Strengthening the Healthcare Safety Net: Language Access Services at Unity Health Care, Inc.

Strengthening the Strengthening the Healthcare Safety Healthcare Safety

Net: Language Net: Language Access Services at Access Services at Unity Health Care, Unity Health Care,

Inc.Inc.Luis Padilla, MD, FAAFPLuis Padilla, MD, FAAFP

June 16, 2008 June 16, 2008

Unity Health Care, IncUnity Health Care, IncMISSIONMISSION

Unity Health Care, Inc. offers a citywide Unity Health Care, Inc. offers a citywide network of quality health and human services network of quality health and human services to the medically underserved regardless of to the medically underserved regardless of race, ethnic background or ability to pay.race, ethnic background or ability to pay.

VISIONVISIONUnity Health Care, Inc. will become the Unity Health Care, Inc. will become the preeminent health care delivery system for the preeminent health care delivery system for the medically underserved of Washington, DC and medically underserved of Washington, DC and recognized by them as the provider of choice.recognized by them as the provider of choice.

www.unityhealthcare.org

Unity as a Community Unity as a Community Health CenterHealth Center

More than More than 2020 years experience in years experience in Washington, DCWashington, DC

Present in Present in all 8 Wardsall 8 Wards of the District of the District of Columbiaof Columbia

Over Over 180180 providers providers Currently Currently 3232 service sites throughout service sites throughout

DC including Mobile Medical UnitsDC including Mobile Medical Units 433,450433,450 visits n 2007 visits n 2007 Healthcare for DC inmatesHealthcare for DC inmates

Unity Health Care Unity Health Care 20072007

2007

Total Users 80,803 Total Visits 433,450

Working Poor, Uninsured, Immigrants

69,565(86%)

Working Poor, Uninsured, Immigrants

387,602

Homeless 11,238(14%)

Homeless 45,848

Unity Health Care Approach Unity Health Care Approach to LEPto LEP

Focus efforts at unified patient communication Focus efforts at unified patient communication through the triad of through the triad of health literacy, cultural health literacy, cultural competency, and limited English competency, and limited English proficiency (LEP)proficiency (LEP)

ActiveActive recruitment recruitment of bilingual and bicultural of bilingual and bicultural staff staff

Diversity and cultural competency Diversity and cultural competency trainingtraining throughout the organizationthroughout the organization

Support its centers with Support its centers with resourcesresources to address to address LEPLEP

Provide low literacy forms and Provide low literacy forms and materialsmaterials

Unity Health Care’sUnity Health Care’sUpper Cardozo Health CenterUpper Cardozo Health Center

Ward one Northwest DCWard one Northwest DC DC’s most ethnically and economically diverse wardDC’s most ethnically and economically diverse ward

Most diverse center in Unity Health Care’s Most diverse center in Unity Health Care’s network network

Over Over 17, 00017, 000 patients enrolled patients enrolled Over Over 76,00076,000 visits in 2007 visits in 2007 Predominately non-English speaking patients Predominately non-English speaking patients

60% Spanish and 10% Amharic60% Spanish and 10% Amharic Low Literacy and Low English Proficiency (LEP) Low Literacy and Low English Proficiency (LEP)

with average with average reading levelreading level at at third to fourth third to fourth gradegrade

Upper Cardozo: Services Upper Cardozo: Services OfferedOffered

Primary and Primary and Preventive Preventive CareCare

DentalDental Social Social

ServicesServices PharmacyPharmacy WICWIC

OB/GYNOB/GYN Mental HealthMental Health LaboratoryLaboratory Specialty Care (HIV, Specialty Care (HIV,

Pulmonary, Pulmonary, Cardiology, Cardiology, Ophthalmology, Ophthalmology, Endocrinology, Endocrinology, Podiatry)Podiatry)

Where do our patients Where do our patients come from?come from?

The AmericasThe Americas

Where do our patients Where do our patients come from?come from?

AfricaAfrica

Where do our patients Where do our patients come from?come from?

Asia, Europe , South Pacific, Asia, Europe , South Pacific, Middle EastMiddle East

Multilingual StaffMultilingual Staff 1717 out of 19 primary care providers speak Spanish out of 19 primary care providers speak Spanish

Over Over 90%90% of support staff are bilingual or of support staff are bilingual or multilingualmultilingual

Languages Spoken by Upper Cardozo StaffLanguages Spoken by Upper Cardozo StaffSpanishSpanish TagalogTagalogFrenchFrench FarsiFarsiAmharicAmharic TigrinyaTigrinyaChineseChinese VietnameseVietnamese

How Our Patients Obtain How Our Patients Obtain InformationInformation

Flyers and BrochuresFlyers and Brochures Spanish language prescription Spanish language prescription

labelslabels

Web based educational materialsWeb based educational materials

Point of care internet accessPoint of care internet access

Language LineLanguage Line

How Our Patients Obtain How Our Patients Obtain InformationInformation

Oral instructions from bilingual staff Oral instructions from bilingual staff after visitsafter visits

Medline-Plus audio/video tutorials in Medline-Plus audio/video tutorials in SpanishSpanish

Community PartnershipsCommunity Partnerships Reach Out and ReadReach Out and Read

Clinic Color GuideClinic Color Guide

Forms and SignsForms and Signs Written at a third to Written at a third to

fourth grade levelfourth grade level

Color codedColor coded

Double sided Double sided bilingualbilingual

Printed in Amharic Printed in Amharic when applicablewhen applicable

Point of Care Computer Point of Care Computer AccessAccess

Internet Access inInternet Access in each exam room each exam room

made possible made possible through a NLM through a NLM grantgrant

Web image searchesWeb image searches MedlinePlus MedlinePlus

TutorialsTutorials Demonstration of Demonstration of

medications, dosing, medications, dosing, etcetc

Phone Interpretation Phone Interpretation ServicesServices

Language LineLanguage Line Over Over 100100 major major

languages and languages and dialects dialects availableavailable

Speaker phones Speaker phones available in each available in each exam roomexam room

Reach Out and Read Reach Out and Read ProgramProgram

National Program National Program designed to designed to promote early promote early childhood literacychildhood literacy

Literacy Promotion Literacy Promotion and books are and books are encouraged at encouraged at well-child visits well-child visits ages 6months-5 ages 6months-5 yearsyears

Clinic Color GuideClinic Color Guide

Future InitiativesFuture Initiatives Computer LabComputer Lab

English Second Language skills English Second Language skills buildingbuilding

Computer skills development Computer skills development

Healthcare System Access EducationHealthcare System Access Education Understanding health benefitsUnderstanding health benefits Patient language access rightsPatient language access rights

DC 2004 Language ActDC 2004 Language Act

Continued ChallengesContinued Challenges Resources needed to expand and Resources needed to expand and

provide language services to provide language services to other languages (Amharic, other languages (Amharic, French, Chinese)French, Chinese)

Resources and staff to assess Resources and staff to assess how patients process and degree how patients process and degree they understand informationthey understand information

Continued ChallengesContinued Challenges Increased adherence to DC Increased adherence to DC

language Act by other language Act by other organizations (hospitals and organizations (hospitals and specialist offices)specialist offices)

Resources to track changes and Resources to track changes and outcomesoutcomes

Recruitment bilingual providers Recruitment bilingual providers Recruitment bilingual nurses Recruitment bilingual nurses

and case managersand case managers

Email ContactEmail Contact

[email protected]