1. Interpretive Services Legal directives and accreditations standards for culturally competent healthcare

2. The following resource was submitted with the purpose of distributing to AONE members as part of the AONE Diversity in Health Care Organizations Toolkit Submitted by: Akron Children’s Hospital Contact person: Lisa Aurilio, MSN, RN, NEA-BC Vice President of Patient Services/Chief Nursing Officer Akron, OH

3. The Joint Commission Ethics Standard  RI 2.100 – The organization respects the patient’s right to and need for effective communication.  EP 3: The hospital provides interpretation (including translation) services as necessary.

4. Limited English Proficiency (LEP)  Those patients/families who cannot speak, read, write or understand the English language at a level that permits them to interact effectively with program service providers.

5. U.S. Department of Justice Office of Civil Rights Safe Harbor  Guidelines to ensure access to written materials and documents for LEP patients served by federally funded health care organizations in order to comply with Title VI of the Civil Rights Act of 1964. Thresholds:  Written translations of agency vital documents provided for each language group that constitutes at least 5% or 1,000 individuals, whichever is less, of the population of persons eligible to be served or encountered by programs in the service area.  If < 50 persons in a language group, the agency provides written notice in the primary language of the LEP group of their right to oral interpretation of vital document written materials, free of cost.

6. LEP regulations: Prohibited Practices  Office of Civil Rights provides the following as examples of practices which may violate Title VI: Providing services to LEP persons that are more limited in scope or are lower in quality, Subjecting LEP persons to unreasonable delays in the delivery of services, Limiting participation in a program or activity on the basis of English proficiency, Providing services to LEP persons that are not as effective as those provided to those who are proficient in English, or Failing to inform LEP persons of the right to receive free interpreter services and/or requiring LEP persons to provide their own interpreter.

7. Safe Harbor Threshold and Service Areas  The Limited English Proficiency (LEP) population in the CHMCA service area that represents 5% or 1,000 individuals in the area is Spanish. U.S. Census Data (2006) Spanish speaking 5 years old +  Summit County7,221  Akron3,906  Total population 512,567  Mahoning County 6,566

8. Urgent Need for CHMCA: Spanish translation of vital documents  Vital document: A document, paper or electronic, that contains information that is critical for accessing the provider/agency services and/or benefits. U.S. Office of Civil Rights describes vital documents as "applications, consent forms, letters containing eligibility or participation information, notices pertaining to services or benefits, documents that require a response from beneficiaries, and advise of free language assistance, and the like.”  U.S. Department of Health and Human Services, Office of Civil Rights. Policy Guidance. Title VI Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency. September 1, 2000.

9. Translation of Vital Documents  Estimate of costs for translation to Spanish is ~$2600 based on $40/200 word page. Consent and Complaint Forms $480 Free Language Assistance $40 Patient Rights and Responsibilities $40 Intake forms that may have important consequences $2000

10. Translation of Non-vital Documents  Estimate of costs for translation to Spanish is ~ $40,000 based on $40/200 word page. Patient Menus $300 Patient education materials for home-going instructions ~$40,000  Care Information Sheets (460) ~ $20,000  Tips To Grow By (230) ~20,000

11. Interpreter Services  Other LEP populations served: Hearing impaired and deaf populations Limited English Proficient populations  Hispanic Languages  Asian Languages: Mandarin Chinese, Vietnamese, Korean, Karen (Myanmar)  Arabic Languages  Indian Languages  African Languages: Somali

12. Interpreter Services: Language Banks Akron Children’s Hospital 2006 (Annualized) 20072008 (Through 10-15) 2008 (Annualized) Billed Interpreter Encounters International Institute: 90% in 2008 91267386440 Interpreter Bills $10,815$31,196$56,309$64,353

13. Language Bank Interpreter Bills

14. Interpreter Services by Language

15. Interpreter Services: Language Line Akron Children’s Hospital 200620072008 (through September) Billed Interpreter Encounters 808872844 Interpreter Bills $22297$23604$31255

16. Interpreter Services: Sign Interpreters GreenLeaf Family Services 200620072008 (through October) Billed Interpreter Encounters 548476 Interpreter Bills $3,446 $6,262 $4,848

17. 2008 Projections Interpreter Services  Language Line Interpreters - $41,673  Language Bank Interpreters - $64,353  Sign Interpreters- $ 6,000 Interpreter charges Total - $112,026

18. Models for Provision of Coordination  Designated hospital position Combine Customer Service, Family Centered Care and Interpretive Services Patient Family Education Community Outreach Social Work Department  Contract with outside group(s) such as International Institute of Akron or AT&T Language Line for service coordination.

19. Current Needs  Comply with The Joint Commission & Safe Harbor provisions: Translation of existing and new vital documents Maintenance of translated vital documents Written notice of language access rights Technologies to assist with all LEP populations Interpreter services for LEP and deaf/hearing impaired populations A telephone voice mail menu in Spanish Staff education on accessing resources

20. Proposal: Coordinator Interpretive Services  Develop language assistance plan and measures Coordinate qualified interpreter services  Interpreters proficient in English and the second language; knowledge in both languages of relevant specialized terms or concepts; completion of training on the skills and ethics of interpretation, awareness of relevant cultural issues. Resource to direct care staff serving LEP populations  Education and consultation to promote culturally competent care in compliance with federal regulations such as Safe Harbor provisions and regulatory standards such as The Joint Commission. Monitor and update the language assistance plan

21. Finances Necessary  Position costs if hired by CHMCA (1 FTE = $60-$80 K plus fringes)  Ongoing costs of contracted document translation and interpretive services  State-of-the-art medical interpretation technology program

22. Financial Reasons to Hire a Coordinator Now  Assures compliance with Federal and Joint Commission standards prevents costly litigation.  Opportunities to control interpreter costs: Encourage use of Language Line for less critical needs (dual hand-set phones) Educate staff to reduce “downtime” for live interpreters Require authorization from interpreter services

23. Financial Reasons for Coordinator Explore alternative companies – telephone/video interpreter services Hire or contract for high use language interpreters with an organization-wide focus Require bilingual coordinator who can provide limited interpreter and translation services Improve data tracking and monitoring Explore grants and collaborative efforts

24. Administrative Decisions Needed  Funds for document translation  Coordinator position and location within the organization  Operating budget for Interpretive Services