Fairview Language Services Training for contracted interpreters Agenda

Fairview Language Services Training for contracted interpreters

Agenda Ø Overview of Fairview Ø Interpreter Expectations Ø Health Requirements Ø Patient Safety

Fairview Language Services Delivery Model • Leadership: Director, supervisor and 3 coordinators/trainers (one in each hospital) • Onsite leadership at Ridges (Stacy Montgomery) • Onsite leadership at Southdale (Cathy Utne) • Central Scheduling Office – 7 days/24 hour coverage • More than 60 Staff interpreters in 14 languages • Contracts with 8 local agencies • 24 -hour telephone interpreting access – Language Line/Cyracom – more than 150 spoken languages

Department’s Role Within Fairview Ø Interpreting Ø Translation Ø Outreach Ø Education and Consultation

• Interpreting requires training in – Medical Terminology – Professional Ethics – Hospital Policy. • Document translation, examples: – Patient Education – Billing Materials – Informed Consent (regulatory mandate) • Outreach/Collaboration with local/statewide community-based organizations and agencies serving – Deaf communities – Hard of hearing communities – Immigrant communities

• Education & Consultation: Educate patients and families – Navigating the health system – Understanding western biomedical model of care. Educate Fairview staff – Accessing interpreter services – Working effectively with interpreters Consult providers in learning about – Cultural Traditions – Spiritual Traditions – Religious Traditions of the patients and communities we serve:

ØMission ØVision ØGoals

Mission (Our Purpose) “Our mission is to provide high quality interpreter services. We commit to use our training, linguistic skills, and cultural knowledge to bridge the communication gap between health care providers and patients including their families.

Vision (Where we are going) To become the preferred provider/organization for patients and their families who need language services in Minnesota

Goals (How we are going to do it) Ø Provide excellent, culturally competent services and expertise that meet or exceed professional, state and national standards by continuously measuring and improving all that we do. Ø Develop a top quality, well-trained language services team. Ø Foster and model effective, respectful organizational teamwork and communication to become an integral part of the health care delivery team. Ø Make effective and efficient use of our resources.

Legal Requirements • Title VI Civil Rights Act 1964 “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance” • ADA Title III (American Disabilities Act) • LEP Executive Order 13166 issued in 2000 • CLAS Standards issued by OMH of US DHHS • Fairview System Language Access Policy

Legal Definitions • Limited English Proficient (LEP) individual: Any individual who cannot speak, read, write or understand the English language at a level that permits them to interact effectively with health care providers and social service agencies. • Deaf: Any individual who is unable to hear well enough to rely on his/her hearing and use it as a means of processing information. • Hard of Hearing: Any individual with a mild-to-moderate hearing loss. Or it can denote a deaf person who doesn't have/want any cultural affiliation with the Deaf community. Or both. The HOH dilemma: in some ways hearing, in some ways deaf, in others, neither.

System Policy for Fairview Language Services has a standard policy for working with Deaf, Hard of Hearing, and Limited English Proficiency (LEP) patients who require interpreters. Our expectation is that all locations in which we coordinate language services will follow this policy. This policy will be made available to you.

Fairview’s Expectations of Contracted Interpreters Ø Scheduling and Billing Ø Interpreter Worksheets Ø Punctuality and Preparedness Ø Competency Ø Enforcement of Expectations Ø Professional Behavior Ø Special Circumstances

Scheduling and Billing • A formal request from Fairview Language Services initiates an interpretation appointment. • All interpreter requests must be received and scheduled through a Fairview contracted interpreter agency. • If an interpreter is aware of an appointment at a Fairview facility for which an interpreter has not been requested, they should contact their agency before going to the appointment to ensure that another interpreter has not been authorized for the visit.

Interpreter Worksheets Must be accurate. • Reflect requested hours. If you need a time extension, call Fairview Language Services at (612) 273 -3780 option #2. • Document arrival and departure time accurately. Must be signed by staff person (front desk, nurse, doctor, etc. ) who can verify appointment took place. Must be turned in to the agency within ___ days to allow enough time for payment processing.

Punctuality & Preparedness • Must arrive on time. • Have the full name of person(s) they are to interpret. • Wear a contracted agency ID badge above the waist. • If an interpreter is running late they should first contact the clinic before the scheduled appointment time. If they do not have the number of the clinic, the interpreter must call Fairview’s Interpreter Services at (612) 273 -3780 option #2.

Competency • Demonstrate a high-level proficiency in reading, writing, and speaking English and the target language. • Have experience in medical interpreting that meets Fairview requirements. • Have knowledge of the NCIHC interpreter code of ethics and standards of practice. • Have basic knowledge of specialized terms and concepts used frequently in the provision of services.

Competency (Cont. ) • Have cultural awareness and competency related to population served. • Keep patient information private and confidential at all times. • Interpret exactly what the patient says to the provider and what the provider says to the patient without omitting or adding any information regardless of their history or knowledge with a patient’s particular case.

Professional Behavior • Dress in a professional manner. Revealing clothing and excessive perfumes or body odor is not acceptable. • Introduce their role as interpreters at the beginning of the encounter with patients and providers. • Focus on the task of interpreting. This means no side conversations, cell phone calls, text messaging. • Interpreter must in interpret in the first person (avoid, “He said” this, “She said” that).

Professional Behavior (Cont. ) • Maintain healthy boundaries with patients and staff. The interpreter is only with the patient when a provider or staff is present. The interpreter leaves the consult room when the nurse, physician, or other staff leaves. • Assist patients in checking in for appointments, scheduling future appointments, or arranging transportation. Never give patients a ride to an appointment. • An appointment should be selected based on the availability of the patient, not on the interpreter’s availability. Appointments should only be made with the clinic or hospital staff present or on the line.

Enforcement of Expectations • No show (without acceptable excuse) First no show: Final warning Second no show: Banning for one year from Fairview system • Tardiness (10 minutes or more after the scheduled time for the appointment) First tardiness: Warning Second tardiness: Final warning Third tardiness: Banning for one year from Fairview system • No name tag First time: Warning Second time: Final warning Third time: Banning for one year from Fairview system

Special circumstances • If for any reason, you are not comfortable with an appointment, please call your agency to excuse yourself. They will schedule a replacement. • If you want a time extension for your appointment, please call your agency. They will call Fairview Language Service to authorize that extension. • Forward requests to make you a permanent interpreter for a specific patient to your agency. • Please note that Fairview interpreters will fulfill as many appointments as possible which may limit the opportunity to have a permanent relationship with a particular patient. • Fairview reserves the right to request that you do NOT interpret for a particular patient.

Quality Control • All interpreters who are scheduled through Language Services must comply with all applicable rules, policies and procedures (including applicable Joint Commission standards) of Fairview as they exist at that time, provided the agency interpreter has been given specific notice (either written or oral) of such rules, policies and procedures. • Fairview Language Services collects reports about concerns with interpreters. These concerns may be ethical or a perceived lack of skills. Language Services’ department leadership will follow up on such concerns.

Health Requirements You must complete Fairview’s health screening requirements prior to accepting your first assignment at any Fairview facility. List of requirements: 1. Measles, mumps and rubella (MMR) 2. Varicella (chicken pox) 3. Tuberculosis (Details on the next slide) Recommended: Hepatitis B (series of 3 immunizations) In addition, Fairview will communicate additional expectations per disease outbreaks (e. g. HINI, Avian Flu, etc)

Tuberculosis • A negative 2 -step skin test (mantoux) is required within the 12 months prior to Fairview work assignment. Interpreters must participate in an annual tuberculosis screening program, for example, completing a symptom questionnaire every 12 months to indicate that you do not have symptoms of active TB. • Agency employees with a positive skin test must have a negative chest x-ray within 12 months prior to beginning of a Fairview work assignment. • If you have been exposed to a patient with active TB, you will be required to show proof of negative mantoux or chest x-ray prior to returning to Fairview facilities. You may bring a letter from your physician if repeat testing or x-ray is not medically indicated.

Agency Requirements • Background check-MDH • Primary source verification of credentials/certificates (ASL) • Language testing and competency evaluations • Agency must ensure interpreter is qualified and has met Fairview’s interpreter requirements

Patient Safety • All agency interpreters must complete Fairview’s annual required learning packet. Additional learning as required by Fairview. • The required learning packet contains important safety information. It also lists resources for interpreters to use. • Required learning packets are distributed to Agencies by June 20 th of each calendar year. Interpreter must sign off that they reviewed by December 31 st of each calendar year. Agencies will be required to submit the list of interpreters who met this requirement in excel or word document. • •

Your work makes a difference in the lives of our patients! Review of the literature: The use of untrained family members and friends to interpret has been associated with omissions, additions, substitutions, volunteered opinions, and semantic errors that can seriously distort translation (Ku & Weidmann, 2003). Interpreted emergency room (ED) patients received significantly more primary care and specialty clinic referrals; were more likely to follow-up in clinic; were less likely to return to the ED; and had the lowest charges from both clinic visits and ED returns (Bernstein, et al. , 2002). Language barriers are a major source of isolation and an obstacle to seeking health care and help for domestic violence for Latina and Asian immigrant women (Bauer, et al. , 2000). Language barriers can result in worse patient reports of satisfaction and quality of care measures, and may increase the likelihood that a patient would not return to the same institution for future care (Carrasquillo, et al. , 1999).

References & Resources • Fairview language access policy. • Fairview Emergency codes. • National Council on Interpreting in Health Care (www. ncihc. org). • Registry of Interpreters for the Deaf (RID) (www. rid. org). • Speaking Together (www. rwjf. org/applications/solicited/cfp. jsp? ID=19507). • Article: Professionalization of community interpreting (www. acebo. com/papers/profslzn. htm). • Joint Commission Standards Document (www. jointcommission. org/Standards). • Crossing the language chasm (www. hablamosjuntos. org/resources/pdf/Crossing_Language_Chasm. pdf). • Eliminating Language barriers from federal programs a report by the U. S. commission on civil rights (www. law. umaryland. edu/marshall/usccr/documents/towardequalaccess. pdf).

Questions? Comments? Thank you for your time!