Risk Management of the LEP Patient and Effective Language Access Plans for 2012: Problems and Solutions to Reach Compliance With The Joint Commission Standards.

Risk Management of the LEP Patient and Effective Language Access Plans for 2012: Problems and Solutions to Reach

Compliance With The Joint Commission Standards

Presented by:Armando Ezquerra Hasbun, Director of Programs, LSA

Shiva Bidar-Sielaff, CCHI Commissioner

LSA Company Overview

About LSA

Founded in 1991 by Laura K.T. Schriver

Horsham, PA headquarters

A network of more than 5,000 Independently Contracted global Linguists

Recently named to Common Sense Advisory’s list of “Top Global Language Services Providers” for the second consecutive year

Over 200 language offerings

100% privately owned

Certified Diversity Enterprise (WMBE)

LSA Company Overview

LSA is proud to offer a full range of language translation services and language interpreter services:

Webinar Objectives

Discuss the current regulatory requirements governing Language Access Plans for LEP populations in healthcare settings

Learn more about the problems healthcare providers and administrators typically encounter when implementing an effective Language Access Plan

Review the recommended options, strategies and solutions to meet Joint Commission Standards, with the ultimate goal of achieving optimal outcomes for all

Understand the importance of using certified and credentialed medical interpreters when caring for an LEP patient, and what certification and credentialing means to The Joint Commission

You are invited to share your experiences, in terms of challenges and successes, at the end of the Webinar during the Q&A session.

The Joint Commission (TJC)

The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 19,000 health care

organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a

condition of licensure and the receipt of Medicaid reimbursement.

Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report.

The declared mission of the organization is:

"To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and

effective care of the highest quality and value.”

Key Guidelines Regarding Equal Language Access Standards

PC.02.01.21: The hospital effectively communicates with patients when providing care, treatment and services.

EP 1: The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care.

EP 2: The hospital communicates with the patient during the provision of care, treatment and services in a manner that meets the patient’s oral and written communication needs.

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on “national origin,” which includes language.

The Americans with Disabilities Act of 1990

Section 504 of the Rehabilitation Act of 1973

How Are Health Care Providers Responding?

Some of the larger providers are at the vanguard, and are setting an example on how to successfully achieve equal language access; on the other hand, the majority of smaller providers are finding themselves in one of the positions listed below:

Rushing to try and meet compliance deadlines

Trying to make sense of guidelines that are not explicit

Struggling for funding that has not been budgeted for

At a loss as to how well their language needs are being met

Having to design, document and perfect their response

The Language Access Plan

The first step to achieving equal language access is to create, develop, apply and continuously supervise your institution’s Language Access Plan

A Language Access Plan is the roadmap that is created to reflect:The linguistic needs of the community your institution serves

Your arrangements for meeting those needs

Your system for the provision of interpretation services:Staff face-to-face interpreters

Per-diem face-to-face interpreters contracted directly

Per-diem face-to-face interpreters from agencies

Remote interpreters from provider pools

Remote telephonic interpreters from language services providers

Remote VRI interpreters from language services providers

Language Access Plan on Interpretation

HR.01.02.01:

It is not appropriate to rely on untrained individuals as the primary

source for bridging communication barriers during medical

encounters with individuals who are deaf or speak a language other

than English. Requirement HR. 01.02.01, EP1 requires hospitals to

define staff qualifications specific to job responsibilities.

Note 4 in EP 1 requires hospitals to specifically ensure that

individuals who provide interpreting and translation services in the

hospital have defined qualifications and competencies.

Language Access Plan on the Use of Untrained Interpreters

Untrained individuals – including family members, friends, other

patients and / or untrained bilingual staff – should not be used to

provide language access services during medical encounters.

Standard HR.01.02.01: The hospital defines staff qualifications

“Qualifications for language interpreters and translators may

be met through language proficiency assessment, education,

training and experience.”

Problems and Possibilities

Lack of Institutional SupportMy institution doesn’t budget for contracting language services

My institution doesn’t have policies in place regarding the proper use of interpreters

My institution relies on bilinguals and doesn’t see the need to do it any other way

Lack of Trained InterpretersOur in-house team has never been trained

Our bilingual personnel has not been tested

We cannot possibly provide interpreters:In all the languages that show up

In all the medical subspecialties needed

At all hours of the day and night

We cannot be sure how our team performs

Problems and Possibilities

Multiple Solutions but No AccountabilityHow can we test for language skills?

How can we determine interpreting ability?

We can’t tell how well an interpreter performs

Conflicts of interest and ethical dilemmas

Correct language but much misunderstanding

Can we rely on “Certified” interpreters?

Trained, Qualified, Certified?The 40-hour specialized training course

The ‘Training the Trainer’ course

The National Certification options available

Health Care Interpreter Qualification

Continued Education and Remote Learning

English and Languages of Limited Diffusion

Problems and Possibilities

Opposition From All Sides: A Shift in Perception and Attitude Is NeededProviders see the process as cumbersome; causes delays

Bilingual providers use their own language skills

Patients rely on their own family and friends

Dual-role employees have extra duties and no pay differential

Remote interpreting has major limitations

Technophobes tend to under use available services

Problems and Possibilities

Understanding Professional InterpretersKnowledge, skills and ability

Training, testing and acquisition of credentials

Applied ethics

Protocol and common standards of practice

Protocol and best practices

Linguistic limitations – consulting the dictionary

Roles and what an Interpreter cannot do

A typical day in the life of a healthcare Interpreter

Problems and Possibilities

Sources of Recurrent ProblemsSudden re-scheduling and cancellations

Reported times and billing reconciliation

How to manage the INFORMED CONSENT FORM

Errors, inaccuracies and incomplete interpretation

The interpreter takes over control of the session

Side conversations in the foreign language

Cannot hear well; disconnections

The interpreter is argumentative or impolite

How LSA Can Help

LSA supports you in your mission by:Helping providers assess their bilingual dual-role staff

Providing training courses to help make interpreters qualified to sit in for the certification examination

Offering continuing education educational sessions on specialized topics for your interpreter corps

Training your providers on how to work with interpreters

Delivering a full range of services to help providers achieve their goals of better outcomes, while meeting all specifications of a Language Access Plan; LSA’s full suite of services includes:

Translation & Localization

Video Remote Interpreting

Interpreting by Telephone

Face-to-Face Interpreting

American Sign Language

Intercultural Consulting

Healthcare Interpreter Certification

A Piece of the Compliance Puzzle: Healthcare Interpreter Certification

Shiva Bidar-Sielaff

CCHI Commissioner

Why is Credentialing Important?

No federal regulations for the healthcare interpreting profession exist

Very few state regulations exist

Major organizations understand importance of competent interpreters:

Office for Civil Rights

Office of Minority Health

The Joint Commission

New Joint Commission Standards

The patient-centered communication standards, approved in December 2009 and released in January 2010, became effective on July 1st, 2012:

HR.01.02.01., EP 1: Individuals providing interpreting or translation services have defined qualifications or competencies

Qualifications for language interpreters may be met throughAssessment (AHI and CHI tests)

Education (U.S. High School or equivalent)

Training (Minimum of 40 hours & Continuing Education)

Experience

Certification Commission for Healthcare Interpreters

CCHI (Certification Commission for Healthcare Interpreters) – “One Voice”

One set of industry-formed standards

Assurance of competencyProfessional certification program

InvolvingInterpreters

Employees and independent contractors

Users of interpreter services

Bringing together the necessary stakeholders through a non-profit organization

Why CCHI Credentials?

The AHITM and CHITM examinations follow the blueprint created by the Job Task Analysis (JTA)

Exams were developed according to NCCA Standards, under direct oversight of CCHI

CCHI exams have been psychometrically validated

Over 1,250 applicants since testing began

509 interpreters nationwide have already earned their CCHI credentials – 165 AHITM and 344 CHITM

Test Development Supporters

Note: The participation by supporters does not constitute ultimate endorsement of CCHI’s certification program.

CCHI Current Credentials

Associate Healthcare InterpreterTM Credential (AHITM)Available to all interpreters except Spanish-, Arabic- and Mandarin-speaking interpreters

Certified Healthcare InterpreterTM Certification (CHITM)Currently available to Spanish-, Arabic- and Mandarin-speaking interpreters

What Is the Associate Healthcare InterpreterTM (AHITM) Credential?

Available to interpreters in ALL languages

Entry point into professional certification

Two-hour, computer-based, 100 question, multiple choice exam in English

Tests the basics of health care interpreting

Preliminary results are immediate at test center

Credential awarded upon successful completion of the written examination (except for Interpreters who are eligible for CHITM)

The AHITM Examination

Managing an Interpreting Encounter 30% - 35%

Healthcare Terminology 22% - 25%

Interacting With Other Healthcare Professionals 20% - 24%

Preparing for an Interpreting Encounter 16% - 20%

Demonstrating Cultural Responsiveness 3% - 6%

What is the Certified Healthcare InterpreterTM (CHITM) Certification?

Currently available in Spanish, Arabic and Mandarin; other languages will continue to be developed

Tests the basics of health care interpreting plus interpreting skills and abilities

AHITM examination + computer-based oral performance examination (takes one hour to complete) = Certification

The CHITM Examination

Knowledge required of health care interpreters (same as AHITM credential)

Interpreting in a health care environment: accurately and completely within a cultural and environmental context:

Interpret consecutively 75 – 80%

Interpret simultaneously 10 – 15%

Sight translate and translate healthcare documents 10 – 15%

Fees

Application: $30 (non-refundable)

AHITM: $175

CHITM: $250

$455 total for Spanish-, Mandarin- and Arabic-speaking interpreters

$205 for all other interpreters

All fees are non-refundable

This is for one examination administration

Credential / Certification Maintenance

CHITM certification and AHITM credential are valid for four years

Maintenance Requirements32 hours total Continuing Education = 16 hours (classroom or contact) in years 1 & 2, 16 hours in years 3 & 4

40 hours of work experience = 20 hours in years 1 & 2, 20 hours in years 3 & 4

CCHI

Certification Commission for Healthcare Interpreters

www.healthcareinterpretercertification.org

[email protected]

Thank You!

Armando Ezquerra Hasbun

Director of Programs, [email protected]

www.lsaweb.com

Shiva Bidar-Sielaff

CCHI Commissioner [email protected]

www.healthcareinterpretercertification.org

Translation and Localization

Face-to-Face Interpreting Video Remote Interpreting (VRI)

American Sign Language (ASL) Intercultural Consulting

Q&A Session