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Overview:
Kaiser Permanente California's southern region has 2.3 million members.A 1990 demographic assessment of membership showed that 25% are Latino,and that a total of 10-12% of members are limited English-speaking and needSpanish speaking providers or interpreters for their medical care. A seconddemographic survey has recently been completed and will be repeated everyfive years. Although some LEP members speak languages other than Spanish,the numbers are small and efforts have centered initially on the needs ofthe Spanish-speaking. For these members, a multi-pronged approach has beenundertaken that includes: epidemiological research, translated materialsfor members, hiring of bilingual providers at appropriate sites, utilizationof tested bilingual staff members as interpreters, contracting with AT&TLanguage Line, training of providers in working with interpreters, and healtheducation classes conducted in Spanish.
Description of the model:
Attempts are made to place bilingual health care providers at sites whichhave the highest numbers of Spanish-speaking patients as demand varies greatlydepending on the geographic location of the clinic or facility. However,sufficient numbers of bilingual providers are not available overall, whichhas led to the use of bilingual/bicultural staff members as interpreters.To ensure proficiency of these employees, oral testing has been implementedand bilingual employees must take the test if they wish to continue receivinga bilingual pay differential. Currently, over 2,000 employees in SouthernCalifornia have undergone testing. Graded by Berlitz, the test is two-tiered,one tier for general fluency and one for medical vocabulary. If employeesdo not pass, they are offered a course to improve their skills and are givenanother chance to take the test. As negotiated with the union, employeeswho have passed the interpretation test receive a $65 per month differentialif 5% or more of their work day is spent in interpreting.
Kaiser is piloting an interpreter training course for bilingual staffat one site, but is awaiting the results before expanding region-wide. Asthere currently is no centralization of interpreter scheduling, all staffhave access to a list of bilingual employees upon whom they may call tointerpret. At present, Kaiser is examining alternative ways of schedulingbilingual employees to interpret. To supplement the employee language bank,Kaiser contracts with AT&T Language Line, primarily for languages otherthan Spanish. Kaiser has found one major drawback to this method: not allexam rooms have phone jacks and speaker phones.
Unique characteristics:
Research into epidemiological patterns affecting the Latino and other minoritypopulations focuses mostly on chronic disease and risk factors. The resultswill be incorporated into provider handbooks, which will cover ethno-culturaland demographic information as well as the results of the research. SeeKaiser Permanente National Program for further description of provider handbooks.
Written and audio materials have been translated into Spanish. For example,the member handbook and enrollment materials have been translated. The HealthPhone Line, which has recorded health education messages, is available inSpanish, and the call processing system is adding lines specifically forSpanish speaking consumers.
Further enhancing services to Kaiser's Spanish speaking members, healtheducators provide classes in Spanish. Bilingual/bicultural patient liaisonstaff in acute care facilities also assist the LEP consumer in using thehealth care system.
At several medical centers, provider staff have received training inworking with interpreters and appropriate handling of cultural differencesin provider-patient interaction styles. Kaiser has developed in-house videosto illustrate good use of interpreters. Providers have received trainingin the use of the AT&T Language Line.
Funding sources:
General revenues.
Contact information:
Jean Gilbert, Ph.D.,
Kaiser Permanente California
393 East Walnut Street, LR-6
Pasadena, CA 91188-8361.
Phone: 818-564-3743
Fax: 818-564-3747
E-mail: Jean.Gilbert@kp.org
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| As with the rest of DiversityRx, this section is a work inprogress and we welcome information on other efforts, programs, and reportsthat will expand upon the information offered here. Pleaselet us know if you have other examples to include here. | ||||||
essentials | models and practices | policy | legalissues | | ||||||
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DiversityRx is sponsored by: |  The National Conference of StateLegislatures |  Resources for Cross Cultural HealthCare |  Henry J. Kaiser Family Foundation | |||
