Transcript Addressing Health Literacy in a Multilingual Population: A

Strengthening the
Healthcare Safety Net:
Language Access Services
at Unity Health Care, Inc.
Luis Padilla, MD, FAAFP
June 16, 2008
Unity Health Care, Inc
MISSION
Unity Health Care, Inc. offers a citywide network of
quality health and human services to the medically
underserved regardless of race, ethnic background
or ability to pay.
VISION
Unity Health Care, Inc. will become the preeminent
health care delivery system for the medically
underserved of Washington, DC and recognized by
them as the provider of choice.
www.unityhealthcare.org
Unity as a Community Health Center




More than 20 years experience in Washington, DC
Present in all
Columbia
8 Wards of the District of
Over 180 providers
Currently 32 service sites throughout DC including
Mobile Medical Units
 433,450 visits n 2007

Healthcare for DC inmates
Unity Health Care 2007
Total Users
80,803
Total Visits
433,450
2007
Working Poor, 69,565
(86%)
Uninsured,
Immigrants
Homeless
11,238
(14%)
Working Poor, 387,602
Uninsured,
Immigrants
Homeless
45,848
Unity Health Care Approach to LEP

Focus efforts at unified patient communication
through the triad of health literacy, cultural
competency, and limited English proficiency
(LEP)
 Active recruitment of bilingual and bicultural staff
 Diversity and cultural competency training
throughout the organization

Support its centers with resources to address LEP

Provide low literacy forms and materials
Unity Health Care’s

Upper Cardozo Health Center
Ward one Northwest DC

DC’s most ethnically and economically diverse ward

Most diverse center in Unity Health Care’s network
Over 17, 000 patients enrolled

Over 76,000 visits in 2007

Predominately non-English speaking patients 60%

Spanish and 10% Amharic

Low Literacy and Low English Proficiency (LEP) with
average reading level at third to fourth grade
Upper Cardozo: Services Offered
Primary and
Preventive Care
 Dental
 Social Services
 Pharmacy
 WIC

OB/GYN
 Mental Health
 Laboratory
 Specialty Care (HIV,
Pulmonary, Cardiology,
Ophthalmology,
Endocrinology,
Podiatry)

Where do our patients come from?
The Americas
Canada
Mexico
USA
Argentina
Bolivia
Brazil
Chile
Columbia
Ecuador
Guyana
Paraguay
Peru
Uruguay
Venezuela
Costa Rica
Cuba
Dominican
Republic
El Salvador
Guatemala
Haiti
Honduras
Jamaica
Nicaragua
Panama
Trinidad
Where do our patients come from?
Africa
Benin
Burkina Faso
Cameroon
Central African
Republic
Chad
Congo
Egypt
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Ivory Coast
Kenya
Liberia
Malawi
Mali
Mauritania
Morocco
Mozambique
Nigeria
Niger
Republic of
Guinea
Senegal
Sierra Leone
Somalia
South Africa
Sudan
Tanzania
Togo
Tunisia
Uganda
Where do our patients come from?
Asia, Europe , South Pacific, Middle East
Bangladesh
China
India
Korea
Laos
Mongolia
Nepal
Russia
Sri Lanka
Thailand
Turkey
Vietnam
Albania
England
France
Greece
Ireland
Italy
Poland
Spain
Australia
New Zeeland
Polynesia
Jordan
Iraq
Israel
Syria
Iran
Multilingual Staff

17 out of 19 primary care providers speak Spanish

Over 90% of support staff are bilingual or multilingual

Languages Spoken by Upper Cardozo Staff
Spanish
Tagalog
French
Farsi
Amharic
Tigrinya
Chinese
Vietnamese
How Our Patients Obtain Information
 Flyers
and Brochures
 Spanish
 Web
language prescription labels
based educational materials
 Point
of care internet access
 Language
Line
How Our Patients Obtain
Information

Oral instructions from bilingual staff after visits

Medline-Plus audio/video tutorials in Spanish

Community Partnerships
 Reach Out and Read

Clinic Color Guide
Forms and Signs

Written at a third to
fourth grade level

Color coded

Double sided bilingual

Printed in Amharic when
applicable
Point of Care Computer Access
Internet Access in
each exam room made
possible through a
NLM grant
 Web image searches
 MedlinePlus Tutorials
 Demonstration of
medications, dosing,
etc

Phone Interpretation Services



Language Line
Over 100 major
languages and dialects
available
Speaker phones
available in each exam
room
Reach Out and Read Program


National Program
designed to promote
early childhood
literacy
Literacy Promotion
and books are
encouraged at wellchild visits ages
6months-5 years
Clinic Color Guide
Future Initiatives

Computer Lab
 English Second Language skills building
 Computer skills development

Healthcare System Access Education
 Understanding health benefits
 Patient language access rights
 DC 2004 Language Act
Continued Challenges
 Resources
needed to expand and
provide language services to other
languages (Amharic, French, Chinese)
 Resources
and staff to assess how
patients process and degree they
understand information
Continued Challenges
 Increased
adherence to DC language
Act by other organizations (hospitals
and specialist offices)
 Resources to track changes and
outcomes
 Recruitment bilingual providers
 Recruitment bilingual nurses and case
managers
Email Contact
[email protected]