1. Physicians Delivering Services in a Second Language How that does and doesn’t happen at Contra Costa Health Services.

2. Need for Physicians to deliver services in a second language - California vs. Nation Census figures: About 43% of Californians speak a language other than English at home - higher than in any other state in the country. About 43% of Californians speak a language other than English at home This doesn't mean they don't also speak English in the home. However, many who do speak languages other than English at home feel that they are not very proficient at English. By contrast, < 20 % of U.S. residents speak another language at home & < 9 % classify themselves as limited English speakers. Health Care disparities: There is a relationship between language access and the disparity of health care outcomes across the various populations in the U.S. Californians may not be receiving optimal health care. The Center for the Health Professions University of California, San Francisco’s Bilingual Proficiency among California’s Health Care Professionals by Catherine Dower

3. Providers delivering services in a patient’s own language – Best Situation Less possibility of mistakes Greater patient satisfaction More efficient – faster visits Cultural sensitivity and knowledge encourages effective care. Improve access to care Helps to mitigate health care disparities Communication is key

4. Bilingual Providers: These providers are actively recruited. Compensated for their skills. Most Health Plans offer searches of practitioner by language skill. Hiring bilingual providers and staff who can communicate directly with patients without the need of an interpreter is clearly the most efficient approach for dealing with language barriers. If providers speak the same language as their patients and especially if they are of similar cultural backgrounds, many problems encountered by their monolingual colleagues can be avoided. * * Diversity RX, Overview of Models and Strategies for Overcoming Linguistic and Cultural Barriers to Health Care: Models: Overview

5. According to the 2008 Foreign Language Survey by the Medical Board of California, 41% of Contra Costa’s physicians speak a ‘foreign’ language. I speak Assessing proficiency –what is missing is an objective assessment of language proficiency Bilingual Providers :

6. Contra Costa Health Services cares for and improves the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.

7. Contra Costa County - one of the few counties in the country to offer a full spectrum of health related services under one organizational structure. Contra Costa Health Services (CCHS) - part of the state’s public health care safety net, providing cost-effective, high quality & culturally appropriate services for all residents of Contra Costa County including the low-income and uninsured populations.

8. 164­bed hospital 8 ambulatory care centers Family practice and specialty care Mental health services Substance abuse treatment Public health programs Environmental health protection Emergency medical services County run Health Plan Full Spectrum of Health Related Services at CCHS:

9. Effective communication with patients is essential to quality care, access to care, and assuring a patient’s adherence to treatment plans, all of which are important to the delivery of quality health care with successful outcomes. Our patients reflect the broad diversity of Contra Costa County’s population Every month our hospital and health centers call for interpretation in over 30 different languages Most months our health care interpreters handle over 3000 calls Contra Costa Health Services is committed to cultural and linguistic competence in the provision of medical care

10. Bilingual Providers at Contra Costa Health Services: Highly valued Actively recruited Paid for language skill Promoted by Health Plan to patience as PCP Tested for language proficiency Provided with experience through residency program

11. Why test for language proficiency?

12. Studies show that many providers over estimate their ability to speak another language When providing health care communication is crucial and accuracy is essential Self assessment tools available - ICE When testing initiated at CCHS - 75% of the providers that said they were proficient were actually highly proficient in the language noted.

13. How we test providers for language proficiency Nationally accredited language test for oral proficiency - LTI Medical terminology not tested. Advanced level score required to be certified as proficient.

14. How proficient are our health care providers? Number of Hospital and Health Center Staff tested – 245 Includes MDs, RNs, LVNs, clerical staff, etc. Must work in clinic setting Number passed at Advanced Level or above – 215 or 87% Given special designation on badge and pay differential Providers tested

15. Just Say No: No badge no talk Staff who have not been tested cannot use non-English language until tested Staff who do not pass test at Advanced Level or above cannot use non- English language – must use an interpreter

16. Next Step – how we stop them from speaking

17. 13 health care interpreters Serve hospital, health clinics, or other departments such as Financial Counseling, Appointment Unit, Public Health, Detention Health or Contra Costa Health Plan (which offers 24 hour advice nursing services) Some work in Refugee Program Resources to Improve Linguistic Access to Health Care –in Good Hands More that 60 video interpretation units throughout the hospital and health centers In-person interpreters and over the phone interpretation also available.

18. Thank you 1.Bilingual Proficiency among California’s Health Care Professionals by Catherine Dower, The Center for the Health Professions, University of California, San Francisco 2. ICE – Industry Collaborative Effort, Employee Language Skills Self-Assessment Tool 3. Language Testing International – LTI, Oral Proficiency Interview ------------------------------------------------------------------------------------------------------- Sally McFalone – Contra Costa Health Services, Linguistic Access Unit smcfalone@hsd.cccounty.us (925) 313-6242smcfalone@hsd.cccounty.us Questions?