Health Unit Language Service Survey REPORT

Health Unit Language Service Survey REPORT Windsor-Essex County Health Unit Department of Epidemiology, Planning, Evaluation, and Quality vember 2015

Contents Contents... 2 Table of Figures... 3 Executive Summary... 4 Introduction... 5 Methodology... 5 Survey Results... 7 General Information... 7 Material Translation... 7 Verbal Translation... 12 Additional Information... 15 Conclusion... 16 Appendix 1. Email Distributed to MOHs... 17 Appendix 2. Fluid Survey Questions... 18 Appendix 3. Language Service Survey FAQs... 23 Appendix 4. Ontario Health Unit Regions... 25 2

Table of Figures Figure 1. Percentage of health units that provide translated materials (n=23)... 7 Figure 2. Health units that translate materials by region (n=23)... 8 Figure 3. Mode of translation (n=16)... 8 Figure 4. Number of languages for translation (n=16)... 9 Figure 5. Languages that materials are translated into (n=16)... 9 Figure 6. Types of translated materials (n=16)... 11 Figure 7. Basis for language of translation (n=16)... 11 Figure 8. Percentage of health units that provide translation services (n=23)... 12 Figure 9. Mode of translation (n=18)... 13 Figure 10. Designated French language positions (n=22)... 13 Figure 11. Designated French language positions by region... 14 Figure 12. Other designated language positions (n=23)... 15 3

Executive Summary On August 17, 2015 the Windsor-Essex County Health Unit (WECHU) invited all Ontario health units to complete an online survey to assess the ways in which client s language needs are being addressed. This survey is part of a larger project that will seek to direct the development of a WECHU-wide language service plan. The language service plan will include an outline of the delivery and implementation of language services offered at the health unit along with the identification of priority languages. As Windsor-Essex County s immigrant population continues to increase, the need for, impact, and use of a language service plan has been recognized as an important aspect to delivering public health services. Provision of public health services that will meet the needs of WECHU clients, including the francophone and immigrant populations, will require the development of a language service plan and related polices. Quantitative and qualitative approaches were used to gather information on language service delivery across Ontario health units. 23 of the 35 health units participated in the survey, resulting in a response rate of approximately 66%. The health units represented all 6 regions across Ontario. Respondent s positions ranged from the Medical Officer of Health, Director, Manager, and various administrative positions. The main themes are summarized as follows: Material Translation: The majority of health units indicated that they provide translated materials to their clients. The most commonly identified method of translation was external. Altogether, the respondents identified at least 12 different languages that materials are translated into. The most common language used for translation was French. Brochures, flyers, and leaflets were the types of materials most commonly translated. Community demographics were the most common basis for the language of translation. Most health units indicated that their website is exclusively English. Verbal Translation: The majority of respondents indicated that translation services are available to clients. Most respondents reported that at least two methods of translation are used (i.e., freelance translators and community services). The two most common identified translation methods were staff members and formal translation services. Most respondents indicated the presence of designated French language positions within their health unit. Other designated language positions such as a German language nurse were very rare among health units. Additional Information: Roughly half of the respondents indicated that translation services are budgeted. The majority of respondents indicated the development and implementation of a health unit wide language service plan, and half reported having formal policies and procedures surrounding language service. Open-ended comments focused primarily on the preferential hiring of bilingual staff. Others commented on the need to further expand their language service policies and procedures. The results presented throughout this report summarize the various ways that Ontario health units are addressing the language needs of their clients. These results may be used to guide future program planning and policy development. This report may be particularly useful when developing programs and policies surrounding language service. 4

Introduction The Windsor-Essex County Health Unit (WECHU) is currently undertaking an assessment to direct the development of a health unit-wide language service plan. The development of a language service plan will assist in ensuring services are provided in an equitable and culturally appropriate way for all community members. This type of plan will include an outline of the delivery and implementation of language services offered at the health unit along with the identification of priority languages. Developing a language service plan will also help to address various barriers to health care such as a delay in the quality of services provided, reduced access to health services, and a decrease in client service understanding and utilization. As Windsor-Essex County s immigrant and newcomer population continues to increase, there is a need to review the language priorities of WECHU clients. Provision of public health services that meet the needs of WECHU clients, including the francophone and immigrant populations, requires the development of a language service plan and related polices. This report provides a summary of the results from an Ontario health unit wide language service survey that was conducted by WECHU. As the survey results and analysis provide various important language service indications, they will be included within the larger scope of a language service project for WECHU. Methodology An online survey that sought to assess current language service practices was administered to all health units across Ontario. The aim of this survey was to gain a comprehensive overview of how Ontario health units are meeting the language needs of their clients by assessing the types and extent of language services that are currently being offered. The online survey was first disseminated via email by WECHU s Medical Officer of Health (MOH) and Chief Executive Officer (CEO), Dr. Gary Kirk. Dr. Kirk invited all MOHs across Ontario health units to participate in the survey. The MOHs were asked to forward the survey details to the most appropriate person(s) at their health unit to respond on behalf of their organization. Appendix 1 provides the email that was distributed to MOHs across Ontario health units. The email was sent on August 17, 2015 and respondents were given until September 11, 2015 to participate. Approximately two weeks after the survey invitation was distributed, a second invitation to participate in the survey was distributed to the Chronic Disease Managers and Epidemiologists at each health unit in order to bolster participation. At the end of survey distribution, a total of 23 of 35 health unit responses were received, resulting in a final response rate of approximately 66%. A PDF copy of the survey was attached to the email upon dissemination. Appendix 2 is a copy of the survey introduction along with all survey questions. The survey was developed using Fluid Surveys at www.fluidsurveys.com, allowing responses to be collected entirely online. 5

Appendix 3 is an FAQ informational sheet that was provided to all health units along with the survey details. Survey respondents could refer to the informational sheet to answer potential questions. The FAQs included: What is the purpose of this survey? What is the larger scope of this project? What is a language service plan and why are they important? What is a designated language position? Is participation in this survey mandatory? What is required of our health unit to take part in this study? Will responses be confidential and anonymous? Can I save the survey and continue later? The survey remained open for participation until September 25, 2015 to allow for late responses. At that time, the survey was set to closed and the results were screened for completeness and accuracy. Duplicate results were received for two health units. Two duplicate results were deleted based on the incompleteness of responses received. 6

Survey Results The following contains a detailed summary of the findings from the Ontario health unit-wide language services survey. This report presents general respondent information, along with material and verbal translation details. General Information Survey respondents were asked to indicate their position title. Various roles were held including the Medical Officer of Health, Director, or Manager, and other administrative positions. The 23 health units that participated in the survey represented all 6 health unit regions across Ontario. Appendix 4 displays all Ontario health unit regions. Material Translation Respondents were asked whether their health unit translates any materials into languages other than English. Seventy percent (n=16) of respondents indicated that their health unit does translate materials into other languages, while 30% (n=7) indicated they do not translate any materials into other languages (see Figure 1). Figure 1. Percentage of health units that provide translated materials (n=23) 30% 70% Figure 2 displays the differences in which health units translate materials by region. It is interesting to note that 5 out of the 6 health units that responded from the South West region indicated that their health unit does not translate any materials into languages other than English. 7

Number of Health Units Figure 2. Health units that translate materials by region (n=23) 6 5 4 3 2 1 0 Central East (n=4) Central West (n=5) Eastern (n=4) rth East (n=3) Health Unit Regions rth West (n=1) South West (n=6) Respondents who indicated that materials are translated into languages other than English were then asked to indicate what method of translation is utilized. The majority (75%, n=12) of respondents indicated that an external method of translation is solely utilized. Nineteen percent (n=3) indicated that both internal and external methods of translation are used, while one respondent indicated that their health unit only uses an internal method of translation. The mode of translation is presented in Figure 3. Figure 3. Mode of translation (n=16) Both internal and external External Internal 6% 19% 75% Respondents were then asked to indicate the number of languages that materials are translated into. Some respondents indicated that only one language is chosen for translation (37.5%, n=6). While other health units indicated that materials are translated into at least 10 8

Number of Health Units different languages (18.75%, n=3). The number of languages that materials are translated into is displayed in Figure 4. Figure 4. Number of languages for translation (n=16) 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 10 + Number of Languages Respondents were next asked to indicate what languages materials are translated into. In total, the health units indicated that materials are translated into at least 12 different languages. The most common language that materials are translated into was French (88%, n=14). Figure 5 displays all of the identified languages that are used for translation. Figure 5. Languages that materials are translated into (n=16) 14 10 4 6 2 3 2 6 5 5 2 4 9

Differences in the languages chosen for translation were noted by region. The most northern and southern regions (i.e., rth East, rth West, and South West) indicated the least number of languages chosen for translation. The Central East and Central West regions identified the highest number of languages that materials are translated into. These differences are indicated in Table 1. Table 1. Languages by region Central East Central West Eastern rth East rth West Arabic 2 1 1 - - - Cantonese 2 3 1 - - - French 3 3 3 3 1 1 Italian 2 - - - - - Korean 3 - - - - - Low German - 2 - - - - Mandarin 2 3 1 - - - Punjabi 2 2 1 - - - Spanish 1 3 1 - - - Tamil 2 - - - - - Vietnamese 3-1 - - - Other 5 6 - - 2 1 South West When asked to indicate the types of materials translated, the most common types were brochures, flyers, and leaflets (94%, n=15). Other common types included posters (75%, n=12) and advertisements (38%, n=6). Fewer health units indicated the translation of internal signage (25%, n=4) and external signage (25%, n=4), fact sheets (25%, n=4), videos (19%, n=3), and educational books (13%, n=2). The different types of materials that are translated at health units are displayed in Figure 6. 10

Figure 6. Types of translated materials (n=16) 15 12 11 6 2 4 4 4 3 Most health units (94%, n=15) indicated that they commonly use community demographics to determine which languages materials should be translated into. Other identified ways that health units decide on the language for translation include individual requests, stakeholder feedback, policy guidelines, and partner consultations. The basis for the language of translation is displayed in Figure 7. Figure 7. Basis for language of translation (n=16) 15 9 2 1 3 2 1 11

Health units were then asked to indicate whether their website is accessible in languages other than English. The majority (78%, n=18) indicated that their website is not accessible in other languages, while 22% (n=5) indicated that it is. Verbal Translation The next section of the survey asked respondents various questions about the availability of verbally translated services. Respondents were asked to report on the ways in which their health unit provides verbal translation. When asked to indicate whether their health unit provides translation services to their clients, the majority (78%, n=18) indicated that they do provide translation services, while 22% (n=5) indicated that their health unit does not provide translation services. The percentage of health units that provide translation services is displayed in Figure 8. Figure 8. Percentage of health units that provide translation services (n=23) 22% 78% When asked to report on the ways in which their health unit translates services for their clients, the majority of respondents (78%, n=14) indicated that two or more methods are used. The most common method of translation was a staff member (i.e., internal employees) (72%, n=13). The second most common method was a formal translation service (i.e., third party organization) (56%, n=10). All methods of translation are displayed in Figure 9. 12

Figure 9. Mode of translation (n=18) 13 10 4 1 7 2 5 Respondents were then asked to report on whether their health unit has designated French language positions. A designated French language position was defined in the survey as a position that requires proficiency in both English and French. Seventy-three percent (n=16) indicated that their health unit does not have designated French language positions, while 27% (n=6) indicated that their health unit does have designated French language positions. For further clarification, a more detailed explanation of a designated language position was provided within the FAQ informational sheet that is presented in Appendix 3. The percentage of health units who have designated French language positions can be found in Figure 10. Figure 10. Designated French language positions (n=22) 27% 73% 13

Number of Health Units Regional differences in the presence of designated French language positions were identified. All responding health units from the Central West, South West, and rth West regions indicated that they do not have any designated French language positions at their health unit. These differences are displayed in Figure 11. Figure 11. Designated French language positions by region 7 6 5 4 3 2 1 0 Central East (n=4) Central West (n=5) Eastern (n=4) rth East (n=3) Health Unit Regions rth West (n=1) South West (n=6) Respondents were next asked to indicate the areas for which the designated French language positions exist within their health unit. The number of positions and title within each department was also requested. Health units indicated the presence of French language designated positions within the departments of Family Health, Dental Health, Healthy Living, Immunization, Sexual Health, School Health, Injury Prevention, Environmental Health, and Healthy Babies/Healthy Children. The most commonly reported designated French language position was a Public Health Nurse. Other popular designated French language positions included Office Assistants, AIDS and Sexual Health Counsellors, and Dental Hygienists. One health unit reported having a total of 240 designated French language positions. These positions were designated as either day one ready or designated only. Day one ready refers to positions in which the staff member must be proficient in French as soon as they start working in the position while designated only means the staff member must work toward the language level as outlined in the job description. The majority of respondents (91%, n=21) indicated that their health unit does not have any other designated language positions, such as a German language nurse. Figure 12 presents the percentage of health units with the presence of other designated language positions. 14

Figure 12. Other designated language positions (n=23) 9% 91% Two health units reported the presence of other designated language positions. One health unit indicated that they provide services in over 28 different languages across numerous positions (e.g., Community Nutrition Educators, Community Oral Health Outreach Workers, and Family Home Visitors), while the other indicated the presence of a single Low German Immigrant Advocate. All designated language positions were reported to be in three departments including Family Health, Dental Health, and Healthy Babies/Healthy Children. Additional Information Respondents were then asked to indicate whether their health unit includes translation services within their budget. Fifty-five percent (n=12) indicated that translation services are budgeted while 45% (n=10) indicated that translation services are not budgeted. When asked to report on whether their health unit has a language service plan, 73% (n=16) indicated the presence of a language service plan, while 27% (n=6) did not have a language service plan. A language service plan was further described within the FAQ informational sheet that is presented in Appendix 3. Respondents were then asked to indicate whether their health unit has created formal policies and procedures regarding language service. Whether health units have formal policies and procedures surrounding language service plans was split with half of the health units having policies and procedures in place and the other half not having any. Ten respondents provided open-ended comments. Comments largely surrounded the preferential hiring of bilingual staff and the need to further expand their language service policies and procedures. Others commented on the use of translation and interpretation services in addition to what is included in their pre-existing, fully developed policies. 15

Conclusion This report has provided a summary of the results from the Ontario health unit-wide language service survey. Many health units participated in the survey, contributing valuable information that will assist in guiding the development of future policy and programing at WECHU. The next step toward quality improvement includes the development of a language service plan and related policies. These results will be taken into consideration along with other research to guide health unit planning and policy implementation. The main findings indicate that Ontario health units recognize the importance of meeting the unique needs of francophone communities and others who lack English language proficiency. To summarize, the survey results indicate the following: The majority of respondents indicated the presence of a language service plan at their health unit. Many respondents also indicated that the clients at their health unit have access to translated materials such as brochures, flyers, and leaflets. Community demographics are used most often to decide on the language for translation. The most common language that materials are translated into is French. In regard to verbal communication, the majority of respondents also indicated that their clients have access to verbal translation services. Most health units use at least two methods of translation such as a third party organization and freelance translators. Staff were most commonly used to provide translation for clients. Many health units identified the presence of designated French language positions within their health unit. Most health units did not have any other designated language positions. Roughly half of the respondents indicated that their health unit includes translation services within their budget. Those who reported having formal policies and procedures surrounding language service was evenly split among the responding health units. One area where health units are potentially failing to meet the language needs of their clients is through their online resources, as the majority of respondents indicated that their website is only available in English. The results presented throughout this report summarize the various ways that Ontario health units are addressing the language needs of their clients. These results may be used to guide future program planning and policy development. This report may be particularly useful when developing programs and policies surrounding language service and translation. 16

Appendix 1. Email Distributed to MOHs Dear Colleagues, The Windsor-Essex County Health Unit is currently undertaking an assessment to direct the development of a health unit wide language service plan. As part of this work, we would like to obtain an accurate representation of current language service practices across Ontario health units. The following survey covers topics that range from material translation, verbal translation and language service policies and procedures. Please forward this email to the most appropriate person(s) at your health unit for completion and Cc jlangeman@wechu.org in the email. We would like to receive one survey submission per health unit. The due date for survey submission is: Friday, September 11th. Upon analysis, survey results will be distributed to all Health Units. Please find attached a PDF of the survey along with an informational FAQ document for your reference. For any additional questions or concerns, please contact Jennifer Langeman via e-mail at jlangeman@wechu.org or telephone at 519-258-2146 ext. 1327. Health Unit Language Service Survey: http://fluidsurveys.com/s/health-unit-languageservice-survey/ Thank you for agreeing to take part in this important survey. Your time is greatly appreciated. Regards, Gary 17

Appendix 2. Fluid Survey Questions *te: The online survey format allowed for branching; the tailoring of question presentation based on the specific responses received. The paper copy of survey does not show the survey s branching logic. For this reason, it is possible that not all survey questions were applicable to the respondent. The use of Fluid Surveys took this into consideration. Health Unit Language Service Survey Welcome to the Health Unit Language Service Survey! Thank you for agreeing to take part in this important survey measuring the language services offered across Ontario health units. The Windsor-Essex County Health Unit is conducting this survey to gain a better understanding of language services offered throughout Ontario. We are requesting one survey submission per health unit. Survey results will be analyzed and compiled into a final report summarizing the need for, impact, and use of language service plans throughout health and social services. The survey results will be combined with other research methods to develop future recommendations for the Windsor-Essex County Health Unit in the area of language service. When referring to language service plans throughout this survey, we are describing in part (or in full) an outline of the delivery and implementation of language services. This plan may identify priority language areas along with programs and services offered in languages other than English. Should you have any questions, comments or concerns regarding this survey or the larger scope of this project, please feel free to contact Jennifer Langeman via e-mail at jlangeman@wechu.org or telephone at 519-258-2146 ext. 1327. This survey should only take 5-10 minutes to complete. Please be assured that all of your answers will be kept confidential. Please click Next to proceed. General Information What health unit do you represent? Health units are listed alphabetically Brant County Health Unit Chatham-Kent Health Unit City of Hamilton Health Unit City of Ottawa Health Unit City of Toronto Health Unit Durham Regional Health Unit Elgin-St. Thomas Health Unit Grey Bruce Health Unit Haldimand-rfolk Health Unit Haliburton, Kawartha, Pine Ridge District Health Unit... 16 additional choices hidden... Sudbury and District Health Unit The District of Algoma Health Unit The Eastern Ontario Health Unit 18

Thunder Bay District Health Unit Timiskaming Health Unit Waterloo Health Unit Wellington-Dufferin-Guelph Health Unit Windsor-Essex County Health Unit York Regional Health Unit What region does your health unit service? What is your title and which department do you work in? Material Translation Does your health unit translate any materials into languages other than English? What method of translation is utilized? Internal External Both internal and external Other than English, how many languages are materials translated into? 1 2 3 4 Other, please specify... What language(s) are materials translated into? (select all that apply) French Italian Mandarin Cantonese Spanish Punjabi Other, please specify... What types of materials are translated into other languages? (select all that apply) 19

Internal Signage External Signage Advertisements Brochures, flyers or leaflets Posters Videos Other, please specify... How does your health unit decide on the language(s) for translation? (select all that apply) One-on-one interviews with clients Group interviews with clients Personal phone calls to clients Surveying clients Information obtained on client records Community demographics Other, please specify... Is your health unit's website accessible in other languages? Verbal Translation Does your health unit provide translation services to their clients? How are services translated for clients? (select all that apply) Formal translation services (i.e., third party organization) Freelance translators (i.e., self-employed translators) Computer assisted translation (i.e., computer software used for translation) Machine translation (i.e., use of device for translation) Staff (i.e., internal employees) Family members (i.e., of those who do not speak English) Community services (i.e., Multicultural Council) Other, please specify... Does your health unit have designated French language positions? (i.e., French Language Nurse) 20

Please indicate the areas for which designated French language positions exist and include the number of positions and title within each department. (i.e., 2 French Language Nurses). If areas are missing, please select the "other" option. Designated French language positions refer to those that require proficiency in both English and French. Family Health Dental Health Healthy Living Immunization Infection Prevention and Control Sexual Health School Health Injury Prevention Chronic Disease Environmental Health Emergency Prevention Healthy Babies/Healthy Children Other, please specify... Besides French, does your health unit have other designated language positions? (i.e., German Language Nurse), please specify the language(s) and position(s)... Please indicate the areas for which other designated language positions exist and include the number of positions and title within each department. (i.e., 2 German Language Nurses). If areas are missing, please select the "other" option. Designated language positions refer to those that require proficiency in language(s) other than English. Family Health Dental Health Healthy Living Immunization Infection Prevention and Control Sexual Health School Health Injury Prevention Chronic Disease Environmental Health Emergency Prevention Healthy Babies/Healthy Children Other, please specify... 21

Additional Information Are translation services budgeted? Does your health unit have a language service plan? Does your health unit have formal policies and procedures surrounding language service? Are you willing to be contacted to share your policies and procedures? Please provide your e-mail for follow-up. Do you have any additional comments? 22

Appendix 3. Language Service Survey FAQs Q1: What is the purpose of this survey? This survey seeks to gain an accurate representation of current language service practices across Ontario health units. Survey topics range from material translation, verbal translation and language service policies and procedures. Survey questions seek to aid in the identification of if and how Ontario health units provide language services to their clients. Q2: What is the larger scope of this project? Survey results will be analyzed and compiled into a final report summarizing the need for, impact, and use of language service plans throughout health and social services. The survey results will be combined with other research methods to develop future recommendations for the Windsor-Essex County Health Unit in the area of language service. Survey analysis will provide pertinent information that will direct the development of a health unit wide language service plan. The development of a language service plan will assist in addressing various barriers to health care, ensuring equal access to quality care. Q3: What is a language service plan and why are they important? When referring to language service plans throughout this survey, we are describing in part (or in full) an outline of the delivery and implementation of language services. This plan may identify priority language areas along with programs and services that are offered in languages other than English. Language barriers in health care are associated with various negative implications such as a delay in the quality of services provided, a decrease in the access to health services and diminished client understanding and service utilization. A language service plan seeks to address these barriers to health care, increasing the scope of services provided and ensuring equal access for all. Q4: What is a designated language position? When referring to designated language positions throughout this survey, we are describing specific positions within your health unit that require proficiency in language(s) other than English. Proficiency in language(s) other than English must be a required qualification in order for the position to be considered designated language. Q5: Is participation in this survey mandatory? Participation in this survey is completely voluntary, without any penalty for choosing not to participate. However, should you choose to participate, please ensure the survey is completed by Friday, September 11th, as data analysis will commence following this date. Q6: What is required of our health unit to take part in this study? We would like to receive one survey submission per health unit. Survey completion may only require the attention of one staff member. However, input from multiple staff 23

members may be necessary for the answering of some questions that require detailed information. If willing, follow up may be required during data analysis to obtain additional information and consultation. A PDF document version of the survey has been provided to assist with the ease of survey completion. Feel free to share survey questions with your colleagues to ensure response accuracy. Please note that the branching logic of the survey is not indicated on the PDF version and thus, it is possible that not all questions will be applicable to your health unit. Q7: Will responses be confidential and anonymous? All survey responses will be kept confidential and anonymous. Survey results will be anonymously reported, providing a broad representation of language services provided throughout Ontario public health units. Q8: Can I save the survey and continue later?, a save and continue later button is located on the bottom of each page of the survey. At any point during survey completion, you can stop working on the survey, save the information that was entered and complete it at a later time. This function may require usage if collaboration among colleagues is required when answering questions. 24

Appendix 4. Ontario Health Unit Regions Source: Association of Local Public Health Agencies. (2014). Public Health Units. Retrieved from http://www.alphaweb.org/?page=phu 25

Windsor-Essex County Health Unit Department of Epidemiology, Planning, Evaluation, and Quality 1005 Ouellette Avenue Windsor, Ontario N9A 4J8 www.wechu.org 519-258-2146 Windsor-Essex County Health Unit, vember 2015.