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
• Mandated for 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 Commissions 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
Support Team Development

• 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

• 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 its 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/finalrepor
  t.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_at_stvincent.org