Policy Action Plan

1. Policy Action Plan: Policy Action Plan TALK.LISTEN.CONNECT. Quality Care Listens to You Melissa Salgado-Bellin University of Illinois at Chicago May 8, 2013

2. Introduction Understanding Language Access: GroupExercise • Diet, Hypertension, X-Ray • NPO, ACHS, PRN • Now imagine you DO NOT understand English and people are using medical terminology around you.

3. CASE EXAMPLE • Patient 13 year old Gricelda Zamora, parents spoke limited English. • Developed severe abdominal pain brought to Emergency Room with no interpreter. • Instructed to bring back daughter if symptoms worsened otherwise follow-up in 3 days. Chen, A. H., Youdelman, M.K., Brooks, J. (2007). The legal framework for healthcare settings: title VI and beyond. Journal General Internal Medicine. 22 (suppl2): 362-7. doi10.1007/s11606-007-0366-2

4. CASE EXAMPLE THE LANGUAGE BARRIER • Gricelda’s pain worsened, but parents thought they could not bring back daughter until 3 days later. • Within two days, her pain was so severe she was brought to hospital. • Appendix ruptured, and she died a few hours later. Chen, A. H., Youdelman, M.K., Brooks, J. (2007). The legal framework for healthcare settings: title VI and beyond. Journal General Internal Medicine. 22 (suppl2): 362-7. doi10.1007/s11606-007-0366-2

5. Background • In the U.S., 20.8% of the population speak a language other than English. • Of those who speak another language, 41.8% speak English less than “very well.” Source: U.S. Census Bureau, 2011 American Community Survey. • In 2011, U.S. Census Bureau of the 291, 524, 091 million individuals surveyed approximately 91% spoke English “very well” and 9% “less than very well. • 20% of U.S. population 5 years and older reported speaking a language other than English at home. • Census Bureau codes 381 detailed languages • Categorizes smaller sets of 4 “language groups.” • 62 percent spoke Spanish • 19 percent spoke other Indo-European languages • 15 percent spoke an Asian or Pacific Island language • 4 percent spoke some other language.

6. Background

7. Multilingual Population in Illinois

8. Chicago Statistics • Among Chicago residents who speak a language other than English at home, over 18% speak English “less than very well.” Source: U.S. Census Bureau, Quick Facts 2011

9. What is Language Access? In the Healthcare Setting- • Ability for LEP patients or individuals with communication barriers to communicate with health care providers in their primary language or communication method. Terminology: Limited English Proficiency (LEP)

10. Medical Misunderstandings COMMON among English Speakers Health Literacy (National Patient Safety Foundation, 2011) • 90 million people in the U.S. may be at risk because of the difficulty in patient experience in understanding health information. • 1 in 5 American adults reads at the 5th grade level or below. • Average Americanreads at the 8th to 9th grade level, health care materials are written above the 10th grade level. • Literacy skills are stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group. National Patient Safety Foundation (2011 ). Health Literacy At-A-Glance. Retrieved from: http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_Stats_English.pdf

11. Current Laws Protecting Language Access • FEDERAL • Title VI Civil Rights Act of 1964 • STATE • Language Assistance Services Act Health Facilities and Regulation (210 ILCS 87/) Language Assistance Service Act • “where language or communication barriers exist between patients and the staff of a health facility, arrangements shall be made for interpreters or bilingual professional staff to ensure adequate and speedy communication…”

12. Current Practices • Medical Interpreters: • Person-to-Person • bilingual staff, volunteers, family members • Telephone • Pacific Interpreters 24/7 access • Video “ I strive to aid communication with the clarity and direction of my voice, the proper way of positioning myself in the room, facial expressions and body language in order to  make sure that messages are flowing back and forth with as little interruption as possible.” - Medical Interpreter, Rush University Medical Center

13. Who are the Medical Interpreters? • Training- (ex.) 100 hours formal training, 40 hours supervised training. • The training program covers : interpreter ethics and techniques, culture and its impact on interpreting, and basic medical terminology. • Certification- Need 18 years +, high school diploma, medical interpretation education that includes minimum 40 hours+ education, proficiency in English, and target language. • Average annual salary- $42,000-$44,000 in Chicago

14. Proposed Action- Cook County Code Ordinace Amendment Chapter 38, section 38-94 • Cook County Healthcare Access Protection Initiative “HAPI” • (1) … “To ensure that low- income, uninsured individuals living in the County have access to basic, affordable health care, and to assist the County with its cost of caring for uninsured patients other hospitals either cannot or will not care for, each general hospital operating in the County that is not a safety-net hospital as defined in subsection…”

15. Policy Action Plan • (e) of this Ordinance shall annually provide financial assistance as defined in subsection to provide basic, affordable health care which includes language translation services in order to ensure all patients receive accurate, quality, and safe care while in the hospital setting. Reimbursement of Language Services to include: 1) Face-to-face or telephone communication to patients in their preferred language. 2) Written or standard illustrations to explain medical procedures or language.

16. Policy Paramours John P. Daley- Commissioner 11th District • Committee Chair • Audit • Finance • Committee Membership Technology • Rules & Administration • Veterans • Co-Sponsor of HAPI

17. Policy Paramours Deborah Sims- Commissioner 5th District • Committee Chair • Finance - Tax Delinquency  • Roads & Bridges • Committee Vice-Chair • Finance • Committee Membership • Capital Improvement • Contract Compliance • Finance - Labor • Human Relations • Rules & Administration • Workforce, Job Development & Training Opportunities • Vice-chair of Finance Committee

18. Governmental Stakeholders • Centers for Medicare and Medicaid Services     • Cook County Department of Public Health • Cook County Board of Directors • Illinois Department of Public Health • Illinois Advisory Committee to the U.S. Commission on Civil Rights  • LEP.GOV •U.S. Department of Health and Human Services- Office of Minority Health • State Children's Health Insurance Program

19. Non-Governmental Stakeholders Health Organizations American Nursing AssociationAmerican Medical AssociationAmerican Public Health AssociationAmerican Speech and Language Health AssociationSociety for Social Work Leaders in Health CareMedical Language Interpreter Services Illinois Language ServicesNational Board of Certification for Medical InterpretersPacific InterpretersCommunity-Based Organizations/Language Access Organizations Asian Health CoalitionAsian American Advancing JusticeChicago Hispanic Health Coalition Many Languages One Voice D.C. Language Access CoalitionMulticultural Community ServiceNational Health Law Program

20. References • Chen, A. H., Youdelman, M.K., Brooks, J. (2007). The legal framework for healthcare settings: title VI and beyond. Journal General Internal Medicine. 22 (suppl2): 362-7. doi10.1007/s11606-007-0366-2 • Cook County Board of Commissioners. Health and Human Services, Article V, Chapter 38, section 38-94. Retrieved from http://www.edwinreyes.org/wp-content/uploads/2010/01/Hapi-Ordinance.pdf • Cook County Government. (2011). Deborah Sims commissioner 5th district. Retrieved from http://www.cookcountygov.com/portal/server.pt/gateway/PTARGS_0_0_336_226_0_43/http%3B/www.cookcountygov.com/ccWeb.Leadership/LeadershipProfile.aspx?commiss_id=484 • Cook County Government. (2011). John P. Daley commissioner 11th district. Retrieved from http://www.cookcountygov.com/portal/server.pt/gateway/PTARGS_0_0_336_226_0_43/http%3B/www.cookcountygov.com/ccWeb.Leadership/LeadershipProfile.aspx?commiss_id=495 • DupageFederation on Human Services Reform. (2013). Language Access Resource Center. Retrieved from http://www.dupagefederation.org/index.php/language-and-cultural-competency/language-access-resource-center/item/language-access-resource-center#training-interpreters • Health Facilities and Regulation. (210 ILCS 87/1-19). Language Assistance Services Act. Retrieved from http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ACTID=1235&ChapterID=21. • National Patient Safety Foundation (2011 ). Health Literacy At-A-Glance. Retrieved from: http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_Stats_English.pdf

21. References • Shin, H.B. and Kominski, R.A. (2010). Language use in the United States: 2007. American Community Survey Reports. Retrieved from http://www.census.gov/prod/2010pubs/acs-12.pdf • Smal, P. (2012). Rush Interpreter Helps ‘Keep Communication Alive.’ Rush University Medical System. Retrieved from: http://rushinperson.rush.edu/2012/11/05/interpreter-at-rush-keeping-communication-alive/#more-5362 • U.S. Census Bureau. (2010). State and County QuickFacts: Chicago (city), Illinois. U.S. Department of Commerce. Retrieved from http://quickfacts.census.gov/qfd/states/17/1714000.html • U.S. Census Bureau. (2011). American Community Survey. Languages spoken at home 2011. Retrieved from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_1YR_S1601&prodType=table • U.S. Census Bureau. (2007). Figure 3 Percentage of population who spoke another language other than English at home: 2007. American Community Survey. • United States Judiciary Committee. (n.d.) Recess Reading: An Occasional Feature From The Judiciary Committee. The Civil Rights Act of 1964. Retrieved from http://www.judiciary.senate.gov/about/history/CivilRightsAct.cfm