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  • 1. 2013 VAFCC & VRHA Joint Conference Valerie McAllister CLAS Specialist Office of Minority Health and Health Equity
  • 2. Workshop Objectives • Enhance participant’s awareness of the best practices in providing culturally appropriate services to Virginia’s increasingly diverse communities • Increase participant’s knowledge of laws that drive services to the limited English proficient (LEP) population • Provide resources to assist participants in working more efficiently and effectively across cultures 2
  • 3. Did You Know? Virginia trends...between 1990 – 2006 the Asian population more than doubled the Hispanic population almost tripled between 2000 - 2006 Virginia health districts served patients who spoke nearly 100 different languages in 2008. During 2008 VDH utilized the language translation service for 11,338 calls. 3
  • 4. Commonwealth of Virginia 2.59 2.78 0.07 Racial / Ethnic Distribution in Virginia 2009 4.86 0.34 19.67 69.69 White American Indians Native Hawaiian 4 Black Some Other Race Two or More Races Asian
  • 5. LEP’s Effect on Health Care Without effective language services, patients with limited English proficiency: • May have less access to primary care • May be less likely to receive follow-up appointments after Emergency Department visits • May be less likely to understand their diagnoses, medications, and follow-up instructions • May be less satisfied with care received • May not receive equivalent levels of preventive care 5
  • 6. Effective Health Communication— Not Just for Clinicians Understanding and delivering effective health communication is the charge of all health care professionals from all parts of your organization •Dentist •Physicians •Nurses •Direct Service •Social Workers •Front-Office •Patient Relations •Billing •Pharmacists •Medical Interpreter Each individual involved in a health care encounter is a key player in ensuring that information is not only delivered to the patient, but is understood by the patient. 6
  • 7. Unified Health Communication: Like a Three-Legged Stool • Unified health communication is the seat of the stool, and health literacy, cultural competency, and LEP are the legs. 7
  • 8. The Importance of Health Communication 8
  • 9. Communication Resources for LEP Individuals Individuals Right to Know Interpreting Translation Assistive Technology/Communication Tools Signage Way-Finding (Navigation) Community Involvement Training 9
  • 10. Civil Rights Act of 1964 • Applies to federally funded institutions or programs through direct or indirect funds • Prohibits discrimination based on race, color, or national origin • Ensures equal access to services and benefits 10
  • 11. Regulatory Requirements and Compliance Standards • Title VI Civil Rights Act of 1964 • National CLAS Standards for Health and Health Care, 2012 11
  • 12. To Whom Does Title VI Apply? “Covered entities” include all recipients of federal financial assistance through: • Grants • Loans • Contracts • Training • Use or donation of equipment or property • Indirectly through state agencies, county agencies, private agencies 12
  • 13. Title VI of the Civil Rights Act of 1964 Recipients of federal financial assistance shall not: • Deny an individual a service, aid, or benefit • Provide a benefit, etc. which is different or provided in a different manner • Subject an individual to segregation or special treatment 13
  • 14. Executive Order 13166 Title VI Civil Rights Act of 1964 • Ensures access to interpreting services free of charge • Discourages use of family, friends, minors as interpreters • Stresses the importance of language testing and trained interpreters 14
  • 15. HHS LEP Policy Guide • Clarifies the principles of Title VI with respect to LEP persons • Details reasonable policies and procedures to ensure meaningful access to services • Copies are available on OCR’s website: www.hhs.gov/ocr 15
  • 16. National CLAS Standards Purpose • Advance Health Equity • Improve Quality • Eliminate Health Care Disparities Themes • Principal Standard • Governance, Leadership, and Workforce • Communication and Language Assistance • Engagement, Continuous Improvement and Accountability 16
  • 17. What are Culturally and Linguistically Appropriate Services? 17
  • 18. Who Are Our Consumers? • Economically disadvantaged • Limited language competence • Racial and ethnic minority • Cultural isolation 18 • Geographic isolation • Disability • Age vulnerability
  • 19. The Risks of Using Untrained Interpreters • Unknown language competency • No orientation to medical interpretation • No or little knowledge of medical terminology • Previous relationship with patient • Relationship with patient could compromise the quality of the session 19
  • 20. Maintaining Control of the Encounter The provider can do a lot to enhance the quality of the session: •Empower the Patient •Greeting in Native Language •Body language •Casual Conversation •Eye Contact (When appropriate) •Remember that everything said is interpreted 20
  • 21. Maintaining Control of the Encounter Ask questions directly to your patient Ask open ended questions Speak about one problem or symptom at a time Avoid using slang or idioms “Up and at ‘em” “I’m feeling under the weather” “Barking up the wrong tree” “Up the creek without a paddle” “A tough nut to crack” 21
  • 22. Children as Interpreters • Imbalance of power • Lack of Maturity • Lack of Language Proficiency • Uncomfortable role • Negates confidentiality 22
  • 23. Programs and Services Supported Through CLAS Funding 23
  • 24. CLAS Resources 24
  • 25. 25
  • 26. Culturally and Linguistically Appropriate Services (CLAS) CLAS Act Website (CLASActVirginia.org) Culturally and linguistically appropriate health care information Conferences, trainings and other events Policies, regulations and laws Studies, data, research reports and assessment tools 26 Multicultural health and human service programs Translated patient education information Language Identification Poster
  • 27. Culturally and Linguistically Appropriate Services (CLAS) Virginia Medical Interpreter Collaborative (VMIC) VMIC: A collaboration of community partners passionate about meeting the needs of the limited English proficient (LEP) community www.vmicn.org 27
  • 28. Culturally and Linguistically Appropriate Services (CLAS) Virginia Medical Interpreter Database (VMID) Virginia Medical Interpreter Database (VMID) • Database of trained Medical Interpreters in Virginia • An avenue for trained Medical Interpreters to offer their skills • Links to culturally and linguistically appropriate resources 28
  • 29. VDH CLAS Initiatives The Language Identification Poster 29 Navigating the U.S. Heath Care System
  • 30. The Navigating Toolkit is Available in 4 Languages 30
  • 31. 2010 Virginia Language Needs Assessment 31
  • 32. Identifying Your Patient’s Language You can’t provide language assistance to your patients with LEP until you know what language they speak 32
  • 33. VDH Health Districts 33
  • 34. Health Equity & Culturally Appropriate Health Training Series 34
  • 35. OMHHE As you can see Culturally and Linguistically Appropriate Services is a link that connects all that we do! 35
  • 36. For More Information, Contact: Valerie McAllister Office of Minority Health and Health Equity Division of Multicultural Health & Community Engagement CLAS Specialist http://www.vdh.virginia.gov/healthpolicy/index. htm valerie.mcallister@vdh.virginia.gov (804) 864-7437 36
  • 37. Questions 37