Language Services: The Why and the How

1. The Office of Health Equity Language Services:The Why and the How Medical Student Orientation December 2011

2. Office of Health Equity (OHE) • Goal: • Identify and address documented health disparities in No. Virginia. • Objectives: • Community: Partner with a broad-based community steering committee to create a shared long-term vision to address disparities in selected local communities. • Quality: Improve quality patient outcomes and contribute to the reduction in regional health disparities. • Service: Increase patient, employee and physician satisfaction through the delivery of comprehensive services that will help meet individual and cultural needs.

3. Selected Office of Health Equity Programs and Services Language Services Spoken language interpretation Sign language interpretation and the provision of other services for the deaf or hard of hearing Translation of vital documents Training and Education Diversity, Cultural Competence and Health Equity Education 21st Century Leadership Development Now We’re Talking! Bi-lingual staff interpreter training

4. Objectives Recognize the importance of providing culturally and linguistically appropriate services Explain the role of the patient and companion in determining what services are required for effective communication Identify the laws governing language services Identify four ways to access spoken language interpreter services at Inova Describe the five steps to follow in providing services to the Deaf or Hard of Hearing Explain how to arrange for sign language interpreters and/or auxiliary aids at Inova

5. Northern Virginia: An International Community • Highly diverse community of approximately 2,623,079 people • 45% of the people identifies with a minority group • Approximately 24% are foreign born • Over 33% speak a language other than English at home • Among the most common foreign languages spoken at home in Northern Virginia are: • Spanish • Amharic • Chinese • Korean • Vietnamese • Arabic • Farsi • Urdu The region we serve * Northern Virginia Data Book http://209.190.220.93/Demographics/databook/index.html

6. Patient Centered Care and Effective Communication

7. Patient Centered Care and Cultural Competence • Patient Centered Care supports Inova’s mission to provide excellence in health care, education and research. • Patient centered care is by definition culturally and linguistically appropriate. • Patient centered care ensures that patients, companions and providers partner in care and explore all health options • Patient centered care is delivered in a manner that meets patient preferences. • It is deeply respectful of patient and family values, beliefs and traditions. you you Experiences Perceived Reality The “truth” The “truth” • 7

8. Patient Centered Care and Effective Communication • Provision of patient centered care requires effective communication • Effective communication requires that information be understood by all parties involved in care AND • Information must be understood thoroughly enough that the parties involved can use or act upon information exchanged. • This is true for all patients regardless of race, ethnicity, age, gender, education, religion, socio-economic status, language spoken, and so forth.

9. Laws Governing Language Services

10. Spoken Language No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. Title VI of the Civil Rights Act of 1964 • Language is considered a proxy for national origin. (precedent, beginning 1926) • We must provide the same quality care regardless of and language spoken. • Enforced by the Office for Civil Rights (OCR). • 10

11. Spoken Language: Highlights of Title VI • Trained medical interpreters must be provided to our Limited English proficient patients at nocost to the patient • Vital documents must be translated and communicated in patient’s language, including: • application and enrollment forms • letters or notices re eligibility or changes in benefits • anything requiring a response • patient consent forms • documents of a legal or financial nature • 11

12. Sign Language/Services for Deaf or Hard of Hearing Title III of the Americans with Disabilities Act (ADA) No individual may be discriminated against in the full and equal enjoyment of goods, services, facilities, privileges and accommodations in privately operated commercial facilities that are open to the public. • ADA ensures equal access to goods and services for persons who are deaf or hard of hearing. • ADA requires effective communication, and the provision of appropriate auxiliary aids and services (including qualified interpreters) when necessary to ensure effective communication for patients with disabilities • Enforced by the Department of Justice (DoJ)

13. What is a Companion under the law? Companions must be offered language assistance The term “Companion” means: a person who is limited English proficient or deaf or hard of hearing and needs to communicate with the staff about the patient’s care. Includes but is not limited to: Someone who assists in providing care or comfort Someone who assists in decision-making Legal guardian Power of Attorney Disclosure of information to the Companion is governed by HIPAA If there is a question as to whether the individual meets the definition above, consider the individual a companion

14. Interpreter Policy Summary • Any patient and/or companion who is limited English proficient or deaf or hard of hearing must be offered interpreter services or auxiliary aids, free of charge • Interpreter services must be provided by trained interpreters. • Friends and family may not be used as interpreters unless specifically requested by the patient and charted accordingly. • Minor children should never be used as interpreters. • In an extreme emergency, render any necessary and appropriate medical treatment and use your best efforts to provide the most effective communication possible until the interpreter arrives. • 14

15. Language Services:Your Responsibilities

16. Initial Communication Assessment Special Needs Form Purpose: Allows patients/companions to alert us to: (1) Spoken Language Preference, (2) Hard of Hearing, or (3) Deaf At the first opportunity: Have patient/companion complete form Sign and date form Maintain the form in the patient’s chart behind tab: Communication/Special Needs Provide to ALL Patients One form will suffice for identifying communication needs of any given patient and his or her companions

17. Your Responsibilities Further Communication Assessment Secure Needed Resources Documentation Initial Communication Assessment: Special Needs Form Spoken Language For a patient/companion who selects a language other than English * Sign Language For our patients and/or companions who selects deaf or hard of hearing Further Communication Assessment Secure Needed Resources Until an Interpreter Arrives When an Interpreter Arrives Documentation

18. Spoken Languages

19. Step 1: Additional Communication Assessment • In completing the Special Needs Form • Rely on the patient’s or companion’s own assessment of his/her English proficiency in determining the need for an interpreter. • The question is: “In what language do you prefer to receive care?” • To assist with Special Needs Form, may use “I Speak” cards • Record patient’s language preference in his or her record (CREG 1 screen in GECE)

20. Upon Receipt of Special Needs Form indicating Spanish language preference • Spanish Staff Interpreters at facilities with greatest need: • Inova Fairfax Hospital: Emergency Department • 703-776-5070 (24/7 coverage) • Inova Fairfax Hospital: Women’s Services • 703-776-6976 (24/7 coverage) • Inova Fairfax Hospital for Children, IFH Tower, & IHVI • 703-776-6835 (24/7 coverage) • Inova Alexandria Hospital • 703-504-7127 (7 days a week: 7 a.m. – 11 p.m.) • Inova Loudoun Hospital • 703-858-8929 (7 days a week: 8 a.m. – midnight) Step 2: Secure Interpreter Services

21. Step 2: Secure Interpreter Services • Upon Receipt of Special Needs Form indicating a language preference other than English • Services available at ALL Inova facilities in multiple languages: • Volunteer Interpreters who have completed medical interpreter training. • Search “Language Bank” on InovaNet • Over 600 volunteer interpreters in 45 languages at 20 Inova sites • Language Line • Available 24/7 in 150 languages • On-Site Contract Interpreters • Schedule appointments: (703) 776-7641

22. Step 3: Documentation • In the patient chart: • All requests for service • All refusals of service • Your response to requests or refusals of service • Name/identifying number of interpreter used • Any unusual circumstances If it isn’t documented, it didn’t happen.

23. Services for DEAF or Hard of Hearing

24. Services for the Deaf and Hard of Hearing Your Responsibilities Understanding the patient’s perspective will help you understand the need to rely on the patient to tell us what services or aids are needed for effective communication. We must identify and assist 100% of our patients and companions who are deaf or hard of hearing. There is a 0 tolerance policy

25. Step 1: Required Communication Assessment Deaf or Hard of Hearing Communication Request Form Purpose: Allows patients/companions who are deaf or hard of hearing to specify needs Immediately upon receipt of a completed Special Needs Form Provide the Deaf or Hard of Hearing Communication Request Form (CRF) to any patient/companion who indicates deaf/hard of hearing Patient/companion bases request on his or her preferences Assist in completion of the form, but do NOT dissuade from requesting services

26. Step 1: Required Communication Assessment Deaf or Hard of Hearing Communication Request Form • Detach and provide Complaint Resolution Form (p. 2 of CRF) • Maintain completed Deaf Hard of Hearing Communication Request Form in patient’s chart behind chart tab: Communication/Special Needs. • Place Deaf/HOH Chart Flag (yellow 8 ½ x 14” form) in front of physician orders • Do Not tear off bottom edge until preparing chart for Medical Records • Do Not remove forms when thinning chart

27. Step 1: Required Communication Assessment Deaf or Hard of Hearing Communication Request Form • If the patient identifies a deaf/hard of hearing companion who is not at the hospital, but will require service upon arrival, staff must • Provide the patient with the contact information for anyone on the unit who can assist the companion in completing the Deaf or Hard of Hearing Communication Request Form (CRF) and/or • Provide the CRF to the companion when he/she identifies him/herself. • Complete FLWHEAR screen in GECE. Screen has been revised to be consistent with the CRF will be entered into GECE. • The CRF stands for successive visits and services should be scheduled in advance as necessary.

28. Step 1: Communication Assessment • If you are approached by an individual who is deaf or hard of hearing in a public area of the hospital, help the patient/companion locate appropriate staff to assist them in completing forms and getting services. • Examples of how you may help include: • Accompany the patient/companion to an appropriate unit in the hospital (for example, assigned unit, registration, information, etc.) • Locate clinical or registration staff or unit secretaries, etc., who may be able to assist • Locate a NexTalk unit that may help to facilitate discussion • Exchange written notes , if appropriate, to answer immediate questions (for example, to provide directions) Rely on one another!

29. Step 2: Secure the Needed Resources Within 15 minutesof receiving completed Deaf or Hard of Hearing Communication Request Form, staff must: • Call 703-776-7641 • System-wide phone number • Answered 24/7/365 • Use for scheduled and emergent needs • Time frame to have a Sign Language interpreter on site for emergent needs: within 2 hours of receiving the Communication Request Form Within 30 minutes of receiving completed CRF, staff must: • Secure NexTalk video remote interpreter where available, and/or • Secure the appropriate auxiliary aids/services • Communication Kits deployed throughout all Operating Units Know where the needed equipment is stored and… know how to use it!

30. Step 2: Secure the Needed Resources Available Auxiliary Aids and Services These devices and services are available free ofcharge to patients or companions: • Sign Language and Oral Interpreters • Video Remote Interpreters (NexTalk) • TTY’s • Pocketalkers (assistive amplification devices best for moderately hearing impaired people) • Written Materials • Telephone Handset Amplifiers • Telephones compatible with hearing aids • Closed captioning of hospital programs • Virginia Relay Service -711 TTY Pocket Talker

31. Step 3: Until the Interpreter Arrives • Communicate by writing notes • Use multiple means of communicating • Chart all notes exchanged • Use NexTalk (Video Remote Interpreting) where available • In EDs, L&Ds and for check-out from Administrative Director • Do not rely on lip reading • Unless the patient insists it is his/her preferred method of communication • Document what you do!

32. Step 4: When the Interpreter Arrives Sign Language Interpreter Schedule Within 90 minutes after the interpreter has been provided AND when a patient is expected to remain in the hospital 12 or more hours: • Interview the Patient and/or Companion with the use of the interpreter to determine the Sign Language Interpreter Schedule for the expected duration of stay. • Base the Schedule exclusively on the Patient’s and/or Companion’s wishes • Provide information to assist patient/companion in completing schedule

33. Step 4: When the interpreter arrives Sign Language Interpreter Schedule • Sign the completed Interpreter Schedule, and have patient/companion so, as well • Call 703-776-7641 to activate the schedule, AND • Maintain the completed schedule in the patient’s chart behind the chart tab: Communication/Special Needs • Provide a hard copy to the patient/companion • As conditions change, periodically consult the patient/companion to assess the Interpreter Schedule and modify, if necessary. • When revisions are made, follow the steps above. • Patients and/or Companions have the right to request a change to their schedule at any time.

34. Step 4: When the interpreter arrives Sign Language Interpreter Schedule • Staff must assist the Patient and/or Companion in completing the schedule by providing the following information (to the extent that it is both reasonably ascertainable and allowed under HIPAA and other applicable laws): • the anticipated period of time that the patient will be in the Hospital; • the nature of the patient’s condition, including its seriousness and stability; • the likelihood of needing to communicate with the Patient or Companion at unexpected or unforeseen times; • the most common hours that Hospital Personnel will need to communicate with the Patient or Companion; and • the availability of 24-hour interpreter services and auxiliary aids free of charge.

35. Step 5: Documentation Requirements • In the patient chart: • All requests for or refusals of service • Your response to the such requests for or refusals of service • Any notes exchanged • Types of services or auxiliary aids used • Any unusual circumstances • Note the interpreter name, date, and time of arrival and departure on the Interpreter Encounter Form. If it isn’t documented, it didn’t happen.

36. Additional Information INTERPRETER SERVICES

37. Additional Information • 37