1. 1 Conversational Spanish Courses for Front-Line Staff: Increasing the Reservoir of Language and Cultural Competency Skills for the Public Health Workforce Susan P. Amador, MPH Betsy Swanson Hollinger, MPH Noel Bazini-Barakat, RN, MSN, MPH Los Angeles County, Department of Public Health APHA 2009

2. 2 Learning Objectives After reviewing content, Observers should be able to: Identify the steps to plan, develop and implement a Spanish language training for public health workforce members Describe the steps and results of the courses’ evaluation plan and its impact on future workforce development and training planning

3. 3 Needs Assessment 38% of Los Angeles County residents primarily speak Spanish in the home. Many of these residents also seek Public Health services. Inability of Public Health staff to communicate due to language barriers increases the possibility of medical errors, thus stressing the importance of providing Spanish language and cultural competency training opportunities to workforce members* Workforce members who interface with Spanish speaking patients include public health nurses, health educators, public health investigators, clerks/receptionists/ secretaries, occupational and physical therapists, research analysts and epidemiology analysts *Gadon, et al. (2007). Caring for patients with limited English proficiency: the perspectives of small group practitioners. Journal of General Internal Medicine, 22 (Suppl 2): 341-346.)

4. 4 Project History Grant sought in February 2008 from the SEIU Local 721 union/County of Los Angeles Million $ Training Fund Grant award of $45,000 in April 2008 to implement Spanish courses in 2009 Course enrollment began in Fall 2008 Implementation: January - June 2009 Impact evaluation: six-month follow-up surveys currently in progress

5. 5 Stakeholders and Partners Involved Los Angeles County Department of Public Health, Organizational Development and Training: Project Coordinator SEIU Local 721/Los Angeles County Million $ Training Fund: Funders Worker Education & Resource Center, Inc.: Vendor Los Angeles County Department of Public Health: Front-line staff receiving training

6. 6 Methods Six-month class implementation timeframe Six-month follow-up impact study Recruitment based on: –SEIU Local 721 membership –Public Health Division representation –Justification of staff time: must have regular, direct contact with Spanish-speaking patients or clients Course site selection criteria: Classrooms geographically dispersed through out the county

7. 7 Spanish Class Interventions Total of six courses offered from January to June 2009 Four basic Level 1 courses offered –Maximum of 15 participants per course, or 60 participants total –Participants must have little to no previous Spanish language skill Two intermediate Level 2 courses offered –Maximum of 15 participants per course, or 30 participants total –Participants must have successfully passed the Level 1 or pass the Level 1 Post Test Course length: –Class held once each week; 3 hours per class session; 8 consecutive weeks Mandatory supervisor approval

8. 8 Sample of Level 1: Course Content Greetings and farewells (including basic introduction of the workforce member’s public health job function and purpose) Days of the week, months, time of day, numbers, counting, and colors Directional commands and questions (e.g., “where is the sexually transmitted disease clinic?”) Family vocabulary and Parts of the body The Spanish alphabet, personal pronouns, vowels, and important basic verbs (“to be” or “ser” and “estar”, and “to have” or “tener”) Basic public health assessment questions and vocabulary related to being immunized or screened for infectious diseases such as Tuberculosis, acute communicable diseases, or STDs

9. 9 Evaluation Measures Level 1 and Level 2 courses Pre and Post Test language assessment exams –Certificates given only upon passing Post Test Evaluation given at last class session Six-month post-class Zoomerang impact survey to: –Participants –Supervisors of the class participants

10. 10 Evaluation Summary: Level 1 Course PERCENTAGE WHICH OBJECTIVES WERE MET SOMEWHAT OR NOT AT ALL MET FULLY MET LEVELS OF CONFIDENCE AND APPLY & USE BEFORE AND AFTER COURSE BEFORE AFTER CONFIDENCE APPLY & USE PRETEST POSTTEST KNOWLEDGE OF CONTENT

11. 11 Evaluation Summary: Level 2 Course SOMEWHAT OR NOT AT ALL MET NO RESPONSE PERCENTAGE WHICH OBJECTIVES WERE MET FULLY MET LEVELS OF CONFIDENCE AND APPLY & USE BEFORE AND AFTER COURSE BEFORE AFTER CONFIDENCE APPLY & USE PRETEST POSTTEST KNOWLEDGE OF CONTENT

12. 12 Comments from Class Participants Level 1: This course gave me the confidence to ask questions in Spanish and the new vocabulary words that are important in my line of work. Over half of our clients are Spanish speaking, and after completing this course I will be able to assist in translation

13. 13 Comments from Class Participants Level 2: After this course I will be able to converse with patients rather than waiting for a language line or an interpreter. This not only saves money and time but is also more personal for the patients. Learning the HIV/AIDS and other public health terms/questions will be extremely helpful when communicating with patients.

14. 14 Summary Level 1 courses have greater knowledge changes Limitation on Level 2 courses: participants entered with higher Spanish language proficiency so knowledge increases were less Develop Departmental policy to ensure opportunities to receive Level 1 courses for staff needing to provide assistance to monolingual Spanish speakers Research funding to offer Level 1 courses on a continuous basis for staff, every other year