Strengthening the Healthcare Safety Net: Language Access Services at Unity Health Care, Inc. Luis Padilla, MD, FAAFP June 16, 2008

Unity Health Care, Inc MISSION Unity Health Care, Inc. offers a citywide network of quality health and human services to the medically underserved regardless of race, ethnic background or ability to pay. VISION Unity Health Care, Inc. will become the preeminent health care delivery system for the medically underserved of Washington, DC and recognized by them as the provider of choice.

Unity as a Community Health Center More than 20 years experience in Washington, DC More than 20 years experience in Washington, DC Present in all 8 Wards of the District of Columbia Present in all 8 Wards of the District of Columbia Over 180 providers Over 180 providers Currently 32 service sites throughout DC including Mobile Medical Units Currently 32 service sites throughout DC including Mobile Medical Units 433,450 visits n ,450 visits n 2007 Healthcare for DC inmates Healthcare for DC inmates

Unity Health Care Total Users 80,803 Total Visits 433,450 Working Poor, Uninsured, Immigrants 69,565 (86%) Working Poor, Uninsured, Immigrants 387,602 Homeless 11,238 (14%) Homeless 45,848

Unity Health Care Approach to LEP Focus efforts at unified patient communication through the triad of health literacy, cultural competency, and limited English proficiency (LEP) Focus efforts at unified patient communication through the triad of health literacy, cultural competency, and limited English proficiency (LEP) Active recruitment of bilingual and bicultural staff Active recruitment of bilingual and bicultural staff Diversity and cultural competency training throughout the organization Diversity and cultural competency training throughout the organization Support its centers with resources to address LEP Support its centers with resources to address LEP Provide low literacy forms and materials Provide low literacy forms and materials

Unity Health Care’s Upper Cardozo Health Center Ward one Northwest DC Ward one Northwest DC DC’s most ethnically and economically diverse ward DC’s most ethnically and economically diverse ward Most diverse center in Unity Health Care’s network Most diverse center in Unity Health Care’s network Over 17, 000 patients enrolled Over 17, 000 patients enrolled Over 76,000 visits in 2007 Over 76,000 visits in 2007 Predominately non-English speaking patients 60% Spanish and 10% Amharic Predominately non-English speaking patients 60% Spanish and 10% Amharic Low Literacy and Low English Proficiency (LEP) with average reading level at third to fourth grade Low Literacy and Low English Proficiency (LEP) with average reading level at third to fourth grade

Upper Cardozo: Services Offered Primary and Preventive Care Primary and Preventive Care Dental Dental Social Services Social Services Pharmacy Pharmacy WIC WIC OB/GYN OB/GYN Mental Health Mental Health Laboratory Laboratory Specialty Care (HIV, Pulmonary, Cardiology, Ophthalmology, Endocrinology, Podiatry) Specialty Care (HIV, Pulmonary, Cardiology, Ophthalmology, Endocrinology, Podiatry)

Where do our patients come from? The Americas Canada Mexico USA Argentina Bolivia Brazil Chile Columbia Ecuador Guyana Paraguay Peru Uruguay Venezuela Costa Rica Cuba Dominican Republic El Salvador Guatemala Haiti Honduras Jamaica Nicaragua Panama Trinidad

Where do our patients come from? Africa Benin Burkina Faso Cameroon Central African Republic Chad Congo Egypt Eritrea Ethiopia Gabon Gambia Ghana Ivory Coast Kenya Liberia Malawi Mali Mauritania Morocco Mozambique Nigeria Niger Republic of Guinea Senegal Sierra Leone Somalia South Africa Sudan Tanzania Togo Tunisia Uganda

Where do our patients come from? Asia, Europe, South Pacific, Middle East Bangladesh China India Korea Laos Mongolia Nepal Russia Sri Lanka Thailand Turkey Vietnam Albania England France Greece Ireland Italy Poland Spain Australia New Zeeland Polynesia Jordan Iraq Israel Syria Iran

Multilingual Staff 17 out of 19 primary care providers speak Spanish 17 out of 19 primary care providers speak Spanish Over 90% of support staff are bilingual or multilingual Over 90% of support staff are bilingual or multilingual Languages Spoken by Upper Cardozo Staff Languages Spoken by Upper Cardozo Staff SpanishTagalog FrenchFarsi AmharicTigrinya ChineseVietnamese

How Our Patients Obtain Information Flyers and Brochures Flyers and Brochures Spanish language prescription labels Spanish language prescription labels Web based educational materials Web based educational materials Point of care internet access Point of care internet access Language Line Language Line

How Our Patients Obtain Information Oral instructions from bilingual staff after visits Oral instructions from bilingual staff after visits Medline-Plus audio/video tutorials in Spanish Medline-Plus audio/video tutorials in Spanish Community Partnerships Community Partnerships Reach Out and Read Reach Out and Read Clinic Color Guide Clinic Color Guide

Forms and Signs Written at a third to fourth grade level Written at a third to fourth grade level Color coded Color coded Double sided bilingual Double sided bilingual Printed in Amharic when applicable Printed in Amharic when applicable

Point of Care Computer Access Internet Access in Internet Access in each exam room made possible through a NLM grant each exam room made possible through a NLM grant Web image searches Web image searches MedlinePlus Tutorials MedlinePlus Tutorials Demonstration of medications, dosing, etc Demonstration of medications, dosing, etc

Phone Interpretation Services Language Line Language Line Over 100 major languages and dialects available Over 100 major languages and dialects available Speaker phones available in each exam room Speaker phones available in each exam room

Reach Out and Read Program National Program designed to promote early childhood literacy National Program designed to promote early childhood literacy Literacy Promotion and books are encouraged at well- child visits ages 6months-5 years Literacy Promotion and books are encouraged at well- child visits ages 6months-5 years

Clinic Color Guide

Future Initiatives Computer Lab Computer Lab English Second Language skills building English Second Language skills building Computer skills development Computer skills development Healthcare System Access Education Healthcare System Access Education Understanding health benefits Understanding health benefits Patient language access rights Patient language access rights DC 2004 Language Act DC 2004 Language Act

Continued Challenges Resources needed to expand and provide language services to other languages (Amharic, French, Chinese) Resources needed to expand and provide language services to other languages (Amharic, French, Chinese) Resources and staff to assess how patients process and degree they understand information Resources and staff to assess how patients process and degree they understand information

Continued Challenges Increased adherence to DC language Act by other organizations (hospitals and specialist offices) Increased adherence to DC language Act by other organizations (hospitals and specialist offices) Resources to track changes and outcomes Resources to track changes and outcomes Recruitment bilingual providers Recruitment bilingual providers Recruitment bilingual nurses and case managers Recruitment bilingual nurses and case managers

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