Bird’s Eye View: Developing and Implementing Language Services

1. Bird’s Eye View: Developing and Implementing Language Services Vilma Seymour, Manager Office of Language Services September 21, 2010

2. Objectives...Check your LAP pulse • Assess the language needs of the individuals you serve • Assess your organizational capabilities for language services • Plan for interpreting services, written material, signage and way-finding, and community involvement • Evaluate language services provided

3. The VCU Health System • VCU Health System, the clinical delivery component of the VCU Medical Center, • Only academic medical center in Central Virginia • Referral center for the state and Mid-Atlantic • MCV Hospitals • 779 licensed beds • Only Level I Trauma Center in region • MCV Physicians • 550-physician, faculty group practice

4. Patient Demographics are Rapidly Changing

5. Delivering Patient-Centered Care Effective language services plan enables: • The care team to address the patients’ needs at the appropriate time and place • Enhanced patient education opportunities • Improved communication about vital documents • Assist in expediting the discharge process

6. Title VI: Any Entity Receiving Federal Funds... ...Required to give meaningful language access to LEP populations: • Oral and written services: • Translated Vital Documents of Dominant Language • Trained Interpreters and Bilingual Staff to Provide Language Assistance • Protocols Ensuring Language Proficiency of Interpreters and Bilingual Staff  • Legally Compliant Language Access Plan or LEP Plan 

7. 14 National CLAS Standards (Culturally and Linguistically Appropriate Services) • DHHS • Office of Minority Health • Standards 4, 5, 6, and 7 (are only enforced by Title VI)

8. Step 1: The Four Factor Analysis • Number of LEPP Eligible for Service • Frequency LEPP Use the Service • Nature and Importance of the Service • Resources Available to the Provider and Cost* of Providing Language Assistance *Note: Unfunded mandate; cost is a non-issue

9. Step 2: Assess How Language Assistance Is Provided • On-site Interpreters (Foreign and ASL) • Approved (Trained) Bilingual Staff • Certified Remote American Sign Language Interpreters • Trained Telephonic Interpreters • Translated Documents of dominant language • Way Finding / Signage

10. Step 3: Training and Implementation • Language Assessment • Minimum of 40 hr medical interpreter competency training • Staff Training Implementation at all Levels • Buy-in by ALL Departments • In-service for Updates MANDATORY at all VCU Health System facilities

11. Step 4: Introspection Have LEP patients been asked: • to have their documents translated ? • to come back another day? • why he/she does not speak English? Has staff at your facility: • Self-identified as being bilingual and provide language assistance without training? • Prevented children from serving as interpreters for their parents?

12. Clearly Define Policies and Procedures Elements: • Determine patient population – LEP, Sensory disabilities, cognitive impairment, or communication impairment • Inform patient of no charge for interpreting/ translation services 24 x 7 • Identify and document interactions in charts with LEP patients from point of entry to exit • Provide health hazard signage at points of entry in dominant language for most effective communication possible

13. Types of Interpreters 1Staff Spanish Interpreter 18 On-Site PRN Foreign Language : (7) Spanish • French • Korean • Arabic • Mandarin, Shanghainese, Cantonese (Chinese) • Khmer (Cambodian) • Vietnamese • Dutch • German • Russian • Japanese • Portuguese • Greek Foreign Language Telephonic Interpreter Vendor 335 dual-set phones in 132 locations at VCUHS 56 languagesrequestedannually American Sign Language Remote Access 5 video conferencing monitors VA Department of Deaf and Hard Hearing 24 nationally certified American Sign Language on-site interpreters

14. Required Internal Medical Interpreter Competency Training • 40 – hr: Interpreting in Health and Community Settings - multilingual (NOVA AHEC curriculum) • 60 – hr: Spanish Bilingual Assistant (National Medical Interpreter Project) • Reduces reliance on ad-hoc interpreters (family and friends) • Reduces interpretation by providers and staff with limited language skills • Continuing Education Modules (in progress)

17. Training Activities • New Employee Orientation • Semi – annual Post-baccalaureate Nurse Residency • Internal Learning Exchange for language assessments of House staff • In-services for Communication & Language Services Policy and Procedures • Internship with School of Medicine for new interpreters for community engagement

18. In-service for Language Access Technology • Video monitor to access remote American Sign Language Interpreter • Dual Hand-set telephone to access foreign language interpreters • Amplified telephones for hearing-impaired patients • VA Relay (711) and TTY telephones • Request form Web Submittal

19. Language Services vs Language Assistance Plan During a recent American Hospital Association webinar: • 87% of all registrants provide language services and have a LAP in place • 38% review the plan at least once a year • 30% provide Title VI training to all staff

20. Language Services vs Language Assistance Plan...continued Jonathan Levy, Director of Language Services, CyraCom • Do you equate providing language services to having a Language Assistance Plan? Language Assistance Plan is more than providing language services. • Language Assistance Plan is not the Language Assistance Policy

21. Collaborate, Collaborate, then...Collaborate Stakeholders with same vision/goals: • Professional Development team • Marketing • Risk Management • Human Resources • Providers • Facilities

22. Do you have Language Assistance Plan? Physical Document • 4 Factor Analysis • Description of how Language Assistance is provided • Training Policy / Plan • Introspection: how do you measure success? How often do you modify plan?

23. Resources to Develop a Language Assistance Plan • LEP.gov – Self Assessment tool • http://www.ncua.gov • DHHS Guidance • External support • Consultants • Language Service Vendor • Lessons From the Field

24. Language Assistance Plan is the Cornerstone... • Identifies the necessary costs • Identifies the necessary tools • Identifies the processes to monitor progress and adjust Shifting the Culture • Corporate, physician, and staff leadership • Staff buy-in • Patient and community expectations

25. vseymour@mcvh-vcu.edu804 – 628 – 1116