Assessing Language Access in Rural Healthcare Facilities: Understanding CLAS

1. Assessing Language Access in Rural Healthcare Facilities: Understanding CLAS Jessica Thomas, MPH, CHES St.Vincent Health Rural and Urban Access to Health LEP Project Coordinator June 10, 2009

2. What I Hope to Answer • What are language access services? • What laws, standards, guidelines are there for these services? • How do you begin to assess language access services in your organization? • What are examples of assessments already done? • What do you do after the assessment? • Where can you find more information?

3. Language Access Services (LAS) • LAS are services designed to ensure effective communication between individuals with limited English proficiency (LEP) and English speakers. Primary LAS include interpretation (oral) and translation (written) services • LAS can also involve provisions that enhance communication, such as signage for wayfinding www.thinkculturalhealth.org Goldwater, J. & Pacheco, G. 10/28/08, Improving Health Communication for LEP Patients: The Health Care Language Services Implementation Guide

4. CLAS Standards • National Standards for Culturally & Linguistically Appropriate Services in Health Care • Based on Title VI of the Civil Rights Act of 1964 • Developed by OMH/DHHS in March 2001 • 14 standards, divided into three categories: • Culturally Competent Care • Standards 1-3 • Recommendations • Language Access Services • Standards 4-7 • Mandatedfor recipients of federal funds • Organizational Supports • Standards 8-14 • Guidelines

5. CLAS Standards Mandated Language Access Services Standards: • Health care organizations (HCOs) provide language assistance services (eg. Bilingual staff, interpreter services) • Patients receive oral and written notices of their right to language assistance services • HCOs assure the language competence of their interpreters and bilingual staff • HCOs provide informational materials and signs in the languages of their patients

6. The Joint Commission’s Response • Hospitals, Language & Culture Study • The Joint Commission, with funding from The Commonwealth Fund, is developing accreditation standards for hospitals that will promote, facilitate, and advance the provision of culturally competent patient-centered care.  These standards will build upon the research framework from the ongoing HLC study. • Standards available for public comment May 2009 • www.jointcommission.org/standards/fieldreviews/ • Piloting these standards July – December 2009 • Planned implementation January 2011 • Implementation Guide available January 2011

7. Assessing Language Access Services & Organizational Capabilities

8. Leadership support – A Must! Very difficult task without support from organization leadership Pulling together a team… “Diversity group” Include people from a variety of areas in the Diversity group: Quality/Risk Management Social Services Outpatient areas Community groups Support & Team Development • Leadership • Front-line staff • Physicians • HR

9. 4-Factor Analysis • Number of LEP patients your organization serves or could serve • Frequency of the contact that LEP patients have with your organization • Nature and importance of services provided by your organization • Resources available to the program and the costs

10. Organizational Capabilities Assessment Process: SV Example • December 2007 – March 2008 • Surveyed facilities by use of comprehensive “facility assessment” • Completed by Diversity groups • April 2008 – July 2008 • Surveyed associates in all facilities • 4227 responses of 12,000 associates • Overall SV Health assessment • System-wide gap-analysis for planning and benchmarking purposes

11. Assessment Tools • Facility Assessment Tool: • RUAH utilized several individual surveys to create a practical survey that is easy to use in the healthcare setting – it’s not perfect, but it worked! • Covers interpreter use/availability, policies & procedures, translation use/availability, translated hospital signage, leadership support, associate/staff knowledge of resources • Associate Assessment • 9 questions, quick and painless • Covers accessing interpreters, translated documents, resources as well as information on Language Line phone use

12. Assessment Tools • Why use two separate surveys? • Should not make assumptions about what associates/staff know, understand, use on daily basis • Diversity groups learned the depth of the project through the facility assessment • Discrepancies in facility and associate assessments highlighted the need for associate education on language access policies, procedures and resources

13. Utilizing the Results • All SV facilities are different and therefore one blanket LEP plan would not be specific enough for each facility (16 beds to 600 beds) • Each facility has used the results to create LEP plans with specific action items, responsible persons, and expected completion dates • Diversity groups taking ownership of the LEP plans • Overall SV Health LEP Plan to address system issues

14. Utilizing the Results, continued… • Examples in work plans • Install appropriate telephonic interpreter equipment (dual handset phones) • Create or revise language access policy and procedures (to include appropriate interpreters, document translation, documenting interpreter need, etc.) • Bilingual associates to complete Bridging the Gap Medical Interpreter Training • Include language access information in new hire orientation

15. Suggested Resources • Office of Minority Health • www.omhrc.gov • National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report • http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf • LEP Federal Interagency Website • www.LEP.gov • The Joint Commission • http://www.jointcommission.org/PatientSafety/HLC/ • California Health Care Safety Net Institute • Straight Talk: Model Hospital Policies and Procedures on Language Access • www.safetynetinstitute.org

16. "We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams." – Jimmy Carter

17. Thank You! Jessica Thomas, MPH, CHES St.Vincent Health Rural and Urban Access to Health (RUAH) 317-583-3215 jlthoma4@stvincent.org