1. Working with Interpreters to
Improve Access to Care for the
Limited Proficient Patients.
Julia Sosa, MS, RD
Office of Minority Health
November 10, 2011

2. Why Cultural and Linguistic
Competence?
• Changing Demographics
• Health Disparities
• ADPH provides the preventive and primary care
services that are essential to decreasing health
disparities
• Improving access to services of the Health
Department improves the health of our
community

3. Civil Rights Title VI
• Title Vi of the Civil Rights Act
• 1964
• Prohibits discrimination
“No person in the US shall, on ground of race,
color, or national origin, be excluded from
participation in, be denied the benefits of, or
be subjected to discrimination under any
program or activity receiving Federal financial
assistance

4. National CLAS Standards
Culturally and
Linguistically
Appropriate
Services in Health Care
Recognizing the impact of language and cultural values on
access to health care, the Office of Minority Health was
mandated by Congress to design and develop initiatives to
eliminate barriers and to promote access to health care for
Limited English Proficient persons.
© 2003 Kaiser Permanente, National Diversity - National Linguistic & Cultural Programs

5. CLAS
1
Culturally Competent 6
Care 11
Qualifications for Bilingual Collection of Data
and Interpreter Services on Communities
2
Staff Diversity
7 12
Translated Materials Community Partnerships
for CLAS
3
Staff Education
and Training 8
Organizational Framework for
Cultural Competence 13
Complaint and Grievance
4 Resolution
Qualified Language 9
Assistance Services
Organizational
Self-Assessment
14
Information for
5 the Public
Notices to Patients of the 10
Right to Language Collection of Data
Assistance Services on Individual Patients

6. Communication
• Communication is more than just words. Cultures have a
variety of norms that influence the non verbal aspects of
getting the message across.
• The purpose of communication is culturally defined.
• Facial expression and eye contact are learned behaviors and are
unconscious.
• Whom and how we touch is culturally prescribed.
• Not talking is also culturally prescribed.
Manging Diversity by Lee
Gardenswart and Anita

7. Ways of Communication When
Language Barriers
• Non Verbal communication
• Facial expressions
• Voice intonation
• Emotional responses
• Eye Contact
• Touching
• Smile

8. Tips for Working With People Who Speak
Another Language
• Do not think that people who are struggling with
English are stupid
• Learn greetings, titles of respect, and attitude
toward touching
• Write numbers down when giving instructions
• Ask questions in several different ways
• Be friendly, accepting and approaching
“ Everybody relates to a smile”

9. How should a provider offer oral
interpretation services?
• Various options for language assistance
• Use of bilingual staff
• Staff interpreters
• Contracting for interpreters
• Telephone interpreter lines
• Community volunteers

10. Modes of Interpretation
• Simultaneous
• Is real time interpreting. Speaker talks and
interpreter listens and reproduces in another
language. All this occurs at the same time.
• Consecutive
• Involves a pause between language
conversations: interpreter listens to the entire
original phrase or passage, then the interpreter
says it in another language.

11. Working Effectively with Interpreters
• Speak directly to the patient
• Consider interpreter positioning
• Be attentive to the pace of your interpreter
• Avoid medical jargon
• Check for understanding

12. Speak directly to the patient
• Due to language barrier, it is easy to feel like you
are carrying on a conversation with the
interpreter
• Look at the patient/parent when you speak and
when they speak
• Address the patient/parent directly as “You”, not
“Tell her that…”

13. Use of Body Language
Your care for the patient and their family
transcends language barriers.
• Eye contact
• Pat on the shoulder
• Smile
• Show of concern
If you are not sure what is appropriate, ask.

14. Risks of Not Using
Language Services
No way of knowing quality of
interpretation provided by children,
family members, friends, Internet
translators

15. It Is Going To Take A Team Effort!

16. Contact Information
• Julia Sosa, MS, RD
Assistant Director Office of Minority Health
The RSA Tower, Suite 710
201 Monroe St
Montgomery, AL 36104
(334) 206-3812
julia.sosa@adph.state.al.us