Linguistically Appropriate Health Care

*Language Access Responsibilities – Overview for DHS Employees**:* This presentation for DHS employees provides general information about the DHS LEP Plan, basic principles, and tips for communicating with LEP persons.

Designed to help women deal with child abuse issues that might arise during treatment for alcohol abuse or drug abuse. Defines child abuse, lists symptoms of abuse, and suggests how counselors can help with coping and healing.

This guide provides healthcare organizations with step by step guidance on how to assess language needs of patients, assess organizational capabilities, and plan and implement language access services, including resources regarding interpretation, translation, signage, notifying patients of language access services, community involvement, funding sources, and samples of waivers, and more.

This toolkit was developed for physicians and the health care teams with whom they work and presents a systems approach to re-designing an office practice to provide the highest quality care possible to Limited English Proficient (LEP) patients.

Advocates at Make the Road New York (MRNY), an organization that promotes equality and justice for all New Yorkers, and New York Lawyers for the Public Interest (NYLPI), a non-profit civil rights law firm that advocates for immigrants and communities of color, applaud Governor Cuomo’s signing of a new Executive Order this morning which will ensure that state government services are accessible to all regardless of English language ability

This brief highlights the effects of language barriers on patient safety, quality of health care, and the challenges organizations must overcome in order to effectively address language barriers. Drawing on the experiences of the 10 Hablamos Juntos demonstration sites, this brief highlights the lessons that participating providers, health plans and other organizations learned, and suggests next steps that need to be taken in order to ensure that the Nation’s LEP patients receive safe, high quality health care.

Created by the Industry Collaboration Effort’s (ICE) nation-wide team of health professionals, this toolkit includes tips on interaction with a diverse patient base, communication across language barriers, understanding patients from various cultural backgrounds, and key resources.

This document was developed by the National Association of State Workforce Agencies (NASWA) to assist states in ensuring that LEP persons receive meaningful access to federally assisted programs and services. It provides basic steps for the development & implementation of a LEP Plan

Promoting appropriate use of physicians’ non-English language skills in clinical care Inadequate, incorrect or incomplete communication has profound implications for patient care and is a leading cause of health and health care disparities for populations with limited English proficiency (LEP), whose access to quality care is often affected by language barriers. The elimination of disparities is a matter of great moral and practical concern for our nation, including the more than 70 professional societies and aligned organizations that comprise the Commission to End Health Care Disparities.

This 2005 Health Affairs publication reviews the evidence on the link between linguistic competence and health care quality and the impact of particular language assistance strategies. Drawing on the experiences of fourteen health plans that have been at the forefront of linguistic competence efforts, lessons on ways to improve the availability and quality of interpreter services for plans, purchasers, policymakers, and researchers are identified.

This second chapter of Intercultural Communication: Identities in a Global Community by Fred E. Jandt, is part of a book on communicating across cultures and focuses on “how definitions of communication reflect culture” and “the skills that make you competent in intercultural communication.”

Expresses the importance of significance of having trained Medical Interpreters in healthcare in order to gain a clearer understanding of effective communication. It further indicates how patience with patients is essential to good doctoring.

Hablamos Juntos means “We speak together.” Its mission is to improve communication between health care providers and their patients with limited English proficiency. Their website provides a wealth of information on the use of universal symbols for health care in signage, developing quality Spanish language materials, interpreters and interpreting, and affordable solutions

This Issue Brief was developed after Grant makers In Health convened a group of experts from philanthropy, research, health care practice, and policy in April 2003 to discuss the roles of language and culture in providing effective health care. This Issue Brief contains sections on recent immigration trends and demographic changes, the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients; strategies for improving language access; and advancing research.

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests. The study, done at two pediatric ERs, found that when Spanish-speaking families had access to a professional interpreter, 12 percent of translation slips — such as adding or omitting certain words and phrases — could have had “clinical consequences,” like giving a wrong medication dose

Interpreting Certification Fact Sheet The Certification Commission for Healthcare Interpreters (CCHI) is a member of the Institute for Credentialing Excellence

The mission of JNCL-NCLIS is to ensure that Americans have the opportunity to learn English and at least one other language, to advance the language profession in the US, and to raise awareness about the importance of language and international education to the national interest. We shape national policy for World Languages, ASL, and international education and to raise the profile of the language enterprise. JNCL and NCLIS represent the language profession to the United States. As professional organizations in teaching, translation, interpreting, testing, research, and many other fields, we raise public awareness of language as an enterprise vital to national well-being. The language enterprise employs 500,000 Americans who work to foster mutual understanding and who deserve continued public support.

This website consists of new studies published in a special Robert Wood Johnson Foundation-supported supplement to the Journal of General Internal Medicine that examine the consequences of language barriers for patients who speak little, if any English, and the absence of language services in health care settings.

This Health Canada report describes current research on language barriers and analyzes their impact on access to quality health care. Health Canada is Canada’s Federal department responsible for access to health care and good health of Canadians.

The California Endowment commissioned an annotated bibliography of the research on the prevalence, role and effects of language barriers in health care. The goal of this publication is to provide a comprehensive – but given the extent and pace of research, not exhaustive – review of the research literature in this area.

The Language Portal provides “‘one-stop shopping’ for the many local government administrators, policymakers, and others who are looking for ways to provide high-quality and cost-effective translation and interpretation services.”

LEP.gov promotes a positive and cooperative understanding of the importance of language access to federal programs and federally assisted programs. The website supports fair, reasoned and consistent implementation of Executive Order 13166, Title VI, and the Title VI regulations regarding language access. The site also acts as a clearinghouse, providing and linking to information, tools, and technical assistance regarding Limited English Proficiency and language services for federal agencies, recipients of federal funds, users of federal programs and federally assisted programs, and other stakeholders.

The aim of this paper is to describe various approaches that have been taken or could be taken to avoid the linguistic incompatibility that impedes full and equal access to health care on the part of health care providers and their patients when they do not speak the same language.

‘Covered California’ translates to California Cubierto in Spanish, but what exactly does it mean?’’ said Laura Lopez, Street Level Health Project’s executive director, who immigrated to the United States from Peru years ago. ‘‘It’s not just providing a piece of paper that says this is what is covered. It’s really having people on the ground talking with the community.’’

National Council on Interpreting in Health Care develops national guidance standards for interpreters in the health care field

This Department of Labor, Bureau of Labor Statistics website provides occupation information on interpreters and translators, including the nature of the work, training, earnings, and more.

This manual, compiled by the California Primary Care Association, shares promising approaches to the top five challenges in providing health services to Limited English Proficient (LEP) populations. The top five challenges were determined using survey and interview methods.

The National Health Law program developed a short survey instrument and distributed it to interested organizations nationwide during the fall of 2001 and winter of 2002. From the completed surveys, 14 programs and projects were selected for more in-depth assessment. Programs were selected to reflect a range of interpreter services in different health care settings, funding sources, and costs of implementation.

To assess current innovations, the National Health Law Program conducted site visits and phone interviews at small health care provider settings. Certain services emerged as “promising practices”—creative, effective methods that are replicable by other small providers. The authors include an eight-step plan to help providers develop a strategy to meet the needs of their LEP patients and the community.

This issue of the Refugee Report focuses on language programs relating to refugee life. Included is a comprehensive report and fact sheet on linguistic access to health care. These can be found in the articles “Funding for Health Care Language Services” and “Language Interpretation in the Delivery of Health Care Services.”

This fact sheet provides information on interpreter use and language assistance policies from a study that “explored how rural hospitals are meeting the needs of LEP patients, reflecting the Federal standards for culturally and linguistically appropriate services (CLAS standards).”

“A national program funded by the Robert Wood Johnson Foundation aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). Speaking Together integrates quality improvement with language services, and brings together hospitals to pilot new performance measures and test valuable techniques for reducing health care disparities associated with language barriers.”

The adoption of hospital policies and procedures is the essential mechanism to making a significant change in the operational actions of the U.S. hospital industry, and has been used throughout the history of this industry as a mechanism to change practice and establish expectations on a challenging issue. This document is designed to offer hospitals a set of tools to utilize in updating their own internal Policy and Procedure Manuals.

The purpose of this chapter is to provide clinicians with knowledge and skills to develop their competency in working with interpreters. This chapter provides a practical guide to identifying common problems in interpreting, the role of the cultural interpreter, interpreting formats and stages, and effective communication skills in working with non-English-speaking patients. The therapeutic triad model is introduced as an effective tool in working with interpreters.

When someone arrives at the hospital who doesn’t speak English very well, it’s common for workers at the hospital who are fluent in that language —doctors, nurses, even administrative staff — to step in and act as the patient’s interpreter. Though they may be well-meaning, not to mention more affordable than trained interpreters, relying on such accidental interpreters during medical treatment is not the best idea, research has found

An extensive resource guide to mean “to assist health professionals improve and incorporate cultural and linguistic competence into their practice. The resource guide provides an overview of guiding principles, framework, curriculum development, implementation strategies, and a toolkit to assist providers and staff.”

This document provides tips that can help you write educational oral health materials that are easy for everyone to understand.

This website provides the definition, skills needed, background, impact and more regarding health literacy.

Health Literacy Consulting offers a free monthly newsletter and helps organizations communicate in a way people can understand.

The National Institute for Literacy provides statistics and facts about the state of health literacy in the United States.

Presented by the American Medical Association and American Medical Association Foundation, these three modules provide a general overview of health literacy in the United States (Module 1), tools on creating a shame free environment (Module 2), and enhancing patient interaction and communication (Module 3).

Providing Culturally Appropriate Education on Type 2 Diabetes to Rural American Indians

The Latino patient: a cultural guide for health care providers

Clearing up the top 10 myths about translation Translation has an impact on virtually every aspect of society, politics, and economics, but how much of what you know about translation is really true? You might be surprised to learn that translation is a highly diverse and complex market — and one that’s bigger than you might think. Here are ten of the most widely held myths about translation

The California Healthcare Interpreters Association (CHIA) with a grant from The California Endowment has developed this guide on the “Ethical Principles, Protocols and Guidance on Roles & Intervention” for interpretation. It ensures that the standards necessary for effective interpreting are supported as well as explains the important nuances of the profession.

This study, by The California Endowment, assesses current healthcare interpreter training procedures and trends in California. The bases for the analysis are 21 surveys of interpreter training programs in the state. The information on the programs has then been compiled into a “Compendium of Training Programs.” The goal is the overall improvement of healthcare interpreter training programs through information sharing.

The California Endowment’s mission is to expand access to affordable, quality health care for underserved individuals, and to promote fundamental improvements in the health status of all Californians. To help support this mission, they have developed a Language Access initiative, and as part of their technical assistance in this effort, they have commissioned this guide so that we and others may learn more about selecting and using health care interpreter service agencies.

This link will direct you to a language proficiency self-assessment tool that is part of a toolkit called “Better Communication Better Care: Provider Tools to Care for Diverse Populations.”

This Action Kit includes materials that explain the federal laws and policies that require health care providers to ensure access to services for people with limited English proficiency; explain how states pay for Medicaid and SCHIP services, and how they can get federal funding to help pay for language services, such as interpretation, for program enrollees; describe models that some states have adopted to reimburse health care providers for language services; provide information and describe techniques you can use to demonstrate the need for language services in advocacy campaigns; list resources where you may find additional information about language services; and suggest some next steps for getting your advocacy efforts started.

National Center on Immigrant Integration Policy The National Center on Immigrant Integration Policy at MPI is a crossroads for elected officials, grassroots and nonprofit leaders, educators, journalists, researchers, local service providers, state and local agency managers, and others who seek to understand and respond to the challenges and opportunities today’s high rates of immigration create in local communities.

The goal of the Standards, Training and Certification (STC) Committee of the National Council on Interpreting in Health Care (NCIHC) was to create a national code of ethics that would provide the growing profession with a set of shared, essential guiding principles expressing what are considered morally appropriate behaviors for its practitioners as they perform their day-to-day duties

The NCIHC’s mission is to promote culturally competent professional health care interpreting as a means to support equal access to health care for individuals with limited English proficiency. Their web site has a large number of language access resources, including a working paper series examining interpreter qualifications, ethics, models for training, models for the provision of language access services in health care settings, and more.

This research study published in the American Journal of Public Health in 2004 assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency. The change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented was measured. Researchers concluded that providing interpreter services was a financially viable method for enhancing delivery of health care to patients with limited English proficiency

A handy, pocket-sized bi-lingual language guide specifically designed for health-care professionals needing to communicate with Spanish-speaking patients about their medical needs.

“This 28-minute video/DVD is designed to help providers in: choosing an appropriate interpreter, recognizing the signs of professional and unprofessional interpretation, working effectively with a trained interpreter, and guiding an untrained interpreter.”

A spiral bound book containing commonly used clinical phrases with accompanying translations in the following languages:

Arabic Armenian Chinese Creole Farsi French German Greek

Hindi  Italian Japanese Korean Polish Portuguese Russian Spanish

Swahili Ukranian Vietnamese Yiddish

An educational, Spanish video/DVD series created specifically for Latino immigrants. This medical video/DVD addresses “challenges through vivid representations of several medical situations. Topics covered include: Sources for medical insurance, Health benefits, Co-payments, Deductibles, Appointments, Emergency care, Medically Needy and Medicaid, Spend downs, Medical cards and personal information, Medical programs for children, and Phone Interpretation.”

“Medical Spanish is a Virtual Conversations® language program for health professionals who want to communicate directly with Hispanic patients in Spanish. It teaches you relevant vocabulary and phrases you can use in the clinical setting, and it lets you practice speaking them by actually taking the complete medical history of an intelligent Hispanic woman who doesn’t speak English.”

Language identification card used by the Census Bureau to identify primary language(s) spoken. The phrase “mark this box if you read or speak _____” is translated into the following languages on the card: Arabic, Armenian, Bengali, Cambodian, Chamorro, Chinese, Creole, Croatian (Serbo-Croatian), Czech, Dutch, English, Farsi, German, Greek, Hindi, Hmong, Hungarian, Ilocano, Italian, Japanese, Korean, Laotian, Polish, Portuguese, Romanian, Russian, Samoan, Serbian (Serbo-Croatian), Slovak, Spanish, Tagalog, Thai, Tongan, Ukrainian, Urdu, Vietnamese, Yiddish.

This is a glossary of expressions and words in Spanish pertaining to health and medicine. They were collected from recent interviews in deep south Texas and northeastern Mexico. Many are home remedies and cultural beliefs.

The content of this website is “for the purpose of practicing Spanish and improving communication in the health setting.” It “includes phrases for the medical interview and some important terminology, including descriptions of diagnostic studies and how to explain prescriptions.”

Twenty-eight universal health symbols have been created by the Robert Wood Johnson Foundation, Hablamos Juntos in cooperation with the Society for Environmental Graphic Design. These symbols can be an effective communication tool regardless of reading level, therefore helping to eliminate language barriers.

“The MLA Language Map uses data from the 2000 United States census to display the locations and numbers of speakers of thirty languages and three groups of less commonly spoken languages in the United States.”

This Spanish translated website contains information pertaining to Disease Control and Prevention.

A guide that can help you work with your doctor or nurse to choose pain-relief medicine for osteoarthritis.

This brief highlights lessons learned by the ten Hablamos Juntos demonstration sites about the barriers faced by health care organizations in producing useful translated text, and in evaluating those products for quality. Overall, it was found that health care organizations have broad misconceptions about the translation process, and lack effective methods to evaluate translated text. Misguided standards—such as using “back-to-English” translation to check quality—may actually contribute to poor translation. These difficulties make it challenging for organizations to produce useful non-English text. Health care organizations can improve performance in this area by developing systems to identify and produce non-English text, and by building capacity to make decisions about non-English text. In addition, specialized training programs are needed for translators who work primarily with health translations. Many translators also need to improve basic writing proficiency in their native languages.

The State of North Carolina Department of Health and Human Services Division of Public Health provides this resource manual based on the idea that written materials can be one of the most effective communication tools. They determined, however, it is often difficult to determine what and how materials should be translated. This document provides model standards of translation, characteristics of appropriate material, and guidelines for translation.

Provides guidance that will be helpful to programs/agencies when engaging a translator, including the following documents: “Translation Guidance, Translation Request Worksheet, Translation Checklist, Translation Quality Assurance Form and In-House Translation Review.”

The National Board of Certification for Medical Interpreters has launched the National Registry of Certified Medical Interpreters, which serves as a central online resource to verify the credentials of Certified Medical Interpreters (CMI). “The new online registry greatly enhances the functionality of the National Board’s website and provides medical interpreters and healthcare providers alike a helpful tool to better serve limited-English speaking patients,” The National Registry of Certified Medical Interpreters is a searchable online registry that provides further evidence of CMIs’ credentials, in addition to the certificate and wallet card they receive. The registry can be searched by interpreter name, city, state, language and other categories. In addition, hospitals and doctors with very specific interpreter needs can conduct refined searches within the registry by extending the search parameters

Getting it Right is an American Translators Association client education booklet and guide to buying translation. It is available in print and online.