2019-20 TOW #12: Working with Limited English Proficiency (LEP) families

As we work with our increasingly wonderfully diverse families in Seattle, we have an imperative to be knowledgeable in navigating visits with families who do not speak English as their primary language. One of our very talented gen peds faculty, Casey Lion MD MPH, has developed this TOW to share her expertise and research in working with families with Limited English Proficiency (LEP). Here are the resources for this week:

Take-home points in working with LEP families:

  1. How many children have an LEP parents? In the US 15% of children live with at least 1 parent who has LEP; it’s much higher in some areas, and growing everywhere.
  2. How do language barriers affect care? Language barriers are associated with decreased adherence, comprehension, and satisfaction with care, as well as poorer outcomes and increased adverse events. Research by Dr. Lion and team has found that interpreter use improves discharge communication in our own institution. Families with LEP are at risk for inequity. It is our responsibility to try to decrease that risk and prevent errors by using certified interpreters.
  3. What is the legal requirement for interpretation in medical care? Under Title VI of the Civil Rights Act of 1964, federal law requires providers or institutions that receive any federal dollars (including Medicaid, Medicare) to provide medical care in a language patients understand. The rule applies to nearly every hospital and private group in the country. Under the Culturally and Linguistically Appropriate Care (CLAS) Standards, we are legally required to provide professional interpretation.
  4. How do we know when an interpreter is needed? To determine if a patient or caregiver needs an interpreter, ask what language they prefer for discussing medical information. If they want to use a family member or friend to interpret, one way to approach this is to say: “I am so sorry—hospital policy requires me to use a professional interpreter.” Teach-back is an excellent strategy to use to assess for parent or patient understanding.
  5. What type of interpreter form is best? Patients and families tend to report similar satisfaction with in-person, telephone, and video interpretation, while providers tend to prefer in-person and video interpretation. Dr. Lion’s research found video interpreting  in the ED was associated with parents’ improved understanding of the diagnosis and fewer lapses in communication, though there were higher costs for video use. The bottom line is that all modalities can be effective; most important is that we use them.

Enjoy getting to work with families from all over the world!

2019-20 TOW #11: The Medical Home & Children with Special Needs

Among the most fulfilling aspects of primary care is longitudinal relationships with families and addressing comprehensive, holistic needs over time. There is a growing body of data on the health benefits of medical homes, especially for children with special health care needs, and also for typically developing children.

Materials for this week:

Take-home points:

  1. What are the principles and goals of a “medical home”? The “medical home” (or  “health care home” to encompass health maintenance and health promotion) is a model promoted by national agencies including the AAP to provide comprehensive, family-centered, community-based care for patients, especially Children with Special Health Care Needs (CSHCN). The medical home model seeks to provide care that is accessiblefamily-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective. A key part is to overcome barriers of fragmented services and provide care that is proactive, not always reactive.
  2. How many qualify as “Children with Special Health Care Needs (CSHCN)? Large population-based surveys estimate that 13% to 20% of children and youth meet the definition of CSHCN, as defined by parent report. This is probably an underestimate, and many children have two or more conditions.
  3. How does socioeconomic status affect prevalence of CSHCN? Unfortunately, there remain large inequities in chronic health conditions, access to health care services, and unmet specialty care needs based on social determinants of health. National data indicate higher odds for special needs among children living in poverty.
  4. Who should be involved within a medical home? Being an effective medical home requires a team approach. The primary care physician often develops the plan of care, with implementation and coordination managed by nurses, care coordinators, social workers, and the family. Collaboration with school nurses, visiting nurses, and home health aides is also crucial.
  5. What does a care plan include? One of the recommended strategies to help coordinate services for CSHCN is to develop care plans. Suggested care plan components include diagnoses/problem list, care team contact information, patient and family strengths and challenges, prior surgeries and/or procedures, recent lab and other diagnostic studies, assistive technology, and patient and family goals.