1. Nuts and Bolts of Language Access Planning Rodrigo Monterrey CLAS Manager Massachusetts DPH-OHE Sponsored by the Nebraska Association of Local Health Directors and Health Literacy Nebraska through the Federal OMH State Partnership Grant January 13, 2015

2. Agenda: 1.History of Language Access 2.Language Access as part of “CLAS” 3.Steps: How to develop and implement your own Language Access Plan 2

3. Key Terms: 3 Translation: written Interpretation: spoken or American Sign Language, usually simultaneous Bilingual Staff: proficient in additional language, understands content and protocols Translator/Interpreter: trained or certified, contracted or volunteer Vital Documents: critical records, consent forms, eligibility documents, notifications that require a response or action from a client

4. History : Federal: Executive Order #1366 (2000) –"Improving Access to Services for Persons with Limited English Proficiency" –Federal agencies (and those receiving federal funding) to ID services and implement system –Use of a specific approach to determining when/how to provide Language Access –Unfunded mandate 4

5. History (cont): State and Local Agencies (MA): Chapter 151B of the General Laws, Executive Order 478, Administrative Bulletin #16 (2010) –Follows similar suit to the implementation of the national LA standards –Review of resources, populations, and agency- specific language access plans 5

6. History (cont): Emergency Room Interpreters Law (ERIL 2000) 1. Before implementation (“land before time”): –Use of friends, family members –Use of available bilingual persons/staff 2. Post implementation (present): –Competency a key element of interpreters –Hospital-Based Interpreter Services Best Practice Guidance –Training and Interpreter Credentialing –Language access planning 6

7. LAP in CLAS: What is “CLAS”? How does Language Access Planning fit into CLAS? 7

8. CLAS: Culturally and Linguistically Appropriate Services 15 standards for service delivery A framework for continuous quality improvement Goal? To reduce health disparities How? By creating culturally-competent systems of care 8

9. The Standards: Over-arching principle: #1 Governance, Leadership, Workforce: #2-4 Communication and Language Assistance: #5-8 Engagement, Continuous Improvement and Accountability: #9-15 9

10. The Steps: How to Develop and Implement Your Own Language Access Plan

11. 11 Framework: Plan-Do-Study-Act: Rapid-cycle process improvement (SMART Objectives)

12. Plan: Who: include staff from various levels and clients/community-members/stakeholders Why: review your mission/goals/needs. How will language access fit/benefit what you do? What: determine where language access is most needed. What are you hoping to address/improve? When: give yourself an end-date 12

13. Goal: 1.Organization Priority 2.LA Working Group 3.Assessment 4.Policy, Plan & Procedures 5.Interpreters & Translators 6.Document Translation 7.Training 8.Evaluate 13 “Ensure that LEP clients receive services in their preferred language”

14. 1. Organization Priority In order to serve LEP clients Unfunded mandate: –Operating cost – like the light bill –Line item for language services in budget Include in all grant proposals and apply for grants specifically for language access work –Use data to show why it matters Hire qualified bilingual staff 14

15. 2. Working Group Executive Director support Participation from all levels of organization –Management/administrators –Front line (clinical and non-clinical) staff –Clients/advocates/stakeholders Work plan, with SMART objectives, regular meetings and action steps (accountability) 15

16. 3. Assessment What are we already doing well? What resources do we already have? Where are the gaps in service? Who can we partner with? Then go after “low-hanging fruit” 16

17. 4. Policy, Plan & Procedures Language Access Plan and Protocol Working document (never done) Working Group reviews/updates annually Staff routinely trained on it Clients made aware of it 17

18. 5. Interpreters & Translators  List of interpreters and translators Easily accessible by all staff Updated annually Volunteer and employee “bank” for needed languages List qualifications & skills (translation vs. interpretation)  Quality Control (including certification boards) Application/Initial Screening Meeting/Interview with Referral Coordinator Interpreter Protocol & Code of Ethics (2006)  Negotiated lower rate for phone interpreter and video remote interpreter services 18

19. 6. Document Translation Write in Plain Language! (Health Literacy) Translated Document Bank  Easily accessible to staff  Informational materials for clients, staff, family  Signs, notices, forms, vital information Always have multiple people review Then pay for proofreading – less expensive 19

20. 7. Training Build in-house training capacity (FREE) Online training resources (FREE) Partner with agencies, courts or orgs (FREE) LEP Training for all New Hires in Orientation Annual Staff Training –Working with an Interpreter, Language Access Plan & Protocol and Language Access Issues Interpreter Skills-Building Training –Bilingual Staff and Privately Contracted Interpreters 20

21. 8. Evaluation Based on intended outcomes established in the workplan – concrete “measures” “Benchmark” – set a baseline against which to measure progress (e.g. % increase) Set up recurrence – periodic cycle for short, mid and long-term goals (monthly, quarterly, annual) 21

22. Elements of an LAP (template) 1.Purpose of the LAP 2.Mission/Vision 3.Populations Served/Populations within your catchment 4.Service Provisions of the LAP 5.Implementation 6.Complaint Procedure 7.Signatures: CEO, Dirs. (accountability) 22

23. Resources: Agency/Program: http://www.mass.gov/eohhs/docs/dph/health- equity/clas-chapter6.pdf State/County (example): www.montgomerycountymd.gov/LEP/ Federal: http://www.lep.gov/ 23

24. Resources (cont): How to work with an interpreter (video): http://www.health.medicbd.com/library/video?v q=working+with+interpreter&s=relevance&subm it=Search http://www.health.medicbd.com/library/video?v q=working+with+interpreter&s=relevance&subm it=Search Telephonic Interpreters: www.languageline.com www.ctslanguagelink.com www.pacificinterpreters.com www.callopi.com 24

25. 25 Resources (cont):

26. Checklist: 26

27. 27 Questions? Rodrigo Monterrey CLAS Coordinator DPH-Office of Health Equity 250 Washington St. Boston, MA 02108 rodrigo.monterrey@state.ma.us 617-994-9806 (office) 617-938-4024 (cell-phone)

28. Thank you! 28