MA DPH CLAS Manual Chapter 6 Ensure Language Access.pdf

8/20/2019 MA DPH CLAS Manual Chapter 6 Ensure Language Access.pdf

1/29Making CLAS Happen Six Areas for Action –140140 Making CLAS Happen (2013) |Chapter 6: Ensure Language Access

CHAPTER 6:

Ensure Language Access


2/29141 Making CLAS Happen (2013) | Chapter 6: Ensure Language Access

IntroductionUnderstandable care is at the core of culturally competent services. A numberof federal and state laws establish language access requirements (See AppendixB: Overview of Laws). Beyond legal requirements, health providers have aresponsibility to offer understandable care to clients—whether that meansinterpretation services to clients with limited English prociency (LEP),

American Sign Language (ASL) interpretation for deaf persons, or using

strategies to improve communication for clients with limited literacy. Effectivecommunication is essential to empowering clients to become active drivers oftheir own health.

While successful language programs share common elements, each programmust be tailored and scaled to the needs of the populations served.

The goal of this chapter is to present promising practices and to offer basicinformation to help providers develop a language access program tailored tothe clients they serve, the services they offer and the resources available. Itis important to bear in mind that developing a successful program can takesignicant time and effort. Many resources are available to assist you. Seek topartner with language access experts and use the resources at the end of this

chapter.The ve-step guide presented in this chapter is loosely based on the U.S.

Department of Justice’s policy guidance for providing services to limited Englishprocient populations. 1 Further guidance on verbal communication strategies

for persons with sensory disabilities and limited health literacy can be found inChapter 1, Tools 6.1 and 6.5.

U.S. Department of Health and Human Services. Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National OriginDiscrimination Affecting Limited English Procient Persons. U.S. Department of Justice.


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GUIDE

Chapter 6 Guide

Step 1. Identify populations needing language assistance ........................143

Step 2. Assess services and language needs .............................................144Step 3. Plan a language access program ....................................................145

Elements of successful language access programs ......................................145

Step 4. Deliver effective language services ...............................................146Making language services accessible, timely and qualied .........................146

Working with lower literacy clients ............................................................148Cost-effective strategies for interpreter services ..........................................150Training .....................................................................................................151

Step 5. Adapt LEP programs on a regular basis ........................................151

Case Study 6: Tea and Interpreting ......................................................... 153Tools

6.1: Meeting Diverse Communication Needs ..............................................1586.2: Interpreter Competencies and Screening Questions ............................1596.3: Telephonic Interpreter Services ...........................................................1626.4: MDPH Translation Checklist ...............................................................1646.5: Language Access Resources .................................................................165

Language Access Checklist .......................................................................155

CLAS Standards Covered

Standard 5: Offer language assistance to individuals who have limited Englishprociency and/or other communication needs, at no cost to them, to facilitatetimely access to all health care and services.

Standard 6: Inform all individuals of the availability of language assistanceservices clearly and in their preferred language, verbally and in writing.

Standard 7: Ensure the competence of individuals providing languageassistance services, recognizing that the use of untrained individuals and/orminors should be avoided.

Standard 8: Provide easy-to-read print and multimedia materials and signage inthe languages commonly used by the populations in the service area.

CASE STUDIES

TOOLS

CHECKLIST



Step 1. IdentifyPopulations NeedingLanguage Assistance

As with other areas of culturalcompetence, ensuring language accessbegins with data. Having updated

information on the race, ethnicityand languages spoken in your servicearea is essential, especially whenplanning for interpreter servicesand translation. According to theDepartment of Health and HumanServices, the obligation to providemeaningful access and language isfact-dependent. 1 In other words, thelanguage services you should providewill be based on the number of

diverse clients in your service area.Who are the Limited EnglishProcient populations in yourservice area?To establish a need and ensure properservices, seek reliable data about servicepopulations. Learn who your clientsare and what languages they speak.Reviewing demographic trends can alsohelp agencies plan for languages thatwill be needed in the future.

Where do you nd the facts? When seeking data on limited Englishprocient populations, it is importantto look at a variety of sources. Thiscan help prevent confusion and offer arealistic sense of language needs. Takenindividually, each source may havelimitations. When combined, manysources can offer added depth and detail.

You can start with your agency’s owndata, but keep in mind that unless race,ethnicity and primary language datahave been consistently collected, youmay not get the full picture.

A successful group of datasources may include: patientutilization data; community-basedorganizations (Massachusetts Mutual

Assistance Associations, faith-basedorganizations); immigrant and refugeeadvocacy groups; First Language isNot English (FLNE) and LimitedEnglish Procient (LEP) surveys fromthe public school system; municipalboards of health; MassachusettsCommunity Health InformationProle (MassCHIP); and census datafor your service area.

See Chapter 3 for more on datacollection.

Limited EnglishProcient persons aredened by the U.S.Department of Healthand Human ServicesOfce of Civil Rights asindividuals who do notspeak English as their primary language andwho have a limitedability to read, write,speak or understandEnglish. 2

See:Tool 3.4

TOOLS



A successfullanguage servicesassessmentshould:

n Describe clientdemographicsand needs

n Link servicesoffered to clientneeds

n Identify areas andprocedures toimprove

n Anticipate thearrival of newLEP populations

n Analyzeresources andcosts

n Identify fundingopportunities

n Identify bestpractices

Step 2. Assess Servicesand Language Needs

With updated demographic data inhand, you can move on to the nextphase by completing a languageservices assessment. A languageservices assessment will helpyou identify needs and areas forimprovement. What you learn afteran assessment will set the basisfor developing a language serviceprogram according to your needsand resources.

Federal guidelines recommendgoing about the process by asking 3:n What populations do you serve

and what are their language needs?n How important are your services

for each population?n What services are you providing?n What are your resources? How

can you meet language needs withthose resources?

n How will you make populationsaware of your services?

If your organization is getting startedwith cultural competence planning,you can complete a languageassessment as part of the overallassessment discussed in Chapter 4.If you have a formal program inplace, make language assessmentspart of your ongoing culturalcompetence evaluations.

The following questions can serveas a guide for cultural competence

assessments.

n How many LEP individuals in theservice area use your services?

n How many could potentially beusing your services?

n How often do LEP populationscome in contact with yourprogram?

n What services do you offer?n How important are these services

to LEP populations?n How are these services meeting the

needs of LEP populations?n What are the current interpretation

and translation practices?n Where in the organization are

interpreter services needed?n What types of interpreter services,

at what frequency, are needed tomeet the language needs of diverseclients?

n What are your resources?n What are the costs of providing

language access?n What needs do you anticipate, and

what additional resources will youneed as new needs come up?

n How can you obtain new resourcesto meet increasing language needs?

n How can you bring yourprogram to the attention of LEPpopulations?

See:Tool 4.3: AssessmentResources

TOOLS



Step 3. Plan a LanguageAccess Program

Common Elements ofSuccessful Language AccessPrograms 4 5

Though your agency’s language accessprogram will be unique to yourneeds, successful programs sharecommon elements. According toeld research by the CommonwealthFund, successful language accessprograms plan, use consistent dataand processes, use a variety ofcommunity resources, work onlywith trained professionals, and seekfunding from a variety of sources.

Developing a language accessprogram is an involved process. Usingthese best practices can help youorganize your efforts and develop astandard. As you plan, it is importantto remember that interpretation is aspecic and complex skill set. Not allbilingual individuals are well-suitedfor interpretation. Working with onlytrained, professional interpreters canhelp your agency avoid many of the

pitfalls of language services.

The steps to developing asuccessful language access programinclude the following:

n Designate a coordinator to overseeimplementation, training andmonitoring.

n Analyze language needs.

n Identify resources in the community.

n Determine what types of languageassistance are best for the agencyand its clients (e.g., trained staffinterpreters, over-the-phoneinterpretation [OPI] or contractinterpreters).

n Determine how to respond to LEPclients.

n Include interpreter scheduling andtracking systems.

n Notify LEP clients of availablelanguage services.

n Establish policies, standards, andprocedures for interpreter servicesand translation of written materials.

n Update activities after periodic

review.

Interpretation andTranslation: Notto Be Confused

In this guidancemanual, a languageaccess programis dened as onethat includes bothinterpretation andtranslation. Thoughmany peopleuse the termsinterchangeably,interpretation andtranslation are twodifferent services.Both are important,but not the same.

Interpretation isthe oral restatingin one languageof what has beensaid in anotherlanguage.

Translation iswritten conversionof written materialsfrom one languageto another.

See: Tool 6.1TOOLS



Step 4. DeliverLanguage AccessServicesField research done by theMassachusetts Department of PublicHealth 6 revealed three essential

characteristics of successful languageaccess programs. Successful programsoffer interpreter services that are:n Accessible to clients at all pointsn Provided in a timely mannern Offered by consistently trained

interpreters

Whatever your specic languageneeds and resources, you can makesure the interpreter services youprovide are accessible, timely, andqualied. As you work towardthis goal, your ability to treat andcommunicate with clients who speakdifferent languages will improve.

As an added benet, you will haveproof of your efforts for contract andfunding purposes.

The following chart summarizesguidelines and promising practicesused in offering accessible, timely andqualied interpreter services. 7

Making Language Services Accessible, Timely and Qualied

Accessible n Assess language needs at all points of entry.n Inform clients verbally and in writing of their right to an

interpreter at no cost.n Post signs in all points of entry informing clients of their

right to an interpreter.n Offer interpreter services at all points of contact.n Offer vital documents and printed materials in the primary

languages of the service area.

Timely n Offer timely, effective language assistance services.

Qualied n Consistently train interpreters and bilingual staff.n Evaluate interpreters and bilingual staff.n Ensure accuracy of printed materials.n Don’t use friends and family as interpreters.n Never use children as interpreters.

Whatever yourspecic languageneeds and resources,make sure theinterpreter services

you use are accessible,timely and qualied.



Ensure Access toLanguage Services

Assess Language NeedsIt is important to learn what aclient’s preferred language is assoon as possible. Ideally, you shouldask clients what language theyprefer to speak during intake ortelephone registration and record thisinformation in the client’s le. Someideas of how to do this include:n Asking a set of standard questions

in the registration process: Whatis your preferred written andspoken language? Do you need aninterpreter?

n Using “I Speak” point to-cards toidentify languages (see links below).

Inform Clients Verbally and in Writingof Their Right to Interpreter Services

According to the U.S. Departmentof Health and Human Services thepublic should be informed of theavailability of interpreter services atall points of contact. Crucial pointsof contact for signs and noticesinclude registration and waitingareas. Consider also service areasmost frequently used by your limitedEnglish procient clients.

Translation Services

Offer Printed Materials in the PrimaryLanguage of the Service AreaFor programs with limited funds,developing written translations canbe particularly challenging. Youmay wonder when it is necessary to

translate or what materials should betranslated. This section answers somecommon questions about translations.How can I approach translation cost-effectively?

As you plan to translate materials,consider partnering with colleaguesand community organizations. Usingexisting materials, as long as they areappropriate for your clients, can alsobe helpful.

Translating ona Budget

n Use free client education materialsfrom clearinghouses anduniversities.

n Share and “borrow” existingmaterials from colleagues.

n Use visual materials for low-literacy populations.

n Monitor language needsto anticipate languages fortranslation.

BUDGET

¢$

See:Tool 6.5: Language Access ResourcesFor a free “You have a right to interpreter services”poster, visit:http://www.mass.gov/dph/healthequityFor “I Speak” cards, visit:http://www.cultureconnectinc.org/ispeak.html

TOOLS

It is important tolearn what a client’s

preferred language isas soon as possible.Ideally, you shouldask clients whatlanguage they

prefer to speakduring intake ortelephone registrationand record thisinformation in theclient’s le.



When is it Necessary to TranslateMaterials?The U.S. Health and Human ServicesOfce of Civil Rights “Safe HarborLaws” establish that organizationscan offer sufcient proof that they aremaking an effort to meet the needsof LEP groups by providing written

translations for at least:n Ten percent of the eligible

population or 3,000 clients,whichever is less, for all documents

n Five percent of the eligiblepopulation or 1,000 clients,whichever is less, for the most vitaldocuments

Massachusetts Department ofPublic Health (MDPH) best practice

recommendations for hospital-based interpreter services suggestthat written translations should beprovided for LEP populations thatmake up 15% of a program’s clients. 8

Thresholds aside, each agency isresponsible for determining when itis necessary to translate materials.

When serving in areas that arelinguistically integrated, you havethe potential to serve a very diversepopulation. The principle is simple:

Ask who needs your services and howthey will learn about or access thoseservices.n Who lives in your service area?n What languages do they speak?n What services do you have to offer?n How important are your services for

each population?n How will you make populations

aware of your services andinformation?

What materials should we translate? You are best qualied to answerthis question. According to the U.S.Health and Human Services Ofceof Civil Rights, documents that are“vital” to the program should takepriority. Examples of vital documentsinclude:n Signs, directions and notices

about the availability of interpreterservices

n Legal documents:– Consent forms– Client rights and responsibilities– Privacy notices– Client complaint forms– Grievance policies

– Client intake forms– Client education materialsrelevant to particular LEPpopulations

How can I meet the needs of lower-literacy clients?Providing language-specic clientmaterials may not address the needsof clients with lower literacy levels.Identifying and using a client’spreferred language is a good rststep, but is sometimes not enough.

You may make every effort totranslate materials, but if your clientcannot read, your efforts will be invain. Dig deeper to learn whetherclients can really understand. Canthey read well? Do they understandinstructions?

Be sensitive. Remember thatmany lower-literacy clients are oftentoo embarrassed to admit that theydo not understand forms or thatthey struggle to communicate withmedical staff.

See:Tool 6.4: Translation ChecklistTool 6.5: Translation Resources

TOOLS

Don’t AssumeLiteracy

n More than95 million

Americansdo not readwell enoughto understanda prescriptionlabel.

n More than 22million patientsreport theydo not speakEnglish “verywell.”

n Clients withlanguageand literacylimitations:– Use preventive

services lessoften

– Are more likelynot to takemedication asdirected

– Have worsehealthoutcomes

Source: The American

Medical Association, EthicalForce Program (2006)



Contract, Staff, Bank or Telephone Interpreters?

Staff InterpretersHired as employees; helpful when there is a frequent need for a specic language.Contract InterpretersHired per diem or as freelance interpreters. Typically paid a minimum of 2hours per visit. Helpful for less frequently encountered languages.Employee Language BanksPools of employees who can be called upon to interpret when needed. Work best

when employees are evaluated and trained. Lists must be updated frequently.Community Interpreter BanksCommunity-based agencies contracted to provide trained interpreters—can serveas a shared resource. Especially helpful for interpreters from small populations.Telephonic ServicesInterpreters accessed over a telephone line. Most helpful when time is of theessence, for brief appointments, unusual or rarely encountered languages.Source: Best Practice Recommendations for Hospital-Based Interpreter Services,Massachusetts Department of Public Health (2001)

A 2008 Commonwealth Fund report 9 offers some helpful ideas for workingwith lower-literacy populations:n Make it a team effort, beginning at

the front desk.n Use standardized communication tools.n Use plain language, face-to-face

communication, pictorials, andeducational materials.n Encourage clinicians to partner with

clients to achieve goals.n Commit to creating an environment

where health literacy is not assumed.

Ensure Timely Delivery ofInterpreter ServicesProvide Timely Interpreter Services at

All Points of ContactProviding timely interpreter servicescan help your agency run moreefciently. Timeliness also helps yousave money, especially if you areusing contract interpreters and payingby the hour. For the client, it can be amatter of life or death. Overall, timelyinterpreter services can mean betterservice and satisfaction.

Offering timely interpreter servicesrequires coordination. A scheduling andtracking system is an essential tool that canhelp your agency manage services. Finda system that ts your needs. If yours isa small agency, it may not make sense toinvest in an electronic system. For a largerfacility offering multiple languages, anelectronic scheduling tool may be a goodinvestment that will save money in thelong run.

Provide Effective, Qualied InterpreterServices

When selecting interpreting services,consider your budget, services, languageneeds and duration of visits. Considerhow feasible different types of interpretersmight be for your program. Ask: Will

interpretation for specic languages berequired on a regular basis? How long willthe interpreter be needed? For example,for short appointments, such as dentalappointments, telephone interpreterscan be more cost-effective than contractinterpreters. On the other hand, foragencies regularly offering interpretation ina specic language, staff interpreters wouldbe more adequate.

For your agency,timely servicesmean you run moreefciently. For theclient, timeliness canbe a matter of lifeor death. Overalltimely interpreterservices result inbetter service andsatisfaction.


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Who Should Receive InterpreterTraining?Offer training to all staff andcontractors involved in theinterpreting process, includingbilingual staff who regularly interactwith clients, employee language bankinterpreters, contract or volunteer

interpreters, and staff and providerswho regularly work with interpretersto communicate with clients.Topics for Interpreter Training

While topics for training should betailored to your needs, a few suggestedtopics for interpreter training include:n The link between cultural and

linguistic care and improved healthoutcomes

n Legal requirements and policiesn Quality-of-care issuesn The importance of using qualied

interpretersn Information about your programs

and servicesn Basic health terminologyn Interpreter ethics (condentiality,

accuracy, completeness and ethical

decision-making)n Interpreter intervention techniques,

roles, protocols and procedures.n Interpreter skills (consecutive and

simultaneous interpreting, sighttranslation, patient advocacy,cultural mediation, cross-culturalcommunication).

Successful interpreter programshave found it helpful to use training

opportunities available throughlocal universities and interpretingassociations.

Step 5. Adapt LanguageAccess Programs on aRegular BasisProviding effective language servicesis an ongoing process. In interviewswith the Massachusetts Department

of Public Health, public healthprofessionals have echoed thatmeeting the language needs of diverseclients is an ever-changing effort. Withthe arrival of new populations andchanging needs, it becomes essentialto adapt and update the way languageservices are provided.

To stay current and relevant,language access program coordinatorsshould regularly evaluate their

programs. The process outlined in thischapter not only applies to agenciesdeveloping a formal language accessplan, but also to those conductingassessments of these plans.

See: Tool 6.2: Interpreter Competencies and ScreeningQuestionsTool 6.5: Training ResourcesTOOLS

In interviews withthe MassachusettsDepartment of PublicHealth, public health

professionals haveechoed that meetingthe language needsof diverse clients isan ever-changingeffort. With the arrivalof new populationsand changing needs,it becomes essentialto adapt and updatethe way languageservices are provided.



ConclusionIn your ongoing efforts to maintain a current language access program:

n Monitor LEP populations.n Assess services and language needs.n Plan improvements to your language access program.n Deliver effective language access services according to changing needs.n Adapt language access programs on a regular basis.

This can enable your agency to provide care to clients in a way that they canunderstand and to engage their participation in the care process.



Case Study 6: Tea and Interpreting:Meeting Changing Language Needs

CASE STUDIES

The Program : Great Brook Valley Health Center Services: Primary and urgent care, mental health, social services, dental

care, pharmacy, laboratory, nutrition, optometry, health education,refugee health assessment, counseling and testing, healthmanagement programs, preventive programs, youth programs

Population : Hispanic (42%), Brazilian (27%), white, non-Hispanic, Africanimmigrant, African-American, Albanian, Asian, Native

American, Middle Eastern

BackgroundThe Great Brook Valley Health Center(GBVHC) is diverse at its core—with astaff that speaks 29 languages and comesfrom 36 countries. Seventy percent ofclients do not speak English as theirprimary language. The health centerhouses the Refugee Health AssessmentProgram, serving refugees from 21countries. This program focuses onoffering evaluation and diagnosticservices, referrals, introduction to healthcare services in the U.S., and linkageswith primary care.

Challenge As the only site in Central Massachusettsoffering refugee health assessments,GBVHC serves as a point of entry formany refugees. Because the center servessuch a high volume of LEP populations,offering qualied language accessservices is a priority.

Despite years of experience, adiverse, multilingual staff and teamof trained interpreters to draw upon,

meeting the language needs of aconstantly changing client populationis a challenge.

“We have to constantly adapt, learnabout new groups, and nd trainedinterpreters who speak their language,”says Sue Schlotterbeck, Director ofPlanning and Implementation of GreatBrook Valley Health Center. “It takes alot of coordination.”

ApproachGBVHC has developed an approach tolanguage services that has served the

organization well over the years. Thoughthe approach is adapted as new needsarise, it is broadly based on the followingprinciples.

Keep Track of Language TrendsSchlotterbeck has done this bystaying abreast of both internal andstate demographic data. When she isnotied of the upcoming arrival of anew LEP population, she noties herpartners who train interpreters, whothen prioritize applicants who speakneeded languages.

Work with Partners When GBVHC was having difcultynding Hmong interpreters,Schlotterbeck was able to nd aqualied person by contacting theschool system in a communitywhere there was an existing Hmongpopulation. In turn, she shares

interpreting resources and knowledgewith partners.

“Language servicestake time and follow-through. You have toreach out and thinkof every possible wayto meet client needs.”

– Sue Schlotterbeck,

Director ofPlanning andImplementation,Great Brook ValleyHealth Center



Work Only with TrainedInterpreters

All interpreters offering services atGBVHC must complete extensiveinterpreter training through anorganization that provides interpretertraining which includes pre- andpost-screenings for language uency(such as Central Mass Area HealthEducation Center or UMass MemorialMedical Center).

Hire Staff Reective of thePopulation

According to Schlotterbeck, having adiverse staff that reects their servicepopulation has been key to GBVHC’s

successful language access program.Train Staff to Meet Language NeedsOffering interpreter training toqualied bilingual staff has increasedthe ability of the center to meetincreasing language needs.

Translate Materials Strategically While GBVHC follows translationprotocols for threshold populations, theyapproach translation strategically by:

n Outsourcing vital documents to aprofessional translation agency

n Using available client educationmaterials (clearinghouses)

n Having qualied staff translatematerials

n Ensuring quality of translatedmaterials (strict review by multiplebilingual staff)

n Addressing the needs of low-literacy communities throughvisual materials and one-to-onecommunication

Enhance Client Understanding with

Culturally Relevant Programs African Women’s TeaOne of GBVHC’s unique approaches,the African Women’s Tea offers womenfrom diverse African countries aforum to gather, learn and discusshealth topics, and share experiences.Though participants in this groupcome from many countries (includingBurundi, Congo, Kenya, Liberia,Somalia and Uganda), they are able tocommunicate with each other throughtrained interpreters. The group hasbeen a success, generating interesting,lively discussions and enablingrefugee women to bond over commonexperiences.

Helpful Resources to FindCandidates for Interpreting

n

Voluntary organizations(VOLAGS)n Ofce of Refugee and Immigrant

Servicesn Mutual Assistance Associations

(see Glossary)n Universitiesn Local schoolsn Area hospitalsSee Tool 2.2 for a list of communityand volunteer organizations.

“We have to constantlyadapt, learn aboutnew groups, and ndtrained interpreterswho speak theirlanguage. It takes alot of coordination.”

–Sue Schlotterbeck,Director of Planningand Implementation,Great Brook ValleyHealth Center

Case Study 6: Tea and Interpreting: Meeting Changing Language Needs (cont.)



Chapter 6 Checklist:Ensure Language Access

CHECKLIST

This checklist includes suggested ways for programs to improve cultural

competence. See Appendix A: CLAS Self-Assessment Toolfor measures used by theMassachusetts Department of Public Health in contract monitoring and Requestsfor Responses (RFR).

Step 1. Identify Populations Needing Language Assistance❍ Data from a variety of sources is collected regularly and used to identify

populations with LEP, sensory impairments and other communication needs.

Step 2. Assess Services and Language Needs❍ Language needs assessments are conducted regularly.❍ Language needs and resources are taken into account when planning services.

Step 3. Plan a Language Access Program❍ A designated coordinator oversees language access services.❍ A written plan exists for providing language services in an accessible, timely and

qualied manner to LEP clients, clients who are deaf or hard of hearing, havesensory impairments or limited literacy.

❍ Clear policies and procedures exist regarding language access services.

Step 4. Deliver Effective Language Services❍ Language services are provided in a timely manner.❍ A documented plan exists for explaining documents and conveying information

to those with LEP, sensory impairments or limited literacy.❍ Translated notices regarding availability of no-cost interpreters are posted.❍ Important forms and documents are translated and written at 6th grade reading

level or lower.❍ Strategies (e.g. teach-back, teaching for understanding, assistance reading and

lling out forms, patient navigators) are used to ensure clients with limitedliteracy understand care.

❍

Documentation exists proving competency of interpreters.❍ Data are collected, documenting that interpreter services are adequately

provided (e.g., interpreter services offered? Received?).

Step 5. Adapt Programs Regularly❍ Language access programs are evaluated on a regular basis.❍ Data is reviewed periodically to anticipate language needs and allocate resources.❍ Subcontractors are monitored in their efforts to provide language access to clients with

special communication needs.


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CHAPTER 6: Ensure Language Access

Tools

6.1: Meeting Diverse Communication Needs6.2: Interpreter Competencies and Screening Questions6.3: Telephonic Interpreter Services6.4: Translation Checklist6.5: Language Access Resources



Strategies for Communicating with Clients with Limited Literacy

Assess literacy levels, culture and language. Valid literacy assessments include:n Rapid Estimate of Adult Literacy in Medicine (REALM)

n Short Test of Functional Health Literacy in Adults (S-TOFHLA) 1,2

Ask clients to “ teach back ” information to ensure understanding: 3

n During the informed consent process:“I know I’ve just given you lots of information. For me to know if I did my job properly, could you please repeat back to me the information you just received,mentioning what, why, where, when, who and how the procedure will be done?”

n During registration and clinical encounters:“What questions do you have?” (vs. Do you have any questions?)“For patient safety, could you please tell me in your own words what are you here for today?”

Adapt written materials:n Use plain, clear language.n Simplify written materials, such as registration and informed consent forms,

and prescription labels, to 6th grade reading levels (or lower).n Work with the adult learner community to test and develop written

materials.

Improve navigation and access:n Work with patient navigators or health educators.n Ensure signs are understandable (use universal symbols, graphics, color

coding and pictograms).

Tool 6.1: Meeting DiverseCommunication Needs

TOOLS

1Bass, P.F., Wilson, J.F., Grifth, C.H. 2003. A shortened instrument for literacy screening. Journal of General Internal Medicine 18(12):1036-1038.2Baker, D.W.; Williams, M.V.; Parker, R.M. et al. 1999. Development of a brief test to measure functional health literacy. Patient Educationand Counseling 38(1): 33-42.3National Quality Forum. 2005. Improving patient safety through informed consent for patients with limited health literacy. Washington, DC:NQF.

Use pictorals, technology and visuals (DVDs, interactive multimedia) toimprove education.



Effective Communication for Clients with Sensory Impairments All hospital programs and services are required by the Americans withDisabilities Act (ADA) to provide effective communication for patients, familymembers and hospital visitors who have a disability. The availability of suchresources should be made available in policies and procedures. 5 The JointCommission recommends using the following resources for clients with sensoryimpairments. 6

Auxiliary Aids and Services Augmentative & Alternative (AAC)Resourcesn American Sign Language (ASL)

interpretersn Telecommunications devices for the

deaf (TDD) in public areasn Volume control and hearing-

adaptable telephonesn Closed captioning servicesn Braille materials

n Writing padsn Communication boardsn Visual pain scalesn Speech generating devicesn Adaptive nurse call systems

A Checklist to Improve Communication 7,8,9

❍ Inform clients of their rights.❍ Ask: “What is the best way to communicate with/for you?”❍ Identify client’s preferred language for discussing health care.❍ Identify and address sensory, mobility or communication needs.❍ Identify and accommodate cultural, religious or spiritual beliefs or practices

that inuence care (e.g., modesty and privacy needs, appropriate genderproviders, dietary needs, scheduling to accommodate the need to pray).❍ Maintain eye contact, speak directly to the client, not the interpreter.❍ Explain audio interruptions (phones ringing, knocks on the door) to

patients with sensory impairments.❍ Use precise, objective, neutral and non-discriminatory language.❍ Support clients’ ability to understand and act on health information: use

plain language, avoid jargon and limit the number of messages delivered atone time.

❍ Use visual aids when necessary.❍

Ask the client if there are additional needs that may affect his or her care.❍ Ask the client to identify a support person.❍ Involve clients and famiily in the care process (not as interpreters).❍ Communicate information about unique client needs to the care team

(note in medical records).5U.S. Department of Justice. Civil Rights Division, Disability Rights Section. ADA Business Brief:Communicating with People Who are Deafor Hard of Hearing in Hospital Settings. Washington, D.C.: DOJ Civil Rights Division, 2003. (http://www.ada.gov/hospcombrscr.pdf)6The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap forHospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.7Ibid.8Massachusetts Department of Public Health. Introduction to Deaf Culture for Behavioral Health Practitioners. Boston: MassachusettsDepartment of Public Health, 2013.9Kailes, J., Tips for Interacting with People with Disabilities, Pomona, CA: Harris Family Center for Disability and Health Policy, 2011.

Tool 6.1: Meeting Diverse Communication Needs (cont.)


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Telephonic Interpreter Services (TIS) have grown rather quickly in the last fewyears. Fewer than ten years ago, AT&T Language Line was the only option forthis service. Now there are many agencies, of all sizes, that offer TIS.

Carefully research agencies providing this service, as it isn’t easy to providehigh-quality, reliable translation. Below is a list of some of the many agenciesthat provide this service.

1. Deaf Talk (Carnegie, PA)http://ww.deaf-talk.com/

Video ASL; interpreters for over 150 languages.Connecticut Ofce: Tom Hamilton, Sales & Customer ServicePhone: 860-633-3711 [email protected]

2. Language Line Services (Monterey, California)http://www.languageline.com/page/welcome/Includes ASL video interpretation. Monthly and usage-based fees available.Phone: 1-877-886-3885n Tele Interpreters (Glendale, California)

(Powered by Language Line Services; 170 languages.)Phone: 800-811-7881http://www.teleinterpreters.com/index.aspx

n Online Interpreters is now a subsidiary of Language Line Services.

3. Pacic Interpreters (Portland, Oregon)http://www.pacicinterpreters.com/contactus/contact-us.aspxGeneral Inquiries: (800) 311-1232Sales Department: (800) 324-8060

4. Cyracom (Tucson, Arizona)http://www.cyracom.com/Phone: 800-713-4950

5. AT&T Language LinePhone: 800-752-6096

6. 1-800-TRANSLATE (New York, NY)

http://www.1-800-translate.comCertied interpreters in 157 languages by phone or in person; sign up on-line for immediate access to telephone interpreters.

7. Certied Languages International (Portland, Oregon)http://www.certiedlanguages.com/ Phone interpreters experienced in medical, insurance, nancial and legalterminology, among others. Provides phone interpreters trained in specicbusiness terminology.Phone: 800-CALL-CLI (800-225-5254).

Tool 6.3: Telephonic Interpreter ServicesTOOLS



8. Language Learning Enterprises (Washington, DC)http:// www.lle-inc.com/ Phone: 888-464-8553

9. New World Language Serviceshttp:// www.newworldlanguages.com/

Your cost is kept as low as possible; extensive experience in telephoneinterpretation, including medical and legal terminology. Over 200languages.Phone: 909-915-1201

10.Quest (Sacramento, California)http:// www.questsys.com

A hospital-installed video-conferencing system. Flat-screen monitors aremoved into exam rooms and plugged into the network. A medical staffmember treating a non-English-speaking patient selects the languagerequired. The system calls the appropriate interpreter (there are 18 currently

on staff) whose image appears on screen. Using cameras attached at bothends, the translators can provide immediate remote interpretation, all day,every day.Phone: 800-326-4220

Tool 6.3: Telephonic Interpreter Services (cont.)



The following checklist is used by MDPH agencies in the translation process. It canserve as a model for your own process.

Steps in the Translation Process

❍ Determine target audience, their language, ethnicity, reading level, and otherfactors. Use language guides available from http://www.mass.gov/healthequity.

❍ Develop a list of key health messages the document will convey.

❍ Coordinate the development of materials. All materials should go through areview process before being translated.

❍ Work with individuals who represent the identied language/ethnic group to

ensure materials are appropriate.❍ Choose qualied potential translators.

❍ Obtain an itemized estimate in writing from the translator/agency to establish cost(whether per word, per page, or per project), turnaround time and projectmanagement fees, and to document any special instructions prior to assigning theproject to the translator.

❍ Develop a budget and timeline for translation completion.

❍ Make arrangements to ensure translation will be proofread/edited by a secondtranslator, either by requesting this service from the translation agency whenobtaining a cost estimate or, if working with an individual translator, by selecting asecond translator to perform proofreading/editing services.

❍ Review key messages and technical terms with the translator.

❍ Field-test the rst draft of the translation with representatives of the targetaudience (community providers, community residents).

❍ Negotiate any changes or discrepancies, if needed, by utilizing the Ofce of PublicHealth Strategies and Communications’ (PHSC) glossaries at http://www.mass.gov/ healthequity or by contacting PHSC.

❍ Make sure that the nal translation document includes references, in English, tothe document title and the language into which it has been translated (preferablyin the lower corner of the document). This will allow your staff to identify theappropriate language for distribution.

❍ Have the nal typeset copy proofread by a translator before the document isprinted.

❍ Make a back-up copy of nal translation, image les, and fonts – especially non-Roman characters. Be sure to have alternative formats (e.g. PDF and Rich Text) forall documents that will be posted online.

Tool 6.4: MDPH Translation ChecklistTOOLS



Web ResourcesOfce of Health EquityMassachusetts Department of Public Healthhttp://www.mass.gov/dph/healthequityThe Ofce of Health Equity Web site includes a number of helpful resources includingtranslation guidelines, telephonic interpreter contacts, audience language guides andtranslation glossaries.

Limited English Prociency (LEP): A Federal Interagency Website (LEP)http://www.lep.govThe website of the Federal Interagency Working Group on Limited EnglishProciency. Offers an overview of laws and LEP guidelines; language accessplans; interpretation and translation resources; Frequently Asked Questions;

planning tools; language assistance planning and self assessment tools; and theguidebook “Limited English Prociency: What Federal Agencies and Federally Assisted Programs Should Know About Providing Services to LEP Individuals.”

A Guide to Choosing and Adapting Culturally and LinguisticallyCompetent Health Promotion MaterialsNational Center for Cultural Competence, Georgetown Universityhttp://nccc.georgetown.edu/documents/Materials_Guide.pdfProvides guidance on how to assure that health promotion materials reect theprinciples and practices of cultural and linguistic competence.

A Patient-Centered Guide to Implementing Language Access Services in

Healthcare OrganizationsOfce of Minority Healthhttp://www.minorityhealth.hhs.gov/templates/content.aspx?ID=4375This guide was designed to help health care organizations implement effectivelanguage access services to meet the needs of their limited English procient (LEP)patients.

Health Literacy ResourcesAsk Me 3http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3

National Patient Safety Foundation program designed to improve communicationbetween patients and health care providers, encourage patients to become activemembers of their health care team, and promote healthy outcomes.

Health Literacy Universal Precautions Toolkithttp://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf Commissioned by AHRQ and developed and tested by the University of NorthCarolina at Chapel Hill. Offers primary care practices a way to assess their services forhealth literacy considerations, raise awareness, and work on specic areas.

Tool 6.5: Language Access ResourcesTOOLS


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Tool 6.5: Language Access Resources (cont.)

The Translator’s Home Companionhttp://www.lai.com/thc/thc.htmlOnline glossaries, translation software and engines, links to translation agencies, othertranslation products, a directory of translators, and more. Strongest on Europeanlanguages, but features non-European languages as well.

Multilingual Health Resources and Translated Health Promotion MaterialMassachusetts Health Promotion Clearinghousehttp://www.massclearinghouse.ehs.state.ma.usThe Massachusetts Health Promotion Clearinghouse is a central resource forMassachusetts-developed health education materials, available in multiplelanguages.

“I speak” cardsU.S. Department of Justicehttp://www.justice.gov/crt/about/cor/Pubs/ISpeakCards.pdf

SPIRAL: Selected Patient Information Resources in Asian Languageshttp://www.library.tufts.edu/hhsl/spiral/web.shtml

Joint initiative of South Cove Community Health Center and Tufts University HealthSciences Library; designed to meet consumer and health care provider needs of theSouth Cove community, with consumer information in Chinese, Cambodian/Khmer,Hmong, Korean, Lao, Thai, and Vietnamese.

Medicinatvhttp://www.medicinatv.comSpanish-language site that links to 10,000 health-related sites.

Multilingual Health Education Nethttp://www.multilingual-health-education.netCanadian site sponsored by the British Columbia Ministry of Health, the

Department of Canadian Heritage, the Vancouver Foundation, and partneragencies. Materials in Chinese, Farsi (Persian), Hindi, Korean, Somali, Vietnamese, English, French, Italian, Punjabi, and Spanish.

National Women’s Health Information CenterEnglish: http://www.womenshealth.govU.S. Government-approved women’s health information.

Further Reading Andrulis, D.P. and Brach, C. 2007. Integrating literacy, culture and language toimprove health care quality for diverse populations. American Journal of HealthBehavior, 31, S122-S133.

Nielsen-Bohlman, P; Allison, K.; and David, A. 2004. Health Literacy: APrescription to End Confusion. Washington, DC: National Academies PressTorres, Brunilda. 2001.

Best Practice Recommendations for Hospital-Based Interpreter Services. MassachusettsDepartment of Public Health. Available fromhttp://www.mass.gov/eohhs/docs/dph/health-equity/best-practices.doc

MA DPH CLAS Manual Chapter 6 Ensure Language Access.pdf

Documents

Transcript of MA DPH CLAS Manual Chapter 6 Ensure Language Access.pdf