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Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers

Explore how Community Health Centers (CHCs) address diverse populations, with insights applicable to group practice settings. Insights on Federally Qualified Health Centers (FQHCs) and language access challenges. Learn about Manchester Community Health Center's demographics, language interpretation resources, policies, and patient perspectives.

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Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers

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  1. Best Practices in Multilingual Access- Focus on Group Practice/Community Health Centers Kris McCracken, Dir. of Operations Manchester Community Health Center

  2. Purpose • Provide an Overview of Community Health Centers (CHCs) and how they are Addressing a Growing, Diverse Population • Lessons Learned that could be applied to other Group Practice Settings

  3. What is a Federally Qualified Health Center FQHC)? • A Non-Profit Organization that: • Is a Community Based Organization Governed by a Board of Directors Comprised of 51% Consumers of Services • Serves an Underserved Population or Area • Provides a Comprehensive Scope of Preventive and Primary Health Services to Anyone, Regardless of Insurance Status or Ability to Pay • Provides a Sliding-Fee Scale Based Upon Income for Those without Insurance • Receives Funding Under Section 330 of the Public Health Service Act

  4. CHCs Served 81,000 People in 2004 in New Hampshire

  5. Manchester Community Health CenterDemographics … • PRIMARY SERVICE AREA: Greater Manchester • TOTAL # ACTIVE PATIENTS: Approximately 7,400 • PERCENTAGE of PATIENTS w/FOREIGN LANG PRIMARY: 50+% • LANGUAGES SPOKEN IN SERVICE AREA: 70+ • LANGUAGES SPOKEN at MCHC: 60 • PRIMARY LANGUAGES OF PATIENT POPULATION: Spanish, Arabic, Bosnian, Russian, Mandarin/Cantonese, Vietnamese, Portuguese French, Albanian, many African Languages (Specifically from Sudan, Liberia, Somalia, Kenya, Rwanda and Nigeria) • NUMBER of EMPLOYEES: 55 FTE’s

  6. Language Volume (Over 10 speakers)

  7. Interpretation Expenses FY’04-08

  8. Service Delivery Structure INTERPRETATION RESOURCES: -2 FTE’s dedicated Spanish Interpreters -.5 FTE dedicated Bosnian Interpreter -.5 FTE dedicated Somali/Mai Mai/Zigua Interpreter -Contract with Tele-Interpreters for rare languages -25 Independent Interpreters available (all staff have copy of the list) -Contract with Lutheran Social Services Language Bank -Use of Northeast Ctr. For the Deaf and Hard of Hearing as well as Granite State Independent Living for Sign Language Interpreters -20 Total Bilingual Staff Members (Languages spoken: Spanish, French, Arabic ,Bosnian, Romanian, Russian, Swahili)

  9. Policies & Procedures • Gathering of Country of Birth, Primary Language, and whether an interpreter is needed at intake • Testing for competency of staff who wish to interpret or provide services directly without the aid of an interpreter • Reminder messages in all patient MIS systems that an interpreter is required to “prompt” staff • Training for staff who wish to interpret • Policy regarding use of children or family members • Arranging for interpretation in advance of visit

  10. Human Resources Perspective HISTORY: • At the beginning: one dedicated interpreter and use of staff in addition to their regular position • In the middle: some positions had interpretation as a part of the job description • Current: use of full time interpreters, external consulting interpreters, or language line 90% of the time ISSUES: -Salary differentials? -Who replaces the individual employee who has another position to attend to? -Who is “competent” to interpret? -Are people fluent with oral skills, written skills or both?

  11. Patient Perspective • Gender issues • Cultural issues • Religious concerns • Comfort level with a non-family member • Knowledge of a particular staff person • Knowledge of a particular interpreter (in small communities can be a big problem)

  12. Paperwork! • Patient Intake Forms • Patient/Facility Signs • Patient Consent Forms • Patient Education Materials • Patient Newsletter • Patient Letters (Personalized) • Patient Information regarding specialty care Currently 77 forms and handouts available in our top 9 languages as well as English

  13. ISSUES still on the Fore-Front • After hours access (answering service limitations) Tele-interpreter available for doctor through 3-way conference call. • Recruitment of bilingual direct service providers • Difficulty when referring patients out to specialty care and testing • Loss of funding to Refugee Resettlement Programs

  14. Areas for Consideration • Navigating the American Health Care system • Legal requirements for Interpretation (OCR) • Economic Impact of Providing Services • Adequacy of supply of bilingual/bicultural healthcare professionals • Differences in Cultural Beliefs in regards to healthcare • Availability of refugee/immigrant health records • Difficulties in coordinating care with: • Hospitals • Specialty Providers • Mental Health Providers • Social Service Agencies • VNA’s • Entitlement Programs

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