Promising Practices in Healthcare

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 Clínica 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 Venture: 

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: 

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 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: Venice 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: 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: 

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: 

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: 

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: 

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: 

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: 

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: 

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: 

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: 

Current State Financing * $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 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: 

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: 

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.

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Questions?

Language Access Advocacy Project Contact Information: 

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

Language Access Advocacy Project Contact Information: 

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

Language Access Advocacy Project Contact Information: 

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

Language Access Advocacy Project Contact Information: 

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