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The Third National
Conference on |
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October
2 - 4, 2002, Chicago, IL |
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Preconference | Wed., October 2nd | Th., October 3rd | Fr., October 4th | | ||||||||||
Session C-6: Improving access to health services for limited English-speaking patientsA multi-pronged approach to meeting the needs of limited English proficient enrollees in a Medicaid managed care organizationMeeting the needs of diverse members linguistically and at different educational levels is a major challenge for Medicaid managed care organizations. Quality of translations, utilization of translation companies and effectively utilizing resources is a careful balancing act. Coupled with the needs for appropriate, accurate and culturally competent materials it is equally important to provide verbal communication with limited English proficient (LEP’s) Medicaid enrollees that is relevant and appropriate. Both verbal and written communication with LEP’s in relation to health care issues are not only critical but they are also mandated through federal and in the case of California, state regulations. L.A. Care Health Plan is the largest Medicaid organization in the country with approximately 800,000 members. L.A. Care officially has 10 threshold languages; however, our membership speaks over 30 different languages. This presentation will focus on how a managed care organization is incrementally addressing both verbal and written communication with Medicaid enrollees. Also to be discussed are the lessons learned in translating materials and how technology can help meet these challenges. Verbal communication with members as mentioned earlier is one that presents unique opportunities. Although Los Angeles County has a significant bilingual community in many of the threshold languages, it is resource poor in qualified health care interpreters. Additionally, a study conducted with L.A. Care providers revealed that many providers rely on bilingual staff to provide interpretation services for limited English proficient patients. And, the vast majority have no training in interpreting for patients. To date, we have revamped the process of how translations are conducted and outsourced within the organization. First, L.A. Care offers a bilingual premium program, which provides a financial incentive per pay period for language proficiency in our non-English threshold languages. The policies and procedures for receiving the bonus were rewritten to ensure quality control in terms of written skills in the target language. Many of the recipients form part of our internal translation team. The translation team is composed of individuals with varied job responsibilities, and many a time the demands of translation can be stressful. As a way of mediating multiple demands, we have worked closely with supervisors and with the internal translation team to reward them through our Human Resources Department utilizing company wide programs for employee recognition. As a result of developing an internal translation team, we also found the need to provide support for these individuals since they are not trained translators. Therefore, we developed a "translation curriculum." The premise of the curriculum is multifold: to provide an overall understanding of the translation process, quality control, and improving skills—to name a few. Second, we updated our internal computer systems to read all of our threshold languages. Upgrading our internal computer systems assisted in reducing costs for revising translated materials that were normally outsourced to vendors. Therefore, we developed an internal capacity to address cropping needs for our non-English languages and subsequently this improved our internal response time. Simultaneously, we also worked closely with our internal Information Systems Department to develop on-line forms to request translation and interpretation services; which, afforded us the ability to closely monitor, plan and provide services. In order to address the gap of qualified interpreters, L.A. Care launched a 48-hour health care interpreter-training course at no cost our contracted network of providers and staff. Based on studies conducted both internally and among our contracted network, a health care interpreting course was developed to address the needs of untrained interpreters. Through our surveys we also found that many of the provider offices could not afford to let employees attend training for a full week. In order to accommodate our network, the course was offered as a four part series for 1-_ days every three months. Session I focused on an introduction to health care interpreting; Session II focused on interpreting skills; Session III focused on health care systems, concepts, and vocabulary; and, the final Session IV focused on culture and advocacy. Results from out evaluation of the training and lessons learned will be presented. Born and raised in Vietnam, Elizabeth Nguyen received French schooling, holds a French Baccalaureate Degree in Arts and Literature, and is a graduate of the Center of Linguistic Arts in Saigon, Vietnam. She is also a graduate of the "Bridging the Gap Interpreter Training and Train the Trainers Program" organized by the Cross-Cultural Health Care Program (CCHCP). Elizabeth’s experience and expertise include health care interpretation and translation, development of training curriculum, interpreter and cultural competency training, and consumer education workshops. She is currently a staff member of L.A. Care Health Plan, a Board Director of the California Healthcare Interpreter Association (CHIA) and the co-chair of CHIA Standards and Certification Committee.
Beatriz Solís, is Director of Culture and Linguistic Services for L.A. Care Health Plan. Beatriz developed the first department dedicated to address cultural and linguistic issues in a managed care setting. Prior to her working at L.A. Care, she has focused her research efforts and publications on: HIV/AIDs and the impact of this disease on women of color; Latina sexual health; access to health care coverage for low-income women; and welfare reform.
Bridges to Health: Institutional/Community Partnership to Enhance the Care of Latinos with Diabetes in the Cook County Bureau of Health ServicesThis presentation addresses a methodology which engages Hispanic immigrants as a resource to increase self-management of diabetes and to increase cultural competency among medical providers and health educators at a major metropolitan medical facility. Sponsored by a grant from the DHHS Office of Minority Health, the Bridges to Health (BTH) Program brings together four institutional and community partners to increase access and utilization of health care services for limited-English-proficiency diabetic Hispanics in Chicago including: The Illinois Health Education Consortium/AHEC; the Cook County Bureau of Health Services; Centro San Bonifacio, a community-based health promotion and community development organization; and the University of Illinois at Chicago College of Nursing. Presentation speakers will highlight the innovative approaches and dramatic impact the BTH Project is making within the Network Diabetes Program of the Cook County Bureau of Health Service. During this first year, the Community Health Workers (Promotoras) initiated a series of interactive provider workshops aimed at increasing cultural competency and empathy towards immigrant Latin Americans. A number of staff (12) from the Network Diabetes Program participated in either a one week immersion program or Spanish language classes held twice each week for eight weeks. Following a 50-hour training, the four Promotoras have been integrated as part of a team including physicians, nurses, pharmacists and health educators within four ambulatory clinics of the Cook County Bureau of Health Services to provide culturally appropriate diabetic health education and support to immigrant Latin Americans. Preliminary evaluation shows that the program is having an impact in the following areas: 1) increasing numbers of patients receiving culturally appropriate diabetes education and support in their native language; 2) increased identification of barriers through rapport-building between health promoters and patients; 3) increased provider understanding of Latin American cultures and health-seeking practices. Future evaluation measures are projected to show a decrease in blood glucose levels among patients seen by Community Health Workers, an increase in medical appointments kept, and higher patient satisfaction with care. The presentation will discuss challenges and strategies facing the implementation of the Bridges to Health Program, which have been both logistical and qualitative. Organizing a group of minimally bilingual Community Health Workers to function within a large medical center presented many problems and misunderstandings, especially with regard to the role of the Health Workers and acceptance by health professionals. The presenters will share valuable lessons learned from this program including cultural competency workshop topics and methods utilized to enhance learning, strategies for integrating Community Health Workers into a medical institution, and resources available for health professionals to increase Spanish language proficiency and cultural understanding of Latino health beliefs and practices. Lori Ramos is a co-founder and current Executive Director of Centro San Bonifacio. Ms. Ramos holds an MA in Latin Amercan Studies and a Masters in Public Health from the University of California, Los Angeles. Ms. Ramos has 20 years of experience working directly with Latin American immigrants in Chicago, IL and Los Angeles, CA, including Central American refugee communities. Ms. Ramos has done extensive work in the area of applied medical anthropology, especially in the development of workshops and dialogues between Community Health Workers and medical providers to increase cross-cultural understanding and communication between Hispanic immigrants and providers.
Peg Dublin is a community health nurse in Chicago with over twenty years of experience developing both community and hospital based health promotion programs which feature teams of health professionals and lay health promoters working together. For the past seven years Peg directed the Chicago Health Corps, an AmeriCorps program comprised of individuals from diverse racial, ethnic, educational, and socio-economic backgrounds. More recently, Peg developed the Chicago Spanish Immersion Program, an intensive language and cultural immersion program for volunteers and health care professionals. Ms. Dublin received her nursing degree from Rush University and is currently working with the Maternal and Child Health Program of the UIC School of Public Health and providing consultation to healthcare organizations.
Dr. Enrique Martinez grew up in the Pilsen neighborhood in Chicago, a predominantly Mexican-American neighborhood. He attended Harvard College and The University of Chicago Pritzker School of Medicine, and did his internal medicine residency training at Michael Reese Hospital in Chicago. For the last 12 years he has practiced primary care internal medicine at the Cook County Bureau of Health Services, and has a patient panel that is 95% Hispanic, predominantly non-English speaking. Dr. Martinez is a frequent presenter and lecturer on Hispanic Health Care Issues in the United States. Since 2001, he has been the Project Co-Director of the Bridges to Health Program for the Cook County Bureau of Health Services.
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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essentials | models and practices | policy | legal issues
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Diversity Rx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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