Language Access Assurances in Health and Human Services

Analysis of Existing Policy Options and Recommendations for Improvement

Cecily Rodriguez PAPA 6224 May 2013

Summary
Our changing demographic landscape compels administrators of public health and human services to explore how to ensure that quality services are available for individuals who are limited English proficient. Literature review and consultation with subject matter experts was done to identify existing methods for serving this population. Analysis determined the most reasonable initial method for ensuring access for LEP individuals is to establish threshold language policies. This means that a menu of language services are to be offered automatically for service seekers when a language group meets or exceeds 5% or 500 individuals in a communitys population or the catchment area for the organization.
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Language Access Policies

UNDERSTANDING THE ISSUE

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What is Language Access?

Ensuring that people who dont speak, read, or write in English, or who have some other communication barrier receive EXACTLY the same opportunity to understand the information provided to them as someone who does speak, read, and write in English.
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The Case for Language Services

- Legal Compliance
- Growing language diversity

- Access/Outcomes Equity
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Legal Compliance What Does The Law Say?

Title VI of the Civil Rights Act of 1964 says that no person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination based on race, gender, ethnicity or national origin under any program or activity receiving Federal financial assistance.
Covered Entities
Include any state or local agency, private institution or organization, or any public or private individual that
(1) Operates, provides or engages in health, or social service programs and activities, and (2) Receives Federal financial assistance from HHS directly or through another recipient/ covered entity
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Legal Compliance What Does The Law Say?

Title VI - Meaningful Access
Organizations are required to take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. The Guidance explains that the obligation to provide meaningful access is factdependent and starts with an individualized assessment that balances four factors:
1. 2. 3. 4. Number or Proportion of LEP Individuals Frequency of Contact With the Program Nature and Importance of the Program Resources Available
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Legal Compliance What Does The Law Say?

Presidential Executive Order 13166- August 2000

Was issued to improve access for persons for whom English is not a primary language to federally funded and federally conducted services (state & locally operated). Requires federal agencies that provide services directly to the public to ensure that their own services provide meaningful access for LEP persons. Requires that federal agencies provide guidance to state and local recipients on language access planning and compliance. PAPA 6224 8

Growing Language Diversity

Over 350 languages are spoken in the U.S.
There are more than 47 million people in the nation who speak a language other than English, and over 30 million who were born outside the United States

During the past decade, the number of Spanish and Asian-language speakers grew by 50%
Over 17% of the nations population speak a language other than English at home.
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Access/Outcomes Disparities
Systemic disparities refer to differences in access to or availability of facilities and services. IOM research reported that minorities tend to receive less care, and lower-quality care, than the majority population. For LEP individuals, disparities come about because services in this country, with few exceptions, are delivered in English.
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Access/Outcomes Equity
The Institute of Medicine of the National Academies sayindividuals who do not receive effective health communication tend to: Fail to enroll in health coverage programs Fail to make certain that their dependents are covered Neglect to seek preventive health care Make medication and treatment errors b/c they cannot follow patient instructions
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When Language services are effective.

Preventive Services

Emergency Services

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POLICY CONSIDERATIONS AND STEPS FOR EVALUATION

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Key Stakeholders
Federal
US Dept. of Justice

State
Medicaid & Medicare Agencies

Local
Health and Human Service Agencies

Advocacy groups/ Community/ Associations Private Sector

National Health Law Program Healthcare disparity researchers & advocates State and National Interpreter Associations Interpreter/translator Vendors Bilingual staff who are used as interpreters and translators Immigrant Communities Insurance Companies

US Dept. of HHS Office of Civil Rights US Dept. of HHSOffice of Minority Health Federal regulators State Health & Human Service Agencies State Regulators Local regulators

Program administrators

Policy Makers

Policy Makers

Policy Makers

Immigrant Advocacy Service Seekers & their Groups families Nationalist/Anti Immigration Advocates Certification Service providers of care Commission on Healthcare Interpreters Clinical and Providers English Only contingent
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Program administrators

Program Administrators

Front line Staff

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Policy Options
Status Quo
No language services are in currently in place

Require the implementation of threshold language services

If the population of a language group exceeds a certain percentage, interpretation and translation services shall be provided automatically

Require the use of only qualified interpreters/translators

Agencies will only use individuals who have been tested and trained to provide language services

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Evaluation Criteria
Legal Compliance How well the policy complies with Civil Rights Laws Few or no findings from compliance reviews Fairness/Equity How well the policy balances the potential winners and potential losers All or most eligible service seekers are able to access effective services Cost to Organization Is the cost of implementing and sustaining the policy greater than the benefits the organization would garner? Weighing all associated costs (short and long term) a cost savings is realized Social Benefit Does this policy provide some assurance that society as a whole will benefit from its implementation? Will the policy help to advance a healthy and thriving community? Practical Viability Are there sufficient technical capacities and competencies to meet the goals for the policy? Are there enough interpreter and translation services available to fully implement the policy?
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Trade Offs
Create threshold language policies Use of only certified interpreters & translators

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Planning with the End in Mind

Resources/ Inputs
Assessment of language spoken in the community Identify threshold languages needs (interpreter staffing, translation, settings ) Dedicate staff to coordinate services and training

Activities
Proficiency testing for bilingual staff
Workforce Training Vital document translation

Plan for addressing services for non-threshold languages

Outputs
Staff choose correct type of interpreter based on the type of encounter Accurate translations are available for individuals who need written information in a language other than English

Outcomes
Enhanced communication Legal compliance Better informed recipients of services

Impact
Organizations increase access to individuals who may Enhanced communication results in more efficient PAPA 6224 17 not otherwise receive services assessments and earlier interventions