0 Language Services: The Why and the How April 2013.

1

Language Services: The Why and the How

April 2013

Objectives

• Recognize the importance of providing culturally and linguistically appropriate services

• Explain the role of the patient and companion in determining what services are required for effective communication

• Identify the laws governing language services

• Identify four ways to access spoken language interpreter services at Inova

• Describe the five steps to follow in providing services to the Deaf or Hard of Hearing

• Explain how to arrange for sign language interpreters and/or auxiliary aids at Inova

ATTENTION!

PLEASE NOTE: This module details the

processes required in using the paper forms. Use of

the related Epic flows will be taught separately at

each OU or other entity and to the appropriate staff

as Epic rolls out across the System.

4

Northern Virginia: An International Community

• Highly diverse community of approximately 2,623,079 people

• 45% of the people identify with a minority group

• Approximately 24% are foreign born

• Over 33% speak a language other than English at home; 12% speak English “less than very well”

• Among the most common foreign languages spoken at home in Northern Virginia are:

The region we serve

– Spanish– Amharic– Chinese– Korean

– Vietnamese– Arabic– Farsi– Urdu

* Census 2010 and ACS 2011, 5-year estimate

5

Office of Health Equity (OHE)

Vision:

• A community where all residents have access to resources that promote and sustain health and well being.

Mission:

• To create a community where

• systemic and avoidable health disparities are steadily reduced, so that the gap between the best and worst off is narrowed;

• all residents have equitable access to a full range of high-quality healthcare and support;

• all have equal opportunities for optimal health and well being

Office of Health Equity

Selected Office of Health Equity Programs and Services

• Language Services

• Spoken language interpretation

• Sign Language interpretation and the provision of other services for the deaf or hard of hearing

• Translation of vital documents

• Training and Education

• Diversity, Cultural Competence and Health Equity Education

• 21st Century Leadership Development

• Now We’re Talking! Bi-lingual staff interpreter training

Patient-Centered Care and

Effective Communication

8

Patient-Centered Care and Cultural Competence

you

The “truth”

Experiences

Perceived Reality

you

The “truth”

Patient-Centered Care

• Is by definition culturally and linguistically

appropriate

• Ensures that patients, companions and providers

partner in care and explore all health options

• Is delivered in a manner that meets patient

preferences

• Is deeply respectful of patient and family

values, beliefs and traditions

9

Patient-Centered Care & Effective Communication

• Patient centered care requires effective

communication

• Effective communication requires that

information is understood by all parties

involved in care

AND

• Understood thoroughly enough that the

parties can use or act upon information

exchanged

This is true for all patients regardless of race, ethnicity, age, gender, education,

religion, socio-economic status, language spoken, etc.

Laws Governing

Language Services

11

Spoken Language

No person in the United States shall, on the ground of race, color or

national origin, be excluded from participation in, be denied the

benefits of, or be subjected to discrimination under any program or

activity receiving Federal financial assistance.

• Language is considered a proxy for national origin.

(precedent, beginning 1926)

• We must provide the same quality care regardless of and language spoken

• Enforced by the Office for Civil Rights (OCR)

Title VI of the Civil Rights Act of 1964

12

Spoken Language: Highlights of Title VI

• Trained medical interpreters must be provided to our Limited English

proficient patients at no cost to the patient

• A person who is limited English proficient either does not speak English

or speaks English “less than very well.”

• Vital documents must be translated and communicated in patient’s

language, including:

• application and enrollment forms

• letters or notices regarding eligibility or changes in benefits

• anything requiring a response

• patient consent forms

• documents of a legal or financial nature

Sign Language/Services for Deaf or Hard of Hearing

No individual may be discriminated against in the full and equal

enjoyment of goods, services, facilities, privileges and accommodations

in privately operated commercial facilities that are open to the public.

• ADA ensures equal access to goods and services for persons who are

deaf or hard of hearing

• ADA requires effective communication, and the provision of

appropriate auxiliary aids and services (including qualified interpreters)

when necessary to ensure effective communication for patients with

disabilities

• Enforced by the Department of Justice (DoJ)

Title III of the Americans with Disabilities Act (ADA)

What is a Companion under the law?

• Companions must be offered language assistance

• The term “Companion” means: a person who is limited English proficient or deaf or hard of hearing and needs to communicate with the staff about the patient’s care

• Includes but is not limited to:

• Someone who assists in providing care or comfort

• Someone who assists in decision-making

• Legal guardian

• Power of Attorney

• Disclosure of information to the Companion is governed by HIPAA

• If there is a question as to whether the individual meets the definition above, consider the individual a companion

15

Interpreter Policy Summary

• Any patient and/or companion who is limited English

proficient or deaf or hard of hearing must be offered

interpreter services or auxiliary aids free of charge

• Interpreter services must be provided by trained

interpreters

• Friends and family may not be used as interpreters

unless specifically requested by the patient and charted

accordingly

• Minor children should never be used as interpreters

• In an extreme emergency, render any necessary and appropriate medical

treatment and use your best efforts to provide the most effective communication

possible until the interpreter arrives

Language Services:

Spoken Language:

Your Responsibilities

Spoken Language: Your Responsibilities

17

1. Complete a communication assessment

2. Secure needed interpreters

3. Complete the necessary documentation

Step 1: Spoken Language Assessment

• The question to ask is: “In what language do

you prefer to talk with your doctors or nurses?”

• Rely on the patient’s or companion’s own

assessment of his/her English proficiency in

determining the need for an interpreter.

• Document the patient’s preference in the

patient’s record.

All Patients must be asked their language preference

Step 2: Secure Interpreter Services

If a patient or companion indicates a

language preference other than English

Staff Interpreters (Spanish)

• Inova staff interpreters in Spanish are available

on all Inova hospital campuses

• A complete list with hours of coverage and

phone numbers can be found on InovaNet:

http://inovanet.net.inova.org/?id=1615&sid=1

• Call the appropriate extension to obtain a staff

interpreter at your location

Services available at ALL Inova

facilities in multiple languages:

• Contracted, On-Site Interpreters

• To pre-schedule an interpreter,

access the “Inova Interpreter

Request” on InovaNet

• If the request requires an

immediate response, use the

Language Bank, the interpreter

phones or call the Scheduler at

703-776-7641 (Option 2)


Inova Interpreter Requesthttps://wlcapps.net.inova.org/langreq/LangRequest/LangRequest.html

If patient or companion prefers a language other than English

Services available at ALL Inova facilities in multiple

languages:

• Volunteer Interpreters who have completed 40-hour

medical interpreter training.

• Search “Language Bank” on InovaNet

• Over 600 volunteer interpreters in 45 languages

• Telephonic Interpretation (Interpreter phones)

• Available 24/7 in 170 languages


If patient or companion prefers a language other than English

Step 3: Documentation

In the patient record, document:

• Language preference/ requests for service

• Note name or identifying number of interpreter used

• Refusals of service and how you respond

• Note name of individual chosen to interpret by patient and

relationship to patient

• Emergency situation necessitate the start of care before a trained

interpreter arrives.

• Any unusual circumstances

If it isn’t documented, it didn’t happen.

Services for

Deaf

or Hard of Hearing:

Your Responsibilities

Services for the Deaf/HoH: Your Responsibilities

We must identify and assist 100% of our patients and

companions who are deaf or hard of hearing.

There is a 0 tolerance policy

Understanding the patient’s

perspective will help you understand

the need to rely on the patient to

tell us what services or aids are

needed for effective

communication.

Deaf/HoH: Your Responsibilities

25

1. Complete the necessary communication assessment

2. Secure needed resources

3. Undertake steps until an interpreter arrives

4. Adhere to necessary steps when an interpreter arrives

5. Complete all required documentation

Purpose: Allows patients and companions

to identify as deaf or hard of hearing and

request or decline specific services

•Must be completed by ALL patients

At the first opportunity to assess:

•Provide the CRF to ALL patients

•ALL patients must answer two questions:

1. Are you or any of your

companions deaf?

2. Are you or any of your

companions hard of hearing?

Step 1: Communication Assessment

Deaf or Hard of Hearing Communication Request Form (CRF)

Deaf or Hard of Hearing Communication Request Form

•Patient may indicate that the form stands

for the current course of treatment

• This refers to certain hospital-based

series accounts

• These accounts reset at the first of

each month.

• If a patient is readmitted after the

account resets, he or she will be

required to complete a new CRF


• Only the top section of the CRF

needs to be completed.

• The patient must sign and date

the form and note the time.

• Hospital personnel must also sign

and date the form and indicate

contact information.

• The process is complete.

• Maintain the completed form in the

patient record (fax to Medical

Records)

If neither patient nor companion(s) is deaf or hard of hearing:


When a Patient or Companion is

Deaf or Hard of Hearing

•Any patient or companion who is deaf

or hard of hearing must complete the

middle section of the CRF.

•Purpose: This allows the individual

who is deaf or hard of hearing to:

• Request specific services

and/or auxiliary aids

• Decline services

29

Deaf or Hard of Hearing Communication Request Form:



• The request MUST be based on the patient or companion preferences

• Never try to dissuade a patient or companion from requesting a specific

service or aid

• If circumstances do not allow for the form to be completed by the patient

or companion, you may assist in completing the form

• The patient or companion must sign and date the form and indicate the

time of completion

• Hospital personnel must also sign and date the form and include contact

information

• Maintain the completed form in the patient record (fax to Medical

Records)

30


Deaf or Hard of Hearing

Communication Request Form

•The CRF has a second page, the

FAQ’s/Complaint Resolution

Process

•Detach page 2 and provide this to the

patient or companion

•For any paper chart, you must also

complete and affix to the chart the

Deaf/HOH Chart Flag (yellow 8 ½ x

14” form)

31


Deaf/HoH Patient and/or Companion Identifier

• Any patient or companion who is deaf or hard of hearing must be

offered a visual identifier.

• Use orange wrist bands for this purpose.

• Patient or companion is deaf: Use the band with the symbol

indicating deafness.

• Patient or companion is hard of hearing: Use the band that has

“HOH.”

32



• If a patient identifies a deaf or hard of hearing companion who is not at

the hospital, but will require service upon arrival, staff must:

• Provide the patient with the contact information for anyone on the

unit who can assist the companion in completing the Deaf or Hard

of Hearing Communication Request Form (CRF) and/or

• Provide the CRF to the companion when he/she identifies

him/herself

33


34

In a public area:

• If you are approached by an individual who is deaf or hard of hearing in a public

area of the hospital, help the person locate appropriate staff to assist in

completing forms and getting services.

• Examples of how you may help include:

• Accompany the patient/companion to an appropriate unit in the hospital (for

example, assigned unit, registration, information, etc.)

• Locate clinical or registration staff or unit secretaries, etc., who may be able

to assist

• Locate a NexTalk unit that may help to facilitate discussion

• Exchange written notes , if appropriate, to answer immediate questions (for

example, to provide directions)

Rely on one another!


35

Step 2: Secure the Needed Resources

Within 15 minutes from the time the completed Deaf or Hard of Hearing

Communication Request Form is signed, staff must:

• Call 703-776-7641 to obtain a Sign Language Interpreter– System-wide phone number

– Answered 24/7/365

– Use for scheduled and emergent needs

– Time frame to have a Sign Language interpreter on site for emergent

needs: within 2 hours signing of the Communication Request Form

Within 30 minutes from the time the completed CRF is signed, staff must:

• Secure NexTalk video remote interpreter when requested (where available),

and/or

• Secure the appropriate auxiliary aids/services

36

• Sign Language and Oral Interpreters

• Video Remote Interpreters (NexTalk)

• TTY’s

• Pocketalkers (assistive amplification devices

best used for moderately hearing impaired people)

• Written materials

• Telephone handset amplifiers

• Telephones compatible with hearing aids

• Closed captioning of hospital programs

• Virginia Relay Service -711Pocketalker

TTY

These devices and services are available free of

charge to patients or companions:

Step 2: Secure the Needed Resources

NexTalk

37

Step 3: Until the Interpreter Arrives

• Communicate by writing notes

• Use multiple means of

communicating

• Chart all notes exchanged

• Use NexTalk (Video Remote

Interpreting) where available

• In EDs, L&Ds and for check-out

from Administrative Director

• Do not rely on lip reading

• Unless the patient insists it is

his/her preferred method of

communication

• Document what you do!

Step 4: When the Interpreter Arrives

Sign Language Interpreter Schedule

Within 90 minutes after the interpreter

has been provided AND when a patient

is expected to remain in the hospital 12

or more hours:

• Patient and/or companion must

determine the Sign Language

Interpreter Schedule for the expected

duration of stay

• Base the Schedule exclusively on the -

patient’s and/or companion’s wishes

• Staff must provide information to assist

Step 4: When the interpreter arrives


• The patient or companion and hospital personnel must sign and date the

Interpreter Schedule

• Call 703-776-7641 to activate the completed schedule, AND

• Maintain the completed schedule in the patient’s medical record

• Provide a hard copy to the patient/companion

• Patients and/or companions have the right to request a change to their schedule

at any time

• As conditions change, staff should periodically consult the patient and/or

companion to assess the Interpreter Schedule and modify, if necessary.

• Revised schedule(s) must be called in to 703-776-7641 and maintained in the

patient record (fax to Medical Records)

Step 4: When the interpreter arrives


• Staff must assist the patient and/or companion in completing the schedule

by providing the following information (to the extent that it is both

reasonably ascertainable and allowed under HIPAA):

i. the anticipated period of time that the patient will be in the Hospital;

ii. the nature of the patient’s condition, including its seriousness and

stability;

iii. the likelihood of needing to communicate with the patient or

companion at unexpected or unforeseen times;

iv. the most common hours that hospital personnel will need to

communicate with the patient or companion

v. the availability of 24-hour interpreter services and auxiliary aids free

of charge

Step 5: Documentation Requirements

• In the patient chart document:

• All requests for or refusals of service (documented on the CRF)

• Your response to the such requests for or refusals of service

• Any notes exchanged

• Types of services or auxiliary aids used

• Any unusual circumstances

If it isn’t documented, it didn’t happen.

42

• Compliance with policies and procedures for the Deaf and Hard of Hearing

is monitored by Inova’s ADA Compliance Officer

• Results of random chart audits are shared with departmental leaders for

continuous ongoing quality improvement

• If you become aware of an instance where patients or companions did not

receive their requested deaf or hard of hearing services within the required

timeframes, please report this to the ADA Compliance Officer

• Please note: Contact information for Office of Health Equity Staff

and the ADA Compliance Officer can be on InovaNet:

http://inovanet.net.inova.org/?id=1861&sid=1

Monitoring and Compliance

Additional Information

INTERPRETER SERVICES

0 Language Services: The Why and the How April 2013.

Documents

Transcript of 0 Language Services: The Why and the How April 2013.