Assessing Language Access in Rural Healthcare Facilities: Understanding CLAS Jessica Thomas, MPH, CHES St.Vincent Health Rural and Urban Access to Health.

Assessing Language Assessing Language Access in Rural Access in Rural

Healthcare Facilities: Healthcare Facilities: Understanding CLASUnderstanding CLAS

Jessica Thomas, MPH, CHESJessica Thomas, MPH, CHESSt.Vincent HealthSt.Vincent Health

Rural and Urban Access to HealthRural and Urban Access to HealthLEP Project CoordinatorLEP Project Coordinator

June 10, 2009June 10, 2009

What I Hope to AnswerWhat I Hope to Answer

• What are language access services?What are language access services?• What laws, standards, guidelines are What laws, standards, guidelines are

there for these services?there for these services?• How do you begin to assess language How do you begin to assess language

access services in your organization?access services in your organization?• What are examples of assessments What are examples of assessments

already done?already done?• What do you do after the assessment?What do you do after the assessment?• Where can you find more information?Where can you find more information?

Language Access Language Access Services (LAS)Services (LAS)

• LAS are services designed to ensure LAS are services designed to ensure effective communication between individuals effective communication between individuals with limited English proficiency (LEP) and with limited English proficiency (LEP) and English speakers. Primary LAS include English speakers. Primary LAS include interpretation (oral) and translation (written) interpretation (oral) and translation (written) servicesservices

• LAS can also involve provisions that enhance LAS can also involve provisions that enhance communication, such as signage for communication, such as signage for wayfindingwayfinding

www.thinkculturalhealth.orgwww.thinkculturalhealth.orgGoldwater, J. & Pacheco, G. 10/28/08, Improving Health Communication Goldwater, J. & Pacheco, G. 10/28/08, Improving Health Communication

for LEP Patients: The Health Care Language Services Implementation for LEP Patients: The Health Care Language Services Implementation GuideGuide

CLAS StandardsCLAS Standards• National Standards for Culturally & National Standards for Culturally &

Linguistically Appropriate Services in Health Linguistically Appropriate Services in Health CareCare

• Based on Title VI of the Civil Rights Act of Based on Title VI of the Civil Rights Act of 19641964

• Developed by OMH/DHHS in March 2001Developed by OMH/DHHS in March 2001• 14 standards, divided into three categories:14 standards, divided into three categories:

– Culturally Competent CareCulturally Competent Care• Standards 1-3Standards 1-3• RecommendationsRecommendations

– Language Access ServicesLanguage Access Services• Standards 4-7Standards 4-7• MandatedMandated for recipients of federal fundsfor recipients of federal funds

– Organizational SupportsOrganizational Supports• Standards 8-14Standards 8-14• GuidelinesGuidelines

CLAS StandardsCLAS Standards

Mandated Language Access Services Mandated Language Access Services Standards:Standards:

4.4. Health care organizations (HCOs) provide Health care organizations (HCOs) provide language assistance services (eg. Bilingual language assistance services (eg. Bilingual staff, interpreter services)staff, interpreter services)

5.5. Patients receive oral and written notices of Patients receive oral and written notices of their right to language assistance servicestheir right to language assistance services

6.6. HCOs assure the language competence of HCOs assure the language competence of their interpreters and bilingual stafftheir interpreters and bilingual staff

7.7. HCOs provide informational materials and HCOs provide informational materials and signs in the languages of their patientssigns in the languages of their patients

The Joint Commission’s The Joint Commission’s ResponseResponse

• Hospitals, Language & Culture StudyHospitals, Language & Culture Study– The Joint Commission, with funding from The Joint Commission, with funding from

The Commonwealth FundThe Commonwealth Fund, is developing , is developing accreditation standards for hospitals that will accreditation standards for hospitals that will promote, facilitate, and advance the provision promote, facilitate, and advance the provision of culturally competent patient-centered care.  of culturally competent patient-centered care.  These standards will build upon the research These standards will build upon the research framework from the ongoing HLC study. framework from the ongoing HLC study.

– Standards available for public comment May Standards available for public comment May 20092009• www.jointcommission.org/standards/fieldreviews/www.jointcommission.org/standards/fieldreviews/

– Piloting these standards July – December 2009Piloting these standards July – December 2009– Planned implementation January 2011Planned implementation January 2011

• Implementation Guide available January 2011Implementation Guide available January 2011

Assessing Language Assessing Language Access Services & Access Services &

Organizational Organizational CapabilitiesCapabilities

Support & Team Support & Team DevelopmentDevelopment

• Leadership support – A Must!Leadership support – A Must!– Very difficult task without support from Very difficult task without support from

organization leadershiporganization leadership

• Pulling together a team… “Diversity Pulling together a team… “Diversity group”group”– Include people from a variety of areas in the Include people from a variety of areas in the

Diversity group:Diversity group:

• Quality/Risk Quality/Risk ManagementManagement

• Social ServicesSocial Services• Outpatient areasOutpatient areas• Community groupsCommunity groups

• LeadershipLeadership• Front-line staffFront-line staff• PhysiciansPhysicians• HRHR

4-Factor Analysis4-Factor Analysis

• Number of LEP patients your Number of LEP patients your organization serves or could serveorganization serves or could serve

• Frequency of the contact that LEP Frequency of the contact that LEP patients have with your organizationpatients have with your organization

• Nature and importance of services Nature and importance of services provided by your organizationprovided by your organization

• Resources available to the program Resources available to the program and the costsand the costs

Organizational Capabilities Organizational Capabilities Assessment Process: SV Assessment Process: SV

ExampleExample• December 2007 – March 2008December 2007 – March 2008

– Surveyed facilities by use of Surveyed facilities by use of comprehensive “facility assessment” comprehensive “facility assessment” • Completed by Diversity groupsCompleted by Diversity groups

• April 2008 – July 2008April 2008 – July 2008– Surveyed associates in all facilities Surveyed associates in all facilities

• 4227 responses of 12,000 associates4227 responses of 12,000 associates

• Overall SV Health assessmentOverall SV Health assessment– System-wide gap-analysis for planning System-wide gap-analysis for planning

and benchmarking purposesand benchmarking purposes

Assessment ToolsAssessment Tools• Facility Assessment Tool:Facility Assessment Tool:

– RUAH utilized several individual surveys to RUAH utilized several individual surveys to create a practical survey that is easy to use in create a practical survey that is easy to use in the healthcare setting – it’s not perfect, but it the healthcare setting – it’s not perfect, but it worked!worked!

– Covers interpreter use/availability, policies & Covers interpreter use/availability, policies & procedures, translation use/availability, procedures, translation use/availability, translated hospital signage, leadership support, translated hospital signage, leadership support, associate/staff knowledge of resourcesassociate/staff knowledge of resources

• Associate AssessmentAssociate Assessment– 9 questions, quick and painless9 questions, quick and painless– Covers accessing interpreters, translated Covers accessing interpreters, translated

documents, resources as well as information on documents, resources as well as information on Language Line phone useLanguage Line phone use

Assessment ToolsAssessment Tools

• Why use two separate surveys?Why use two separate surveys?1.1. Should not make assumptions about Should not make assumptions about

what associates/staff know, understand, what associates/staff know, understand, use on daily basisuse on daily basis

2.2. Diversity groups learned the depth of the Diversity groups learned the depth of the project through the facility assessmentproject through the facility assessment

3.3. Discrepancies in facility and associate Discrepancies in facility and associate assessments highlighted the need for assessments highlighted the need for associate education on language access associate education on language access policies, procedures and resourcespolicies, procedures and resources

Utilizing the ResultsUtilizing the Results

• All SV facilities are different and therefore All SV facilities are different and therefore one blanket LEP plan would not be specific one blanket LEP plan would not be specific enough for each facility (16 beds to 600 enough for each facility (16 beds to 600 beds)beds)

• Each facility has used the results to create Each facility has used the results to create LEP plans with specific action items, LEP plans with specific action items, responsible persons, and expected responsible persons, and expected completion datescompletion dates

• Diversity groups taking ownership of the Diversity groups taking ownership of the LEP plansLEP plans

• Overall SV Health LEP Plan to address Overall SV Health LEP Plan to address system issuessystem issues

Utilizing the Results, Utilizing the Results, continued…continued…

• Examples in work plansExamples in work plans– Install appropriate telephonic interpreter Install appropriate telephonic interpreter

equipment (dual handset phones)equipment (dual handset phones)– Create or revise language access policy Create or revise language access policy

and procedures (to include appropriate and procedures (to include appropriate interpreters, document translation, interpreters, document translation, documenting interpreter need, etc.)documenting interpreter need, etc.)

– Bilingual associates to complete Bridging Bilingual associates to complete Bridging the Gap Medical Interpreter Trainingthe Gap Medical Interpreter Training

– Include language access information in Include language access information in new hire orientationnew hire orientation

Suggested ResourcesSuggested Resources• Office of Minority Health Office of Minority Health

– www.omhrc.govwww.omhrc.gov

• National Standards for Culturally and National Standards for Culturally and Linguistically Appropriate Services in Health Linguistically Appropriate Services in Health Care, Final ReportCare, Final Report– http://http://

www.omhrc.gov/assets/pdf/checked/finalreport.pdfwww.omhrc.gov/assets/pdf/checked/finalreport.pdf

• LEP Federal Interagency WebsiteLEP Federal Interagency Website– www.LEP.govwww.LEP.gov

• The Joint CommissionThe Joint Commission– http://www.jointcommission.org/PatientSafety/HLChttp://www.jointcommission.org/PatientSafety/HLC

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• California Health Care Safety Net InstituteCalifornia Health Care Safety Net Institute– Straight Talk: Model Hospital Policies and Straight Talk: Model Hospital Policies and

Procedures on Language AccessProcedures on Language Access– www.safetynetinstitute.orgwww.safetynetinstitute.org

"We have become not a melting pot but a beautiful mosaic. Different people, different beliefs,

different yearnings, different hopes,

different dreams." – Jimmy Carter

Thank You!Thank You!

Jessica Thomas, MPH, CHESJessica Thomas, MPH, CHES

St.Vincent HealthSt.Vincent Health

Rural and Urban Access to Health Rural and Urban Access to Health (RUAH)(RUAH)

317-583-3215317-583-3215

[email protected]@stvincent.org