 Fax

[email protected]

[email protected]

  • California Primary Care Association

Vivian Huang

916-440-8170 x 238

916-440-8172 Fax

[email protected]

language access advocacy project contact information2
Language Access Advocacy Project Contact Information
  • Fresno Health Consumer Center

Teresa Alvarado and Sengthiene Bosavanh


559-570-1253 Fax

[email protected]

[email protected]

  • Latino Coalition for a Healthy California

Lupe Alonzo-Diaz and Patty Diaz


916-448-3248 Fax

[email protected]

[email protected]

language access advocacy project contact information3
Language Access Advocacy Project Contact Information
  • National Health Law Program

Doreena Wong

310-204-6010 x3004

310-204-0891 Fax

[email protected]

Supported by The California Endowment