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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

  • Workforce

    • 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 Repayment

    • 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: RepaymentVenice 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: RepaymentNational 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 Repayment

    • 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: RepaymentGouverneur 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: RepaymentAlameda 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 Repayment

    • 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 Repayment

    • 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 Repayment

    • 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 Repayment

    • 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 Repayment

    • 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 Repayment

    * $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 Repayment

    • 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 Repayment

    • 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

    Resources Repayment

    • 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


    Questions? Repayment

    Language access advocacy project contact information
    Language Access Advocacy Project Contact Information Repayment

    • Asian Pacific American Legal Center

      Hemi Kim

      213-977-7500 x 215

      213-977-7595 Fax

    • Asian & Pacific Islander American Health Forum

      Alice Chen and Gem Daus


      415-954-9999 Fax

    Language access advocacy project contact information1
    Language Access Advocacy Project Contact Information Repayment

    • California Pan-Ethnic Health Network

      Ellen Wu and Martin Martinez


      510-832-1175 Fax

    • California Primary Care Association

      Vivian Huang

      916-440-8170 x 238

      916-440-8172 Fax

    Language access advocacy project contact information2
    Language Access Advocacy Project Contact Information Repayment

    • Fresno Health Consumer Center

      Teresa Alvarado and Sengthiene Bosavanh


      559-570-1253 Fax

    • Latino Coalition for a Healthy California

      Lupe Alonzo-Diaz and Patty Diaz


      916-448-3248 Fax

    Language access advocacy project contact information3
    Language Access Advocacy Project Contact Information Repayment

    • National Health Law Program

      Doreena Wong

      310-204-6010 x3004

      310-204-0891 Fax

      Supported by The California Endowment