Senior Medicare Patrol Program Integration Project (SMPI)

1. Senior Medicare Patrol Program Integration Project (SMPI) A Training Guide to Serving People of: Diverse Needs, Cultures and Backgrounds • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

2. The Training Guide is Designed for: • SMPI volunteers who counsel people of diverse backgrounds and cultures • SMPI staff to improve communication with the diverse people they serve 3. SMPI partners serving diverse audiences • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

3. Key Training Components: • Getting to know our target audiences – In Delaware and in your neighborhood • Cultural Competency – What is it and why is it important to me? • Communication – How to make it better • Language Barriers – How to break them down • Health Literacy – It is not just about reading • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

4. A National Snapshot of Diversity in Our Country • The 2000 U.S. Census confirmed what many suspected for years: • Minority groups are rapidly increasing in the U.S. • America is more ethnically, linguistically and culturally diverse than ever before (Fix, 2001) • According to the U.S. Census by 2050: • The minority population will account for 90 percent of the U.S. growth Riche, M.F. (2000). America’s diversity and growth: Signposts for the 21st century. Washington, D.C.: Population Reference Bureau. Fix, M., Zimmermann, W., & Passel, J. (2001). The integration of immigrant families in the United States. Washington, D.C.: The Urban Institute. U.S. Census Bureau 2003 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

5. Consider These Statistics From the 2000 U. S. Census • The Latino population increased by more than 60 percent over the last decade • 13 percent of Americans, or a total of 34.7 million people, identify themselves as African American or Black • Asian Indians are the fastest-growing segment among all Asian groups in the United States • About one in five Americans (17.9 percent of the population) over age five spoke a foreign language at home • Native Americans comprised 0.9 percent of the U.S. population • Nearly 7 million people (2.4percent of the entire population) identified with more than one race • 2000 United States Census • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees • undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

6. Why the Demographic Change? A shift is our country’s racial and ethnic fabric is due to four main factors: • Large scale immigration (legal and illegal) • Globalization of goods, services and finances • Current immigration policy that emphasizes family unification • The fact that the 2000 U. S. Census allowed people to mark more than one race for the first time in history (Riche, 2000) Riche, M.F. (2000). America’s diversity and growth: Signposts for the 21st century. Washington, D.C.: Population Reference Bureau. Fix, M., Zimmermann, W., & Passel, J. (2001). The integration of immigrant families in the United States. Washington, D.C.: The Urban Institute. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

7. Getting To Know Our Target AudienceIn Delaware and in Our Neighborhood Who is Our Target Audience? Let’s Find out…. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

8. Our Goal is: To take our neighbor- -and- take our world- Out of the Box! • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

9. Taking a Closer Look at Delaware • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

10. Rural Delaware Sussex County is the only county federally designated as “Rural” It is also federally designated as a Medically Underserved Area (MUA) A low-income Health Professional Shortage Area (HPSA) And a Dental HPSA As well as portions west and south of Sussex County as Mental Health HPSA Delaware Rural Health Initiative Report 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

11. Rural Delaware • Income, poverty levels, and access to services may • have direct impact on the population. • Income – Sussex county’s median income has been $7,000 less than the State median from $57,426 to $54,610. • Seaford, Georgetown, Selbyville and other small towns in Sussex county are home to a concentration of African American individuals, many of whom are poor or near poor • In the community of Frankford, over 1/3 of the pop. is African American; 14.5 percent of the residents live below the poverty level • 2000-2007 State by State Median Income, U.S. Census Bureau American Community Survey. Calculations by Center on Budget and Policy Priorities. Summary Tables by Coalition on Human Needs, August 2008 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

12. Medicare Beneficiaries Residing in Rural Delaware • Sussex County is growing! • Between 2000 and 2006 • Delaware’s total population grew by 8.5 percent • Sussex county grew by approximately 14 percent • 90 percent of that growth is from retirees migrating into Sussex county Quality Insights of Pennsylvania Cluster Mapping 2009-2010 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

13. Medicare Beneficiaries Residing in Rural Communities in Delaware By Zip Code County Rural Zip Code # of Beneficiaries Percent Sussex Rural 19969 47 0.1% Sussex Rural 19970 1,906 3.3% Sussex Rural 19971 2,991 5.2% Sussex Rural 19973 3,638 6.4% Sussex Rural 19975 1,944 3.4% Quality Insights of Pennsylvania Cluster Mapping 2009-2010 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

14. Delaware’s Native American Tribal Elders • Who are they? • Where do they live? • What we need to know to best serve them? • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

15. Native American Tribes in Delaware Delaware has two known tribes: The Lenape Indian Tribe of Delaware • The name they call themselves is LENAPE, pronounced, “lun-NAH-pay”. The name means “The People”. The Nanticoke Indian Tribe of Delaware • In Algonquian, the common Indian language of Northeastern Tribes, the word Nanticoke is translated from the original Nantaquak, meaning the tidewater people or people of the tidewaters. 2Nanticoke Culture and History http://native-languages.org/nanticoke.htm • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

16. The Lenape Tribe • History: • The Lenape originated in Smyrna/Cheswold Delaware • Approximately 800 reside there today • Close knit community • Self sufficient with their own schools and churches • Men were typically the providers • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

17. The Lenape Tribe • History • Education was and is important - However, for men, the family farming business would usually take precedence by 8th grade • Approximately half of the women eventually went through high school - Social barriers made it challenging • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

18. The Lenape Tribe Values/Beliefs/Attitudes: • Very proud people • Elders are oftentimes self sufficient, but will lean on family when absolutely necessary • Usually one family member acts as advocate for elder • A mix of spiritual and faith beliefs can be found in the tribe • Methodist • 7th day Adventist • Baptist • Many keep spiritual roots alive and valued • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

19. The Lenape Tribe Gaining Trusted Information Today: • Due to past experiences, elders today may be apprehensive and/or cautious to outside help • Elders traditional means of sharing trusted information with one another • Local meeting places • church • local store • Story telling • Barriers to information might include: • Lack of knowledge or access to computers • Other barriers may be self-inflicted • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

20. The Nanticoke Tribe History: • Worked hard, saved money, and bought land • Supported their family and friends • A small, close-knit community within the community-at-large • Survived by adapting to changes, supporting one another, and befriending people who lived nearby • By 1881, the Nanticoke Tribe was recognized by the state as a legal entity or organization • In 1921, the Nanticoke Indian Association was formed, which was granted non-profit status http://www.native-languages.org/nanticoke.htm • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

21. The Nanticoke Tribe The Land: • Tribally owned lands include three properties: • Nanticoke Indian Center • Nanticoke Indian Museum • A 16 acre tract called Paul Grinnage property donated by Hudson and Schell, LLC • Many farm lands in the areas of Oak Orchard and Millsboro are owned by tribal members • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

22. The Nanticoke Tribe Today: There are approximately 1500 Nanticoke living today in Delaware with most of them residing in Sussex county. Many tribal members are also living in other states. They are proud of their ancestors, appreciate traditions, strive to maintain their heritage, and are enthusiastic about the future. The tribe holds an annual Powwow nearly 30,000 people attend Many different Native American Tribes participate in this Powwow • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

23. Myths and Facts about Native Americans • Myth: All Native Americans are spiritual and live in harmony with nature. • Fact: Assuming that all Native Americans have a mystical spirituality is a broad generalization and can be as damaging as other negative stereotypes. • Many practice a variety of traditional religions, while honoring their traditional cultural beliefs. A Guide to Build Cultural Awareness. American Indian and Alaska Native. Dept. of Health and Human Services. Pub. # (SMA)08-4354. January 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

24. Myths and Facts about Native Americans • Myth: Native Americans have distinct physical characteristics, making them identifiable by how they look. • Fact: Due to Tribal diversity, as well as hundreds of years of inter-Tribal and interracial marriages, there is no single distinguishing “look” for Native Americans. A Guide to Build Cultural Awareness. American Indian and Alaska Native. Dept. of Health and Human Services. Pub. # (SMA)08-4354. January 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

25. Myths and Facts about Native Americans • Myth: Native American people get “Indian money” and don’t pay taxes. • Fact: Few Tribal members receive payments from the Bureau of Indian Affair (BIA) for land held in trust and most do not get significant “Indian money.” • Native Americans pay income tax and sales tax like any other citizen of their State. A Guide to Build Cultural Awareness. American Indian and Alaska Native. Dept. of Health and Human Services. Pub. # (SMA)08-4354. January 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

26. Myths and Facts about Native Americans • Myth: Native Americans have the highest rate of alcoholism. • Fact: While many tribes and villages do experience the negative effects of alcohol abuse, what is less known is that they also have the highest rate of complete abstinence. • Many events ban the use of alcohol and even “social” drinking is discouraged. A Guide to Build Cultural Awareness. American Indian and Alaska Native. Dept. of Health and Human Services. Pub. # (SMA)08-4354. January 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

27. Myths and Facts about Native Americans • Stereotypes can be offensive and hurtful • It should never be assumed that membership in a particular cultural group means that a person either ascribes to any or all of the beliefs or behaviors associated with that cultural • Each person MUST be recognized as a unique individual, who brings their own background, life experiences and personality traits that contribute to who they are • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

28. Cultural Competency What is It? Why is It Important to Me? • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

29. Culture is… What is Culture? • A key component in shaping who we are: -Our • values • attitudes • beliefs • practices • even the holidays we celebrate • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

30. Characteristics of Culture Purnell, Larry D. , Guide to Culturally Competent Health Care. 2009 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

31. Defining Cultural Competency Cultural Competency is: • a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables the system, agency, or those professionals to work effectively in cross- cultural situations (Cross et al., 1989) Kaiser Family Foundation compendium on Cultural Competency initiatives in Health Care: January 2003 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

32. Defining Cultural Competency In health care, describes the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs (Dr. Betancourt et al., 2002) Kaiser Family Foundation compendium on Cultural Competency initiatives in Health Care: January 2003 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

33. Defining Cultural what?..... • Cultural Awareness– An appreciation of the external or material signs of diversity, such as the arts, music, dress, or physical characteristics • Cultural Sensitivity– Attention to personal attitudes and not saying things that might be offensive to someone from a cultural or ethnic background different from yours • Purnell, Larry D. , Guide to Culturally Competent Health Care. 2009. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

34. Culturally Competent! … One needs to show a combination of the following: • Developing an awareness of one’s own thoughts, feelings, and attitudes • Demonstrating knowledge and understanding of another’s culture and culturally specific meanings to topic at hand. (i.e. Health) • Accepting and respecting cultural differences in a manner that facilitates the client’s and family’s abilities to make decisions to meet their needs • Resisting judgmental attitudes such as “different is not as good” • Being open and comfortable to cultural encounters • Adapting care to be congruent with the client’s culture Purnell, Larry D. , Guide to Culturally Competent Health Care. 2009. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

35. Cultural Competency Development is… A Journey - not a goal A process of self-reflection Understanding our own beliefs and biases Knowing what we bring to an encounter • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

36. Benefits of Being Culturally Competent • Better understanding of specific cultural groups • Increase respect for individual differences • Provides dignity • Understand how members of a particular community may behave • Promotes focus on positive characteristics and strengths of a community • Appreciation of cultural differences Family Practitioner's Guide to Culturally Competent Care • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

37. Communicating more Effectively to Reach Diverse Ethnic Communities • Valuing cultural learning styles, background knowledge, and life experiences is an important component of building meaning for culturally diverse learners • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

38. Strategies for Communicating with Older Adults In Person: • Meet in a private space, free of clutter and noise • Invite the person to bring a family member or friend • Face the person directly, and at eye level • Enunciate clearly, but do not shout • Encourage the person to ask questions or take notes • Validate current knowledge and use stories and examples to relay your message Osborne, Helen. Health Literacy Consulting. “Communicating with Older Adults”. 2001 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

39. Strategies for Communicating with Older Adults Over the phone: • Acknowledge that the telephone comes with barriers for communication and only allows for auditory learning • Take responsibility for the direction of the conversation • Choose your words carefully, using common words and avoiding or explaining acronyms • Repeat key words and messages • Redirect talkative callers, as necessary • Smile  Non-verbal messages can come through on the phone. • Osborne, Helen. Health Literacy Consulting. “Communicating with Older Adults”. 2001 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

40. Strategies for Communicating with Older Adults When filling Out Forms: • Give directions one step at a time • Demonstrate & describe how to fill out a form • Appreciate that clients may not like filling out forms • Explain the use of the form • Physical barriers can affect the client ability to complete forms • Be willing to assist in completing the form for them Osborne, Helen. Health Literacy Consulting. “Communicating with Older Adults”. 2001 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

41. Factors that May Affect Ability to Learn: • Physical status– including pain, disability, or both • Emotional status – such as anxiety or depression • Level of motivation • Level of energy • Financial concerns • Primary Language • Cultural values • Support of family, friends, and caregivers Osborne, Helen. Health Literacy Consulting. “Communicating with Older Adults”. 2001 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

42. Communication Models • Designed to help a person have clearer communication with others • Different types of models can help healthcare professional work with their patients A Family Practitioner’s Guide to Culturally Competent Care. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

43. LEARN Model • Listen with sympathy to the person’s perception of the problem • Explain your perceptions of the problem • Acknowledge and discuss differences and similarities • Recommend resolution • Negotiate agreement Berlin EA. & Fowkes WC, Jr.: A teaching framework for cross-cultural health care— Application in family practice, In Cross-cultural Medicine. West J. Med. 1983, 12: 139, 93~98 • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

44. Steps to Better Communication • Ask how they would like to be addressed • Understand that individuals may have different levels of comfort than you • Do not assume that certain behaviors or body language mean limited understanding or intelligence • Listen and observe what is appropriate Modified: Larry Purnell, PhD, RN, FAAN, Professor, University of Delaware, College of Health and Nursing Sciences, Department of Nursing, McDowell Hall, Newark, Delaware. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

45. Steps to Better Communication 5. Learn and/or use basic words and phrases from the individual’s language 6. Do not discount any cultural practices or beliefs (i.e. supernatural, religious, etc.) • Accept that the individual may want family members involved in their affairs • Speak slowly and clearly in simple and straightforward language Modified: Larry Purnell, PhD, RN, FAAN, Professor, University of Delaware, College of Health and Nursing Sciences, Department of Nursing, McDowell Hall, Newark, Delaware. • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

46. Communicating with Older Adults Case Discussion Let’s Practice What We Have Learned • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

47. The Importance of Language • Speaking different languages can impact: • Quality • Treatment • Decisions • Understanding • Compliance • A common language DOES NOT ensure understanding • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

48. Limited English Proficiency (LEP) • In 2003, the DHHS revised its guidance on providing services for people with Limited English • All recipients of federal financial assistance from DHHS are required to provide persons with LEP meaningful access to their programs and activities, including interpreter services DHHS; Civil Rights http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/index.html • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

49. Using Interpreters • Oftentimes, family members or friends will step in to serve as interpreters • In the Healthcare arena, a professional interpreter trained in medical interpreting is strongly recommended • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

50. Best Practices of a Triadic Interview • Pre–session with Interpreter – Establish ground rules, clarify purpose of visit, and set goals • Triadic Interview – You, client, and interpreter • Post-Interview with Interpreter – If necessary… A chance to review the meeting, and examine your procedures and determine if there is room for improvement • Examine your own attitude in the interview A Family Practitioner’s Guide to Culturally Competent Care • This document is financially funded by grant 90SM0005601 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.