- LEP Case and Discussion
- Article: Pay Now or Pay Later, Health Affairs, 2005
- Language Barriers to Health Care in the US, Flores NEJM 2006
Take-home points in working with LEP families:
- 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.
- 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.
- 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.
- 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.
- 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!