Culturally Competent Use of Language Services Health Equity Program 1
CULTURALLY COMPETENT USE OF LANGUAGE SERVICES 1. Importance of Language Services 2. Issues of Legal Liability 3. Choosing Appropriate Interpreters 2
http://youtu.be/framkl5c_fi 3
Key Terms Interpreting Translation 4
THE IMPORTANCE OF LANGUAGE SERVICES Health Disparities Access to Care Quality of Care Cost of Care Risk Management Federal & State Requirements 5
Access to Care Follow-up visits Patients who experienced a language barrier during the medical encounter were significantly less likely to be discharged from the ER with a follow-up appointment than other patients. Sarver et al. JGIM 2000;15:256-264. 6
Quality of Care: Patient Satisfaction Spanish-speaking patients less satisfied with care. Morales et al. JGIM 1999; 14:409-417. LEP patients less satisfied with emergency care. Baker et al. Med Care 1998; 36:1461-1470. LEP patients less willing to return for future care. Carrasquillo et al. JGIM 1999; 14:82-87. 7
Quality of Care Spanish-speaking patients discharged from emergency room without interpreters are less likely to understand: diagnoses, prescribed medications, special instructions or plans for follow-up care. Source: Crane. J Emerg Med 1997; 15(1):1-7. 8
ISSUES OF LEGAL LIABILITY Title VI of the Civil Rights Act of 1964 Physician Liability Risk Management 9
Title VI of the Civil Rights Act of 1964 Prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance.
Office of Civil Rights Investigations include: Telling patients to bring their own interpreter; charging for an interpreter; using an interpreter whose skill level is unknown to the institution (as is the case of unscreened, untrained staff or family members) 11
Physician Liability Individual providers liable for malpractice if they practice medicine on patients with whom they cannot communicate clearly. Think of the implications of getting informed consent without an interpreter from a patient who cannot understand the consent form or even the concept of giving consent 12
Risk Management Place: Florida, 1980 Patient: Willie Ramirez, high school athlete, Spanish speaker Issue: No trained or professional interpreter Result: Quadriplegic intoxicado intoxicated How much is one word worth?
$71 Million 14
CHOOSING APPROPRIATE INTERPRETERS Bilingual Staff Family members Children Trained and Skilled 15
LANGUAGE ACCESS Effective Communication Minimizes disruptions Builds loyalty Creates confidence Increases adherence 16
Identifying the Target Language Language Poster 17
Ad Hoc Interpreters Extremely high risk for: adding material, omitting material, changing the message, giving opinions, and entering into long discussions 18
Bilingual staff Being bilingual does not make one an interpreter Specialized skills involved Language proficiency recommended Training required 19
Family members Often edit patient s message heavily Add their own opinions Answer for the patient Impede development of patient-provider relationship Confidentiality issues Rarely trained accuracy, completeness and impartiality highly questionable 20
Children Guilt: If child does not convey message correctly, if child feels s/he is source of suffering because s/he said something painful Trauma: Children are often traumatized if they are required to pass bad news or are held responsible for negative outcomes 21
A Skilled Medical Interpreter Fluency in two languages Training in interpreting techniques Specialized vocabulary in two languages Knowledge of medical procedures Ability to adjust dialect and register Ability to process meaning, find equivalency in the second language and express it fluently almost instantaneously Excellent memory skills Attention to detail 22
During the Interview Speak: directly to the patient, not to the interpreter in first person in short segments Be patient! Adapted from: The Cross Cultural Health Care Program. Bridging the Gap Textbook. 2010 23
General Tips Providing care across a language barrier takes time. The time spent up front will be paid back by good rapport and clear communication that will avoid wasted time and dangerous misunderstandings down the line. Adapted from: The Cross Cultural Health Care Program. Bridging the Gap Textbook. 2010 24
Thank you! धन यव द Gracias! 謝謝 Waad ku mahadsan tahay لك شكرا For more information Contact: Sandra Miranda Duverge, Health Equity Educator sandra.duverge@passporthealthplan.com 25 25