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Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers

Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers. Kris McCracken, Dir. of Operations Manchester Community Health Center. Purpose. Provide an Overview of Community Health Centers (CHCs) and how they are Addressing a Growing, Diverse Population

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Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers

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  1. Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers Kris McCracken, Dir. of Operations Manchester Community Health Center

  2. Purpose • Provide an Overview of Community Health Centers (CHCs) and how they are Addressing a Growing, Diverse Population • Lessons Learned that could be applied to other Group Practice Settings

  3. What is a Federally Qualified Health Center FQHC)? • A Non-Profit Organization that: • Is a Community Based Organization Governed by a Board of Directors Comprised of 51% Consumers of Services • Serves an Underserved Population or Area • Provides a Comprehensive Scope of Preventive and Primary Health Services to Anyone, Regardless of Insurance Status or Ability to Pay • Provides a Sliding-Fee Scale Based Upon Income for Those without Insurance • Receives Funding Under Section 330 of the Public Health Service Act

  4. CHCs Served 81,000 People in 2004 in New Hampshire

  5. Manchester Community Health CenterDemographics … • PRIMARY SERVICE AREA: Greater Manchester • TOTAL # ACTIVE PATIENTS: Approximately 7,400 • PERCENTAGE of PATIENTS w/FOREIGN LANG PRIMARY: 50+% • LANGUAGES SPOKEN IN SERVICE AREA: 70+ • LANGUAGES SPOKEN at MCHC: 60 • PRIMARY LANGUAGES OF PATIENT POPULATION: Spanish, Arabic, Bosnian, Russian, Mandarin/Cantonese, Vietnamese, Portuguese French, Albanian, many African Languages (Specifically from Sudan, Liberia, Somalia, Kenya, Rwanda and Nigeria) • NUMBER of EMPLOYEES: 55 FTE’s

  6. Language Volume (Over 10 speakers)

  7. Interpretation Expenses FY’04-08

  8. Service Delivery Structure INTERPRETATION RESOURCES: -2 FTE’s dedicated Spanish Interpreters -.5 FTE dedicated Bosnian Interpreter -.5 FTE dedicated Somali/Mai Mai/Zigua Interpreter -Contract with Tele-Interpreters for rare languages -25 Independent Interpreters available (all staff have copy of the list) -Contract with Lutheran Social Services Language Bank -Use of Northeast Ctr. For the Deaf and Hard of Hearing as well as Granite State Independent Living for Sign Language Interpreters -20 Total Bilingual Staff Members (Languages spoken: Spanish, French, Arabic ,Bosnian, Romanian, Russian, Swahili)

  9. Policies & Procedures • Gathering of Country of Birth, Primary Language, and whether an interpreter is needed at intake • Testing for competency of staff who wish to interpret or provide services directly without the aid of an interpreter • Reminder messages in all patient MIS systems that an interpreter is required to “prompt” staff • Training for staff who wish to interpret • Policy regarding use of children or family members • Arranging for interpretation in advance of visit

  10. Human Resources Perspective HISTORY: • At the beginning: one dedicated interpreter and use of staff in addition to their regular position • In the middle: some positions had interpretation as a part of the job description • Current: use of full time interpreters, external consulting interpreters, or language line 90% of the time ISSUES: -Salary differentials? -Who replaces the individual employee who has another position to attend to? -Who is “competent” to interpret? -Are people fluent with oral skills, written skills or both?

  11. Patient Perspective • Gender issues • Cultural issues • Religious concerns • Comfort level with a non-family member • Knowledge of a particular staff person • Knowledge of a particular interpreter (in small communities can be a big problem)

  12. Paperwork! • Patient Intake Forms • Patient/Facility Signs • Patient Consent Forms • Patient Education Materials • Patient Newsletter • Patient Letters (Personalized) • Patient Information regarding specialty care Currently 77 forms and handouts available in our top 9 languages as well as English

  13. ISSUES still on the Fore-Front • After hours access (answering service limitations) Tele-interpreter available for doctor through 3-way conference call. • Recruitment of bilingual direct service providers • Difficulty when referring patients out to specialty care and testing • Loss of funding to Refugee Resettlement Programs

  14. Areas for Consideration • Navigating the American Health Care system • Legal requirements for Interpretation (OCR) • Economic Impact of Providing Services • Adequacy of supply of bilingual/bicultural healthcare professionals • Differences in Cultural Beliefs in regards to healthcare • Availability of refugee/immigrant health records • Difficulties in coordinating care with: • Hospitals • Specialty Providers • Mental Health Providers • Social Service Agencies • VNA’s • Entitlement Programs

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