Importance of Language Services

1. Importance of Language Services Language Access Advocacy Project California 2004

2. Outline of Presentation • Background on Limited English Proficient • Reasons for addressing language barriers • What you can do to advocate for services

3. Who is Limited English Proficient (LEP)? • Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English. • U.S. Census definition: anyone who answers less than “very well” to the question: “How well do you speak English?” [possible answers: very well, well, not well, not at all].

4. United States Demographics • 1990 Census • 31 million spoke language other than English • 14 million considered Limited English Proficient • 2000 Census • 47 million speak language other than English (17.9%) • 21 million considered Limited English Proficient (8.1%)

5. California Demographics • 1990 Census • 8.6 million spoke language other than English • 4.4 million considered Limited English Proficient • 2000 American Community Survey • 13.3 million speak a language other than English • Nearly 7 million are likely LEP

6. California Demographics Disproportionately Foreign-Born • According to the 2000 Census, 25.9% of all Californians are foreign-born compared to 10.4% of the U.S. population • Among Latinos in the United States, 39.1% are foreign-born. • Among Asians and Pacific Islanders, 61.4% are foreign-born. Source: U.S. Census Bureau, “Profile of the Foreign-Born Population in the United States: 2000,” Current Population Reports.

7. Why Language Services are Important • Access to Care • Quality of Care • Cost of Care • Risk Management • State and Federal Requirements • Makes Business Sense

8. Access to Care Primary and Preventive Care • In a national survey, children whose parents responded in English were 2.6 times as likely to have a usual source of care as those whose parents responded in Spanish.Weinick at al. Am J Pub Health 2000; 90:1771-4. • Disparities between LEP and non-LEP patients in colorectal screening and flu shots decreased after implementation of interpreter services program. Jacobs at al. JGIM 2001;16:468-74.

9. Access to Care Follow-up Visits • Patients who experienced a language barrier during the medical encounter were significantly less likely to be discharged from the ER with a follow-up appointment than other patients. Sarver et al. JGIM 2000; 15: 256-264.

10. Quality of Care Patient Satisfaction • Spanish-speaking patients less satisfied with care. Morales et al. JGIM 1999; 14:409-417. • LEP patients less satisfied with emergency care. Baker et al. Med Care 1998; 36:1461-1470. • LEP patients less satisfied with emergency care, less willing to return for future care. Carrasquillo et al. JGIM 1999; 14:82-87.

11. Quality of Care Patient Comprehension and Adherence • LEP patients less likely to understand medication instructions, less likely to receive needed financial assistance, and less likely to return to the same hospital. Andrulis et al. Access Project 2002, What a Difference an Interpreter Can Make. • Spanish-speaking patients discharged from emergency room without interpreters less likely to understand diagnoses, prescribed medications, special instructions or plans for follow-up care. Crane. J Emerg Med 1997; 15(1):1-7. • Spanish-speaking patients more likely to miss appointments and be less adherent to asthma medication if physician did not speak Spanish. Manson. Med Care 1988; 26(12):1119-1128.

12. Cost of Care Emergency Room Costs • Pediatric patients whose families were assessed to have a “language barrier” with the physician had higher charges ($38) and longer stays (20 minutes) than those without language barriers. Hampers et al. Peds 1999; 103(6): 1253-1256. • Non-interpreted LEP patients returned to the ER more frequently and followed-up in clinic less frequently than interpreted patients, who had the lowest 30-day post ER visit charges. Bernstein J, et al. J Immigrant Health 2002; 171-176.

13. Risk Management Medical History Taking • Spanish-speaking pregnant woman not told of miscarriage.Fortier et al. J Healthcare Poor Underserved 1998; 9:S81-100. • Non-English speaking man awarded $71 million for failure to diagnose stroke. Harshan. Med Econ 1984; 289-292.

14. Risk Management Provider Communication • Hmong man had the wrong leg amputated because his son misinterpreted the consent form. In litigation. • Lao woman awarded $1.2 million for wrongful imprisonment for 10 months for noncompliance with tuberculosis treatment; it was never explained why she needed to take her medications. Asian Week, 5/10/00.

15. California Requirements • Dymally-Alatorre Bilingual Services Act • Kopp Act • Department of Health Services Medi-Cal Managed Care Contracts • Managed Risk Medical Insurance Board Healthy Families Contracts • Department of Managed Health Care Private Health Plan Contracts • State Title VI Look-Alike See companion presentation “State and Federal Requirements”

16. Federal Requirements • Title VI of the 1964 Civil Rights Act • Executive Order 13166 • DHHS Office for Civil Rights Policy Guidance • Office of Minority Health CLAS Standards See companion presentation “State and Federal Requirements”

17. Makes Business Sense • Changing demographics of consumers/clients: meets consumer needs, increases consumer satisfaction • Marketing strategy: attracts new clients • Improved quality: increases patient compliance • Risk management: reduces errors/malpractice risk • Cost reductions: decreases unnecessary care

18. What Can YOU Do? • Work with providers and policy makers to improve language access and funding. • Support data collection that can be used to advocate for improved language access and funding. • Consider legislative and/or administrative action. • Document actual costs and estimate cost savings; develop models that would be most appropriate in your state. • Develop initiatives to improve the number of, and trainings for, interpreters.

19. Questions?

20. Language Access Advocacy Project Contact Information • Asian Pacific American Legal Center Hemi Kim 213-977-7500 x 215 213-977-7595 Fax hkim@apalc.org • Asian & Pacific Islander American Health Forum Alice Chen and Gem Daus 415-954-9988 415-954-9999 Fax achen@apiahf.org gdaus@apiahf.org

21. Language Access Advocacy Project Contact Information • California Pan-Ethnic Health Network Ellen Wu and Martin Martinez 510-832-1160 510-832-1175 Fax ewu@cpehn.org mmartinez@cpehn.org • California Primary Care Association Vivian Huang 916-440-8170 x 238 916-440-8172 Fax Vhuang@cpca.org

22. Language Access Advocacy Project Contact Information • Fresno Health Consumer Center Teresa Alvarado and Sengthiene Bosavanh 559-570-1205 559-570-1253 Fax talvarado@centralcallegal.org seng@centralcallegal.org • Latino Coalition for a Healthy California Lupe Alonzo-Diaz and Patty Diaz 916-448-3234 916-448-3248 Fax Lupe@lchc.org Pdiaz@lchc.org

23. Language Access Advocacy Project Contact Information • National Health Law Program Doreena Wong 310-204-6010 x3004 310-204-0891 Fax wong@healthlaw.org Supported by The California Endowment