How: Overview - Hablamos Juntos
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Transcript How: Overview - Hablamos Juntos
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
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
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
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
Promising needs assessments include:
An assessment of community language needs
An internal assessment of institutional needs
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
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
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
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 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
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
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
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
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
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
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
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
Key elements of monitoring and evaluation
include:
Patient satisfaction
Process variables
Outcome and quality measures
Promising Monitoring and Evaluation:
Venice Family Clinic
Free clinic serving primarily Latino and lowincome 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
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
Pilot projects are currently exploring and
testing the use of new technologies:
Remote simultaneous translation
Videoconferencing
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
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
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
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
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
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
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
State
Enrollees
Covered
Providers
Covered
Who the State Pays
Reimbursement
Rate
Admin or
Service
HI
FFS
FFS
Lang. agencies
$36/hr
Service
ID
FFS
FFS
Providers
$7/hr
Service
MA
All
Hospitals
Hospitals
Varies
Admin
ME
FFS
FFS
Providers
$30-$40/hr*
Service
MN
FFS
FFS
Providers
$50/hr**
Admin
MT
All Medicaid
All
Interpreters
$6.25/15 minutes
Admin
NH
FFS
FFS
Interpreters
$15/hr
Admin
UT
FFS
FFS
Lang. agencies
$22 (phone)
Service
$39 (in-person)
WA
FFS
Public entities
Public entities
50% expenses
Admin
WA
FFS
FFS
Brokers
$28/hr
Admin
* $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
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 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
Resources
CPCA’s publication, “Providing Health Care to Limited
English Proficient Patients: A Manual of Promising
Practices” at www.cpca.org.
AAPCHO’s publication, “A Functional Manual for
Providing Linguistically Competent Health Care Services
as Developed by a Community Health Center” at
www.aapcho.org.
NHeLP’s publication “Providing Language Interpretation
Services in Health Care Settings: Examples from the
Field” at www.cmwf.org.
NHeLP and Access Project publication “Language
Services Action Kit: Interpreter Services in Health Care
Settings for People with Limited English Proficiency” at
www.nhelp.org.
Questions?
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
415-954-9988
415-954-9999 Fax
[email protected]
[email protected]
Language Access Advocacy Project
Contact Information
California Pan-Ethnic Health Network
Ellen Wu and Martin Martinez
510-832-1160
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 Information
Fresno Health Consumer Center
Teresa Alvarado and Sengthiene Bosavanh
559-570-1205
559-570-1253 Fax
[email protected]
[email protected]
Latino Coalition for a Healthy California
Lupe Alonzo-Diaz and Patty Diaz
916-448-3234
916-448-3248 Fax
[email protected]
[email protected]
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