Best Practices in Multilingual AccessFocus on Group Practice/Community Health Centers
Kris McCracken, Dir. of Operations
Manchester Community Health Center
Purpose
Provide an Overview of Community
Health Centers (CHCs) and how
they are Addressing a Growing,
Diverse Population
Lessons Learned that could be
applied to other Group Practice
Settings
What is a Federally Qualified Health Center FQHC)?
A Non-Profit Organization that:
Is a Community Based Organization
Governed by a Board of Directors
Comprised of 51% Consumers of Services
Serves an Underserved Population or Area
Provides a Comprehensive Scope of
Preventive and Primary Health Services to
Anyone, Regardless of Insurance Status or
Ability to Pay
Provides a Sliding-Fee Scale Based Upon
Income for Those without Insurance
Receives Funding Under Section 330 of the
Public Health Service Act
NEW HAMPSHIRE
COMMUNITY HEALTH CENTER SERVICE AREAS
Coos County Family
Health Services
(Berlin - 2) (Gorham)
Ammonoosuc Community
Health Services, Inc.
(Littleton) (Woodsville)
(Warren) (Whitefield)
(Franconia)
White Mountain
Community Health
Center
(Conway)
Speare Medical
Associates
(Plymouth) (Bristol)
Health First Family
Care Center
(Franklin)
Avis Goodwin
Community Health
Center
(Dover) (Rochester)
Partners in Health
(Newport)
Families First Health
and Support Center
(Portsmouth)
Capital Region Family
Health Center
(Concord) (Hillsboro)
Lamprey Health Care
(Newmarket)
(Raymond) (Nashua)
Manchester Community
Health Center
Healthcare for the Homeless
(Manchester)
CHCs
Served
81,000
People in
2004 in New
Hampshire
Manchester Community Health
Center
Demographics …
PRIMARY SERVICE AREA: Greater Manchester
TOTAL # ACTIVE PATIENTS: Approximately 7,400
PERCENTAGE of PATIENTS w/FOREIGN LANG PRIMARY: 50+%
LANGUAGES SPOKEN IN SERVICE AREA: 70+
LANGUAGES SPOKEN at MCHC: 60
PRIMARY LANGUAGES OF PATIENT POPULATION: Spanish, Arabic,
Bosnian, Russian, Mandarin/Cantonese, Vietnamese, Portuguese French,
Albanian, many African Languages (Specifically from Sudan, Liberia,
Somalia, Kenya, Rwanda and Nigeria)
NUMBER of EMPLOYEES: 55 FTE’s
Language Volume (Over 10 speakers)
Top 13 Languages Spoken at MCHC
Spanish
Bosnian
Portuguese
Somali/ Mai Mai
Arabic
Albanian
Vietnamese
Chinese (Cant/Mand)
French
Russian/Ukrainian
Creole
Urdu
Korean
1425
201
181
104
68
44
43
40
36
33
20
18
11
0
500
# of Pts Who Speak this
Language
1000
1500
Interpretation Expenses FY’04-08
$160,000
Annual Interpretation Cost
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000
$FY 2004
FY 2005
FY 2006
FY 2007
FY 2008
Service Delivery Structure
INTERPRETATION RESOURCES:
-2 FTE’s dedicated Spanish Interpreters
-.5 FTE dedicated Bosnian Interpreter
-.5 FTE dedicated Somali/Mai Mai/Zigua Interpreter
-Contract with Tele-Interpreters for rare languages
-25 Independent Interpreters available (all staff have copy of the list)
-Contract with Lutheran Social Services Language Bank
-Use of Northeast Ctr. For the Deaf and Hard of Hearing as well as
Granite State Independent Living for Sign Language Interpreters
-20 Total Bilingual Staff Members (Languages spoken: Spanish, French,
Arabic ,Bosnian, Romanian, Russian, Swahili)
Policies & Procedures
Gathering of Country of Birth, Primary Language, and whether an
interpreter is needed at intake
Testing for competency of staff who wish to interpret or provide
services directly without the aid of an interpreter
Reminder messages in all patient MIS systems that an interpreter is
required to “prompt” staff
Training for staff who wish to interpret
Policy regarding use of children or family members
Arranging for interpretation in advance of visit
Human Resources Perspective
HISTORY:
At the beginning: one dedicated interpreter and use of staff in
addition to their regular position
In the middle: some positions had interpretation as a part of the job
description
Current: use of full time interpreters, external consulting interpreters,
or language line 90% of the time
ISSUES:
-Salary differentials?
-Who replaces the individual employee who has another position to
attend to?
-Who is “competent” to interpret?
-Are people fluent with oral skills, written skills or both?
Patient Perspective
Gender issues
Cultural issues
Religious concerns
Comfort level with a non-family member
Knowledge of a particular staff person
Knowledge of a particular interpreter (in small
communities can be a big problem)
Paperwork!
Patient Intake Forms
Patient/Facility Signs
Patient Consent Forms
Patient Education Materials
Patient Newsletter
Patient Letters (Personalized)
Patient Information regarding specialty care
Currently 77 forms and handouts available in our
top 9 languages as well as English
ISSUES still on the Fore-Front
After hours access (answering service
limitations) Tele-interpreter available for
doctor through 3-way conference call.
Recruitment of bilingual direct service
providers
Difficulty when referring patients out to
specialty care and testing
Loss of funding to Refugee Resettlement
Programs
Areas for Consideration
Navigating the American Health Care system
Legal requirements for Interpretation (OCR)
Economic Impact of Providing Services
Adequacy of supply of bilingual/bicultural healthcare professionals
Differences in Cultural Beliefs in regards to healthcare
Availability of refugee/immigrant health records
Difficulties in coordinating care with:
Hospitals
Specialty Providers
Mental Health Providers
Social Service Agencies
VNA’s
Entitlement Programs