Language & Cultural Competency in the Clinic

Transcription

1 Language & Cultural Competency in the Clinic Establishing a trained volunteer interpreter program for NYC free clinics Oz Hasbún Avalos Diverse Medical Scholars Program United Health Foundation/National Medical Fellowships

2 Do you know the difference between an interpreter and a translator?

3 Translation Interpretation Translation involves written language while interpretation involves spoken language.

4 What is an Interpreter? A bilingual or multilingual individual trained in techniques and practices that facilitate communication between two individuals who speak different languages. Why is training required? The literature shows that untrained interpreters commit errors of interpretation at a substantially higher rate than trained ones. Among these are 5 categorical errors.

5 Omission (52%): Not interpreting a word/phrase uttered by the clinician or patient. False Fluency (16%): Using an incorrect word/phrase or words/phrase that does not exist in that particular language. Substitution (13%): Substituting a word/phrase for a different word/phrase than one uttered. Editorialization (10%): Interpreter provided his/her own personal views as the interpretation of a word/phrase uttered. Addition (8%): Interpreter added a word/phrase that was not uttered.

6 One study found: 63% of all errors had potential clinical consequences; mean of 19 per encounter. Errors committed by ad hoc [untrained] interpreters were significantly more likely to be errors of potential clinical consequence. Flores, Glenn, et al. "Errors in medical interpretation and their potential clinical consequences in pediatric encounters." Pediatrics (2003): 6-14.

7 Columbia-Harlem Homeless Medical Partnership (CHHMP) CHHMP was established in 2004 by first-year medical students seeking to address the healthcare needs of the homeless population of Upper Manhattan. In partnership with the Center for Family and Community Medicine (CFCM), CHHMP opened its doors in May 2007 in the basement of St. Mary s Episcopal Church on 126 th Street and Old Broadway. Since its establishment, CHHMP has grown dramatically now even offering dental care, occupational therapy, and (soon) physical therapy on site. Along with expansion of services, CHHMP has seen an evolution in patients served. Now, only about 47% of CHHMP s patients are homeless. Most patients are uninsured/uninsurable. About 30% of CHHMP s patients are Limited English Proficiency (LEP), with the majority being Spanish speakers. Currently, CHHMP does not have any trained interpreters on site and relies solely on a handful of bilingual staff members for provision of care and ad hoc interpretation.

8 Intervention Approach: 1. Recruit pre-medical undergraduate students to become volunteer interpreters at CHHMP (clinic). 2. Develop a training for volunteers based on recently published novel volunteer interpreter training program * and adapt to fit NYC healthcare system regulations/considerations. 3. Use findings and result to expand training to other clinics/community health centers in NYC. * Hasbún Avalos O, Pennington K, Osterberg L, "Revolutionizing Volunteer Interpreter Services: An Evaluation of an Innovative Medical Interpreter Education Program." Journal of General Internal Medicine (2013):

9 Designing the Program, Part I Medical Terminology Cultural Brokering; Healthcare in US Managing Flow & Interpreter Etiquette Roles of Interpreter & Conduit Role 1 st Half Note- Taking, Memory Dev. Modes of Interpretation Code of Ethics

10 Designing the Program, Part II Reflections Peer Assessments Language Labs 2 nd Half Individualized Coaching Interpreting Shifts Shadowing Shifts

11 Timeline 1 st Half of Program 2 nd Half of Program Sept Oct Nov Dec Jan Feb Mar Theory-Driven Instruction Practicum-Driven Instruction

12 Future Considerations Implementing the program at CHHMP, one of Manhattan s many free/reduced-cost clinics working to reduce health disparities, means that the program can serve as a model for the other clinics with similar infrastructures and regulations. After the program is successfully implemented in NYC (at CHHMP) and re- evaluated and compared with the initial pilot site (in California), other CHCs in NYC can incorporate the trained volunteer interpreter model into their own clinics and thereby increase the quality of care for LEP patients in NYC at an even larger scale. Each clinic site that begins offering qualified interpreter services means an increase in quality of care for hundreds of patients!

13 Acknowledgements United Health Foundation/National Medical Fellowship s Diverse Medical Scholars Program Brick Church Grant Dr. James Spears, MD, CHHMP Medical Director Ricardo Bustamante, Interpreter Trainer Megan Rigney, Pre-Medical Advisor, Columbia University Pre- Medical Organization Undergraduate volunteers!