Archive - Report

The California Endowment National Convening on
Language Access Issues in Health Care

Washington, D.C.
July 9, 2002

Background on National Convening on Language Access

Jai Lee Wong, Senior Program Officer, and Alice Hm Chen, Health Policy Scholar in Residence, provided an overview of The California Endowment (TCE) and its work on issues of language access in health.

The California Endwoment (TCE) was established in 1996 as a result of the conversion of Blue Cross of California from a not-for-profit to a for-profit organization. TCE’s mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. Today, it is the largest health foundation in California and the tenth largest foundation in the U.S. In its fiscal year ending February 2001, TCE awarded nearly 700 grants totaling over $191 million. TCE currently has four strategic priority areas: 1) increasing access to health care, 2) reducing health disparities, 3) increasing cultural competence and 4) increasing diversity in the health workforce. Language access issues are part of the cultural competence priority.

In October 1999, TCE convened a consultation in California to examine issues of language access in health care. Participants at that convening made recommendations for funding to TCE in the areas of research, training of interpreters, interpreter training curricula, interpreter standards and certification, and public policy and advocacy. TCE has followed many of the recommendations from that convening, and beginning in early 2000, has awarded over $10 million in grants on language access issues (see list of grants in appendix).

TCE’s first set of grants focused on building the capacity for interpretation and translation services, using three approaches: training and curricula development, policy and systems change and applied research. The applied research project at California State University Long Beach is ongoing, examining whether trained interpreters makes a difference in the accuracy of provider and patient communications and in patient satisfaction among Spanish-speaking women with gestational diabetes.

One training and curricula development project is documenting and replicating the medical interpretation training program developed by the City College of San Francisco and Kaiser Permanente. The program has now begun at two other community colleges in California, Mt. San Antonio and Reedley College. The other training and curricula development project is a collaborative of five community-based interpreter training programs: Asian Health Services, Pacific Asian Language Services (PALS) for Health, Healthy House, Clinicas de Salud del Pueblo and Vista Community Clinic. This collaborative also is documenting a core curriculum based on common training components.

One policy and systems change project is a capacity-building grant to the California Healthcare Interpreters Association (CHIA). CHIA now has four chapters with about 350 members and is now conducting annual statewide conferences. CHIA also is developing standards for interpreters. The other policy and systems change project is a collaborative led by the Asian and Pacific Islander American Health Forum with its partners the National Health Law Program, the California Primary Care Association, the California Pan-Ethnic Health Network, the Latino Coalition for a Healthy California, the Asian Pacific American Legal Center and the Fresno Health Consumer Center of Central California Legal Services. This collaborative has been very active advocating for policy developments on cultural and linguistic issues both in California and at the federal level.

After the significant federal policy developments on language access issues in 2000, there was a significant increase in interest in these issues, especially among providers. In June 2001, TCE held another convening on language access issues, inviting providers, health care administrators and state and local government. TCE also invited presenters who had implemented innovative language assistance services programs in other states. Participants at that convening expressed interest in addressing language access issues but wanted more data, wanted technical assistance and wanted funding to implement their own ideas to increase language access within their systems.

As a result of the recommendations from that convening, TCE funded another set of projects. Kaiser Permanente, the Alameda Alliance for Health and L.A. Care are working together to examine a number of research questions, including comparing trained versus untrained interpreters, different written translation processes and measuring the bilingual proficiency of providers. And although it is outside of California, TCE is funding the New York University School of Medicine to compare a remote simultaneous medical interpretation program with face-to-face interpreters. This was a unique opportunity for evaluation of an innovative language assistance service as it was being implemented.

In the area of policy and systems change, TCE is funding a number of health care systems, including L.A. Care, Scripps Health and St. Joseph Health System, to conduct needs assessments, develop internal policies and procedures, implement training programs and conduct monitoring activities that increase language access within their systems. TCE also has established a Medical Leadership Council on Language Access, with 25 physician associations, medical societies and health care systems, led by the California Academy of Family Physicians. The Council will meet to address language access issues from a provider perspective.

Finally, TCE is supporting the development of a number of products that will provide technical assistance to providers interested in language access issues, including inventories of interpreter services and interpreter training programs in California, an annotated research bibliography on language access issues, an update to the National Health Law Program’s manual on legal issues under Title VI, a policy brief on financing and an analysis of languages spoken and linguistic isolation from Census 2000 data.

As TCE continues to support work on language access issues in California, it is evident that many critical policy decisions take place at the federal level. In fact, California and Washington, D.C.-based organizations have worked together to advocate for the significant policy developments that have taken place in the past few years on language access issues. Accordingly, TCE convened this national consultation on language access issues to receive direct input and recommendations from some of the key national organizations that have been involved in these issues. Other national organizations that have an interest in these issues also were invited to broaden the discussion. The goals of the national convening were:

Overview of National Issues of Language Access in Health Care

Tom Perez, Director of the Clinical Law Program at the University of Maryland School of Law and former Director of the Office of Civil Rights at the U.S. Department of Health and Human Services presented an overview of national issues regarding language access in health care.

Tom Perez, Facilitator; Marcela Urrutia, National Council of La Raza; Mara Youdelman, National Health Law Program and Gabrielle Lessard, National Immigration Law Center

Tom Perez, Facilitator; Marcela Urrutia, National Council of La Raza;
Mara Youdelman, National Health Law Program and Gabrielle Lessard, National Immigration Law Center

There has been critical leadership on these issues of language access in health from The California Endowment (TCE), especially from Jai Lee Wong and TCE Chief Executive Officer Dr. Bob Ross and from the federal government, led by persons such as Maria Echaveste, the Assistant to the President and Deputy Chief of Staff for President Bill Clinton.

Title VI of the Civil Rights Act has been the law since 1964. Duval Patrick, former Assistant Attorney General for Civil Rights called Title VI the sleeping giant of civil rights laws because it applies to all recipients of federal dollars. Yet health providers and others subject to the law were at a disadvantage not because they did not want to comply with the law but did not know how. The process begun by Executive Order 13166 and the many Title VI policy guidances that have now been issued by federal agencies provide that guidance. These guidances were complemented by the efforts of the Department of Health and Human Services (DHHS) Office of Minority Health on the Culturally and Linguistically Appropriate Services (CLAS) standards, published in December 2000. It is important to view language access as a part of the broader issue of cultural competence.

The key issue is: how do we ensure that people who do not speak English fluently access health care and other services? But we may need to frame the issue differently for different audiences: sometimes, as an issue of reducing racial and ethnic health disparities, sometimes as reducing medical errors and sometimes as an issue of quality improvement. It is important to involve the "unusual suspects" – other stakeholders such as the business community, health care purchasers – in our discussions.

There are some significant challenges ahead. There has been some organized opposition to the Executive Order and the policy guidances, especially from the American Medical Association, other physician organizations and some members of Congress. Much of that opposition has focused on the need for financing for language assistance services. A "Pro-English" organization also has filed a lawsuit seeking to overturn Executive Order 13166. And the United States Supreme Court’s April 2001 decision in Alexander v. Sandoval eliminated a private right of action under Title VI, putting more pressure on the federal government to enforce Title VI.

Fortunately, the Bush Administration has continued to support and move forward with the implementation of Executive Order 13166. While there may yet be some weakening of the policy guidances and more centralization under the Department of Justice, there continues to be a commitment to enforce Title VI. And while the March 2002 Office of Management and Budget (OMB) report on Executive Order 13166 may not be a definitive analysis of the actual costs and benefits of implementation, at least it acknowledged the underlying authority of Title VI and that there were significant costs from not complying with Title VI. The limitations of the OMB report highlight the need for "evidence-based advocacy" and more research and data on these issues.

In summary, there are the following critical issues at the national level when it comes to language access in health care:

As a final note, as a result of the initial investments of TCE in these issues, other foundations have also begun to recognize that these are issues they should be involved in, such as the Robert Wood Johnson Foundation, with its Hablamos Juntos initiative, and The Commonwealth Fund, with several recent reports on language access.

Organizational Introductions

Representatives of each participating organization then introduced themselves and briefly discussed the work the organization had done on language access issues (reorganized in alphabetical order). Supplemental material from pre-convening questionnaires and organizational internet websites also have been incorporated.

Advocacy Initiatives for Grassroots Advocates (AIGA)

AIGA, the word for "family" in the Samoan language and the acronym for Advocate Initiatives for Grassroots Access is a nonprofit organization committed to the active promotion and preservation of the languages and culture of Pacific Islanders for future generations. AIGA advocates at the national, state, and local levels, and in public as well as private sectors for the establishment of effective change to improve and enhance the quality of life for Pacific Islanders residing in the United States and in the U.S. Territories.

For Pacific Islanders, language access issues are part of issues of access in general, along with cultural competence. It takes more than printed materials to see a difference in communities; outreach at the grassroots level and in-person resources are needed. For under-recognized communities, there are still many barriers and needs at the local level but such communities also need to be represented at the national level so they are not forgotten and can provide some input. However, in underserved communities, there is little infrastructure and very little ability to follow through on policy and advocacy that takes place at the national level.

There also are issues of low literacy in native languages. It is challenging to understand Medicare and Medicaid materials in English language materials, even before any translation.

Asian and Pacific Islander American Health Forum (APIAHF)

The Asian and Pacific Islander American Health Forum (APIAHF) is a national advocacy organization that seeks to improve the health and well-being of Asian Americans and Pacific Islanders through policy analysis and advocacy, community capacity-building, research and information dissemination.

APIAHF worked with other advocates in urging the issuance of the DHHS Office of Civil Rights policy guidance and Executive Order 131666. APIAHF continues to organize and submit comments on the various policy guidances, the OMB report and other federal regulations related to language access issues (e.g. for Medicaid managed care program and the State Children’s Health Insurance Program).

APIAHF led community efforts to establish the White House Initiative on Asian Americans and Pacific Islanders and the President’s Advisory Commission on Asian Americans and Pacific Islanders created as part of that White House Initiative highlighted issues of language access, especially in its 2001 Interim Report. APIAHF staff also has been a member of the Joint Commission for the Accreditation of Healthcare Organizations (JACHO) Public Advisory Group.

In California, APIAHF has worked with other advocates on an annual report by the Department of Managed Health Care on the quality of language access provided by health plans and on the codification of the cultural competence and language access requirements in California’s Medicaid managed care program and State Children’s Health Insurance Program (AB 2739), which the California Medical Association has supported.

APIAHF also has worked on analyzing the "racial privacy" initiative and its impact on health data and the ability to address health disparities.

Association of American Indian Physicians (AAIP), California Chapter

The Association of American Indian Physicians (AAIP) is dedicated to pursuing excellence in Native American health care by promoting education in the medical disciplines, honoring traditional healing practices and restoring the balance of mind, body, and spirit. AAIP’s 300 members are active in medical education, cross-cultural training between western and traditional medicine, and assisting Indian communities.

AAIP members are committed to maintaining culture, including language, and to securing and solidifying sovereignty. American Indians are very unique: a minority but not immigrants.

AAIP has held cross-cultural conferences and tried to educate non-Indian health professionals about Indian health issues. Technology may not necessarily applicable in Indian country, especially with elders who need face-to-face dealings. Using technology may intimidate and not allow for open communication.

Association of Asian Pacific Community Health Organizations (AAPCHO)

The mission of the Association of Asian Pacific Community Health Organizations (AAPCHO) is to promote advocacy, collaboration and leadership that improve the health status and access of Asian Americans, Native Hawaiians and Pacific Islanders within the United States, its territories and freely associated states, primarily through its member community health clinics. AAPCHO seeks to establish a standard of excellence for community based health care that is equitable, affordable, accessible and culturally and linguistically appropriate to the people it serves.

AAPCHO is an association of 14 community health centers, with 50-60% of its approximately 150,000 patients Limited English Proficient. There are both Presidential and Congressional initiatives to increase the number of community health centers nationally. Yet language access is a key to reducing barriers to access. AAPCHO is working with the Asian and Pacific Islander American Health Forum and the California Primary Care Association to include $10 million for language assistance services as part of the reauthorizations of the community health centers (S.1533). There also is a great need for technical assistance and models for expansion and growth that address language access issues.

In terms of data, AAPCHO is working with some of its centers on a pilot data project with the New York Academy of Medicine to collect utilization data about language assistance services and other enabling services, and ultimately to correlate the utilization data with improved health outcomes, increased patient satisfaction and reduced health care costs.

California Pan-Ethnic Health Network (CPEHN)

The California Pan-Ethnic Health Network (CPEHN) is a statewide network of multicultural health organizations working together to improve health care access and eliminate health status disparities in California’s communities of color. The mission of CPEHN is to promote changes to health policy decision-making and health care delivery systems that improve the health status of our diverse communities. Through a collaborative process with its partners in the African American, Asian and Pacific Islander, Latino and Latina, and Native American communities, CPEHN monitors, analyzes, and informs health care policies, legislation, and business strategies. CPEHN’s key partners are the Asian and Pacific Islander American Health Forum, the Latino Coalition for a Healthy California, the California Black Health Network and the California Rural Indian Health Board.

CPEHN has focused its language access work on California, especially the implementation of the cultural and linguistic standards in Calfornia’s Medicaid managed care program and its State Children’s Health Insurance Program. CPEHN has prepared and submitted comments on the federal Title VI policy guidances and regulations as well as the DHHS Office of Minority Health Culturally and Linguistically Appropriate Services standards. Priority issues are better data collection and better enforcement of existing or strengthened standards.

California Primary Care Association (CPCA)

The mission of the California Primary Care Association (CPCA) is to promote and facilitate equal access to quality health care for individuals and families through organized primary care clinics and clinic networks that seek to maintain cost-effective, affordable medical services, as well as meet the linguistic and cultural needs of California's diverse population.

As representatives of community clinics and health centers, CPCA brings both a consumer and provider perspective because community clinics and health centers were an outgrowth of the civil rights legacy of the 1960’s. For CPCA, workforce issues are critical, especially in rural areas where there are shortages of bilingual providers as well as interpreters. One initiative that CPCA is working on with the Latino Coalition for a Healthy California is a loan repayment program for doctors and dentists to work in medically underserved areas, with priority for language capacity and training in cultural competence (AB 982). CPCA also advocated for a $10 million enhancement in the community health centers reauthorization for language assistance services.

CPCA has been active in preparing and submitting comments to federal policy guidances, regulations, the Office of Management and Budget and the DHHS Office of Minority Health Culturally and Linguistically Appropriate Services (CLAS) standards. CPCA frequently conducts presentations and trainings on Title VI, the CLAS standards and promising practices for providing language assistance services.

The other major issue for CPCA is reimbursement and funding, especially through Medicaid and the State Children’s Health Insurance Program. CPCA has researched models in other states. But there are also funding issues for safety net providers who serve the uninsured who are not reimbursed the same way for medical services. Another need is technical assistance for providers who want to do the right thing. CPCA compiled a promising practices manual as a resource guide for health care providers including templates of documents that health centers use.

CPCA also has conducted research on the "racial privacy" initiative and its impact on community clinic health programs. Future work that CPCA would like to do on language access issues include integrating language access into quality improvement programs and coalition-building, especially at the local level to do advocacy and education.

Harry Lee and Alice Hm Chen

Harry Lee, Federation of Chinese American and Chinese Canadian Medical Societies and Alice Hm Chen, The California Endowment

Federation of Chinese American and Chinese Canadian Medical Societies

The Federation of Chinese American and Chinese Canadian Medical Societies is dedicated to promoting the health status of the Chinese communities in North America, advancing medical knowledge and education with emphasis on aspects related to the Chinese, enhancing communication and relationship among members of the Federation, and promoting the scientific association of medical societies of health professionals of Chinese descent in North America.

The Federation of Chinese American and Chinese Canadian Medical Societies has about 3,000 members, mostly from Chinatowns in San Francisco, Los Angeles and New York. The Federation’s tax-exempt foundation has only been incorporated for about a year and has done more local advocacy but is interested in national work. Some of the Federation’s community education projects have included the development and distribution of bilingual health education pamphlets, e.g., on hepatitis B, osteoporosis, cancer, diabetes, heart disease, etc. Federation members may also have influence in the California Medical Association.

Latino Coalition for a Healthy California (LCHC)

Since its inception, the Latino Coalition for a Healthy California (LCHC) has evolved into a mature and far-reaching organization for community-based health policy development and advocacy. It has forged relationships with state and national health care organizations and has become a recognized subject expert in the California State Legislature. LCHC has strengthened the position of safety net and other providers through advocacy that reinforced the call for under-served Latinos continue to have access to their services, especially for immigrant and rural communities. LCHC’s educational and advocacy efforts have provided an expert voice statewide and in Sacramento for the needs of Latinos living in California, especially those in rural and border areas.

LCHC has worked with its California advocacy partners in developing and supporting the codification of the cultural and linguistic standards in the California Medicaid managed care program and the State Children’s Health Insurance Program (AB 2739). LCHC also is analyzing and conducting education about the "racial privacy" initiative and its impact on health and health disparities. Finally, LCHC has supported the development of the health professions pipeline and diversity in the health workforce, working with the California Medical Association, the California Dental Association, the California Latino Medical Association, the California Primary Care Association and the Welcome Back program. LCHC is not just concerned with physicians and dentists but all health professionals, including nurses and laboratory workers.

Mexican American Legal Defense and Education Fund (MALDEF)

The Mexican American Legal Defense and Education Fund (MALDEF) is the leading nonprofit Latino litigation, advocacy and educational outreach institution in the United States. MALDEF’s mission is to foster sound public policies, laws and programs to safeguard the civil rights of the 35 million Latinos living in the United States and to empower the Latino community to full participate in our society. MALDEF achieves its mission by concentrating its efforts on employment, education, immigration, political access, language and public resource equity issues.

As a civil rights organization, health care is one of several program areas. MALDEF’s Washington, D.C. office monitored and commented on the various Title VI policy guidances. MALDEF also has worked in California on strengthening the Dymally-Alatorre government language access statute, especially to create private right of action for language access issues on the state level. MALDEF also conducts community education on language access issues and is developing a guide for legal service providers as well as community advocates. Finally, MALDEF also has been examining the potential impact of the "racial privacy" initiative on the collection of racial/ethnic data, especially health data.

More collaboration between civil rights organizations and community-based organizations that work with Limited English Proficient organizations is needed. MALDEF also has an interest in disseminating national policy information at the state level and working with advocates on state advocacy strategies.

National Asian Pacific American Legal Consortium (NAPALC)

The National Asian Pacific American Legal Consortium (NAPALC) works to advance the legal and civil rights of Asian Pacific Americans through litigation, public education and public policy. A nationally recognized voice on behalf of Asian Pacific Americans, NAPALC focuses its expertise on anti-Asian violence prevention and education, voting rights, immigration, naturalization, affirmative action, language rights and the census. NAPALC’s affiliates are the Asian Law Caucus in San Francisco, the Asian Pacific American Legal Center in Los Angeles and the Asian American Legal Defense and Education Fund in New York.

Language rights are significant issues for Asian American populations and a priority program area at NAPALC. NAPALC has been working with groups such as the National Council of La Raza, the Mexican American Legal Defense and Education Fund and the Leadership Conference on Civil Rights on public policy activities, including meetings with the White House and federal departments and agencies and retaining the law firm Hogan and Hartson to do background legal analyses. Vincent Eng chairs the Leadership Conference on Civil Rights’ Committee on Language Rights. NAPALC also has participated in Department of Justice stakeholder meetings and has prepared and submitted comments on the Title VI policy guidances and OMB report.

NAPALC also has worked with the Department of Justice and Hogan and Hartson in monitoring the Pro-English case against Executive Order 13166 as well as other English-only lawsuits.

NAPALC has a website on language rights issues and is monitoring English-only initiatives (e.g. Brown County in Wisconsin). NAPALC also conducts community education and training on language access issues.

There is a need to continue working with other federal departments and agencies on their Title VI policy guidances. There also is an ongoing need for community education, including developing standard fact sheets and documenting and disseminating research and other discussions among advocates.

There are other related issues such as ensuring language access in the census, especially in the American Community Survey that will replace the long form, and ensuring access to bilingual ballots and voter information.

National Asian Pacific Center on Aging (NAPCA)

The mission of the National Asian Pacific Center on Aging (NAPCA) is to serve as the leading national advocacy organization committed to the dignity, well-being and quality of life of Asian Pacific Americans in their senior years. NAPCA advocates on behalf the Asian Pacific American aging community at the local, state and national levels, educates Asian Pacific American seniors and the general public on the unique needs of the Asian Pacific American aging community and empowers Asian Pacific American seniors and the aging network to meet the increasing challenges facing the Asian Pacific American aging community.

For the past six years, NAPCA has had a capacity building program, working with community-based organizations on infrastructure development for providers for seniors, including technical assistance, local townhalls, local policy and advocacy. NAPCA also authors a national column published in various Asian American publications answering reader questions about health insurance, Medicaid, Social Security, addressing topics such as qualifying quarters for benefits, citizenship, etc. When these letters are sought and answered in the language of the readers, it dispels the myth that these individuals don’t have questions or concerns.

NAPCA has successfully used simultaneous translation technology at its meetings, including meetings with policymakers, and arranged for simultaneous translation at the community townhall meetings of the President’s Advisory Commission on Asian Americans and Pacific Islanders. NAPCA also was contracted by the former Health Care Financing Administration (HCFA, now the Center for Medicare and Medicaid Services) to do the Chinese translations of HCFA publications on Medicaid. NAPCA is now testing a prototype of a computer-assisted bilingual multimedia program on Medicaid and Medicare eligibility.

NAPCA has engaged in advocacy efforts in support of language access both inside and outside the past and current administrations, through such bodies as the President’s Advisory Commission on Asian Americans and Pacific Islanders and the Interagency Working Group on Limited English Proficiency. NAPCA’s analysis is that the most serious opposition to language access policies comes from groups like the American Medical Association and health providers, and not from policymakers.

National Council of La Raza (NCLR)

The mission of the National Council of La Raza (NCLR) seeks to reduce poverty and discrimination and improve life opportunities for Hispanic Americans. NCLR provides capacity-building assistance to support and strengthen Hispanic community-based organizations and conducts applied research, policy analysis and advocacy, providing a Hispanic perspective on issues such as education, immigration, housing, health, employment and training, and civil rights enforcement.

Language access issues impact all the issues that NCLR works on. NCLR has collaborated with other organizations such as the National Immigration Law Center (NILC), the National Health Law Program, the National Asian Pacific American Legal Center and the Mexican American Legal Defense and Education Fund (MALDEF) on legal analysis, stakeholder meetings, and comments on the Title VI policy guidances. More recently, NCLR worked with NILC and the Department of Justice to develop a website on language access issues and will be working with MALDEF on a video. NCLR also participates in coalitions such as the Leadership Conference on Civil Rights, the National Immigrant Access Coalition (with NILC), and Latino Healthy Families. NCLR is working on a draft Latino health bill that will include an enhanced Medicaid match for language assistance services. NCLR also has conducted community education and training on language access issues.

In California, NCLR has an office that works with organizations such as MALDEF and NILC on language access issues. There is a need for more training on language access issues at the community level, especially in emerging immigrant communities. There also is a need for data, especially showing the cost of not providing language assistance services.

National Health Law Program (NHeLP)

The National Health Law Program (NHeLP) is a national public interest law firm that seeks to improve health care for America’s working and unemployed poor, minorities, the elderly and people with disabilities. NHeLP serves legal services programs, community-based organizations, the private bar, providers and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people. NHeLP seeks to provide a seat at the table for representatives of low-income people, to protect consumers in the emerging managed care systems, and to find creative financing solutions that also preserve government’s responsibility as provider of last resort.

NHeLP has prepared and submitted comments on the Title VI policy guidances, regulations, Office of Management and Budget report and the DHHS Office of Minority Health Culturally and Linguistically Appropriate Services (CLAS) standards. NHeLP has published several reports on language access issues, such as its recent report funded by The Commonwealth Fund, "Providing Language Interpretation Services in Health Care Settings: Examples from the Field" and an forthcoming update to its Title VI legal guide, with a California insert.

NHeLP provides a lot of education, technical assistance and training on language access issues, including conferences sponsored by the Centers for Medicare and Medicaid Services, The Commonwealth Fund, the Robert Wood Johnson Foundation, Families USA and the State Bar of California. NHeLP also is a member of the Standards Subcommittee of the California Department of Consumer Affairs and Department of Health Services Task Force on Culturally and Linguistically Competent Physicians and Dentists and the Policy and Research Committee of the National Council on Interpretation in Health Care.

In California, NHeLP has worked with other organizations on the codification of the cultural and linguistic requirements in California’s Medicaid managed care program and State Children’s Health Insurance Program, strengthening of the Dymally-Alatorre Bilingual Services Act and analyzing the "racial privacy" initiative. NHeLP also has worked at the local level with the Los Angeles County Department of Health Services Cultural and Linguistic Task Force on adopting cultural and linguistic competency standards.

NHeLP’s priorities for language access work are:

1) reimbursement and funding, beyond Medicaid and State Children’s Health Insurance Program: for example, NHeLP is working with the Access Project on state strategies to access federal reimbursement, conducting a survey of states on funding strategies and hopes to develop a state tool kit on reimbursement and financing strategies.

2) data: there are lots of anecdotes but little hard data on costs and benefits.

3) education and training of consumers, advocates and providers.

National Immigration Forum

The purpose of the National Immigration Forum is to embrace and uphold America’s tradition as a nation of immigrants. The National Immigration Forum advocates and builds public support for public policies that welcome immigrants and refugees and that are fair and supportive to newcomers in our country.

The National Immigration Forum has been more focused on admissions and immigration enforcement issues. However, it does have a long-term interest in "immigrant integration" issues, including the work of its Center for the New American Community (with funding from the Carnegie Corporation). Issues of interest include promoting more public and private resources for English language instruction and focusing on shared values (e.g., legalization is for taxpaying, hard-working families on the road to citizenship). In the National Immigration Forum’s experience, national policy issues related to immigrants are divided into three broad groupings: admissions and enforcement; civil rights and civil liberties; access to public benefits. (Language access issues could be included in the latter two).

It is important to coordinate policy efforts, especially where certain immigrant policies may overlap with language access policies; it is important that the issues are not played off of each other. There are many newcomer-run organizations, hometown associations, traditional civil rights groups, labor and business groups, even education providers and criminal justice providers that are working on other immigration issues that could be engaged on some of these language access issues. And there may be different legislative and political allies, depending on how the issues are framed.

National Immigration Law Center (NILC)

The National Immigration Law Center (NILC) is a national support center whose mission is to protect and promote the rights and opportunities of low-income immigrants and their family members. NILC staff specialize in immigration law, and the employment and public benefits rights of immigrants. NILC conducts policy analysis and impact litigation and provides publications, technical advice, and trainings to a broad constituency of legal aid agencies, community groups, and pro bono attorneys.

As part of NILC’s work on immigrant access to public benefits, language access has been identified as a significant barrier to access. NILC has conducted community education and training regarding Executive Order 13166 and the CLAS standards and worked most recently on comments to Department of Justice Title VI policy guidance, other agency policy guidances and a response to the OMB request for information.

NILC is interested in working on federal reimbursement strategies for states and counties. NILC also is interested in working on language access issue in other contexts such as law enforcement, workplace health and safety and disaster and emergency response.

National Latino Council on Alcohol and Tobacco Prevention (LCAT)

The mission of the National Latino Council on Alcohol and Tobacco (LCAT) is to combat alcohol and tobacco problems and their underlying causes in Latino communities through research, policy analysis, community education, training and information dissemination. LCAT concentrates its efforts on informing public opinion and promoting changes on local, state and federal policies that affect advertising, access, enforcement and consumption of these products by Latino youth.

LCAT has been active in working with other national groups in developing and implementing the "Out of Many, One" multicultural consensus agenda on health disparities, with language access issues included as part of cultural competency. LCAT also has been active in the Racial and Ethnic Health Disparities Coalition advocating for increased federal appropriations to address health disparities, such as additional funding for the Department of Health and Human Services Office of Minority Health. But there is a need for policy infrastructure on minority health issues at national level generally.

LCAT has been working on securing reimbursement of tobacco cessation services under Medicaid and Medicare from the Center for Medicare and Medicaid Services. It seems that there is a lack of knowledge about language access issues and reimbursement among state Medicaid directors. Has there been work on language access issues done with groups such as the National Association of County Health Officials?

LCAT also works in "emerging" Latino states, e.g., in Indiana and Illinois, with local groups such as Latinos for a Healthy Illinois and the Midwest Hispanic Health Coalition. A hospital in Indiana has an interpreter and translation service that now provides those services to other government agencies and private businesses and has become a self-sufficient business.

Priority issues that TCE could support are language access issues for substance abuse services, the development of health professionals with language capacity, convening other foundations to fund language access issues and creating linkages between immigrant issues and health issues, especially at state and local levels

Michael Bird and Ellen Wu

Michael Bird, National Native American AIDS Prevention Center and Ellen Wu, California Pan-Ethnic Health Network

National Native American AIDS Prevention Center (NNAAPC)

The National Native American AIDS Prevention Center's mission is to stop the spread of HIV and related diseases among American Indians, Alaskan Natives, Native Hawaiians, and to improve the quality of life for those infected and affected by HIV/AIDS.

Language access is not a reality for many at the service level and interpreter services are not given the attention or support they deserve. As indigenous peoples and as ethnic populations and communities, we must be inclusive, committed to social justice and committed to diversity.

Michael Bird also has been part of "Out of Many, One" coalition effort and as the past president of the American Public Health Association, many activities, including those with DHHS, on addressing health disparities.

Southeast Asian Resource Action Center (SEARAC)

SEARAC’s principal mission is to advance the interests of Southeast Asian Americans by promoting community empowerment and leadership development. SEARAC is an advocate and key representative for the diverse Southeast Asian American community. As a national organization, SEARAC serves as a coalition builder and leader, facilitator, mediator, representative and coordinator. SEARAC is uniquely qualified to strengthen the capacity of ethnic networks, mutual assistance associations, and other community-based organizations.

Like many organizations, SEARAC is still learning how to monitor policies that impact its communities, such as executive orders and legislation. SEARAC’s expertise had been in refugee rights, refugee protection and refugee resettlement. In the last four years, there has been a shift in focus to domestic issues, to civil rights issues for former refugees who are now in the United States, such as welfare reform, immigration reform, health, and education. SEARAC works with about 137 Mutual Assistance Associations (MAAs), trying to translate policy information for the local communities. But it is a challenge to represent diverse Southeast Asian American communities, with many different languages. SEARAC only has one staff person who works on all these issues: language access, immigration, welfare, health, etc.

Language access issues are cross-cutting as an access issue. SEARAC has worked with the Department of Justice on its Title VI policy guidance and was pleased that the guidance makes specific reference to MAAs as possible providers of language assistance services. There is an ongoing need for community education and training, especially for front-line workers at social service agencies.

<h1></h1> <p> Ruth Perot, Harry Lee and Jeannette Noltenius</p>

Ruth Perot, Summit Health Institute for Research and Education;
Harry Lee, Federation of Chinese American and Chinese Canadian Medical Societies and
Jeannette Noltenius, National Latino Council on Alcohol and Tobacco

Summit Health Institute for Research and Education (SHIRE)

The Summit Health Institute for Research and Education (SHIRE) acts as a trusted resource to communities, government agencies, corporations, educational institutions and foundations seeking to address health disparities and expand access to health care. SHIRE works to build linkages among stakeholders in which communities of color play key roles in mounting and sustaining programs that will close health gaps and meet unique community needs.

SHIRE has served as the coordinator of the "Out of Many, One" coalition and also works with the Racial and Ethnic Health Disparities Coalition. SHIRE also is working on a report to the Centers for Medicare and Medicaid Services (CMS) based on a workshop on improving cultural competency and is evaluating a cultural competency curriculum for community health centers for the Bureau of Primary Health Care.

There is diversity of African Americans with language needs, e.g. Haitians, Dominicans, Ethiopians, etc. There also is a need for training in cultural competence and language access issues for African American health providers. Organizations such as the National Medical Association and other African American providers can work in coalition in addressing the opposition to language access by the American Medical Association. Finally, national organizations need support for infrastructure to increase their capacity to better work with local organizations.

DISCUSSION

Participants then engaged in brainstorming discussions, facilitated by Maria Echaveste. Participants addressed the following questions:

What does success in ensuring language access for health consumers look like?

How do we get there? Who pays for language assistance services?

What types of policy advocacy are needed?

Capacity-building at state and local levels on policy issues

At state level, e.g. pursuing strategies for federal reimbursement of language assistance services

Clayton Fong and Harry Lee

Clayton Fong, National Asian Pacific American Center on Aging and
Harry Lee, Federation of Chinese American and Chinese Canadian Medical Societies

What communication and information dissemination needs are there that would increase the effectiveness of advocacy on language access issues at the federal level?

How do we most effectively frame issues of language access in health care?

Maria Echaveste, Alice Hm Chen, Tom Perez, Lee Wong, Deeana Jang, Harry Lee and Sakinah Carter

Maria Echaveste, Faciliator; Alice Hm Chen, The California Endowment; Tom Perez, Faciliator;
Jai Lee Wong, The California Endowment; Deeana Jang, Department of Health and Human Services Office of Civil Rights;
Harry Lee, Federation of Chinese American and Chinese Canadian Medical Societies
and Sakinah Carter, The California Endowment

What education, training and advocacy work is needed by health care providers?

Ernest Tai, Deeana Jang and Jai Lee Won

Ernest Tai, Asian and Pacific Islander American Health Forum; Deeana Jang, Department of Health and Human Services
Office of Civil Rights and Jai Lee Wong, The California Endowment

RECOMMENDATIONS

Finally, participants were asked to make recommendations for the most effective strategies to enhance language access in health care at the federal level:

After a prioritization process, the advocacy (federal, state and local), data collection and national coalition/organization recommendations were highlighted.

Ignatius Bau and Facilitator Tom Perez

Ignatius Bau, Asian and Pacific Islander American Health Forum and Tom Perez, Facilitator

Report prepared by:
Ignatius Bau
Asian and Pacific Islander American Health Forum
September 2002

THE CALIFORNIA ENDOWMENT NATIONAL CONVENING ON LANGUAGE ACCESS JULY 9, 2002


PARTICIPANTS

Michael Bird, Executive Director
National Native American AIDS Prevention Center
436-14 th Street Suite 1020
Oakland, CA 94612
P 510-444-2051 x305
F 510-444-1593
mlittlebird@nnaapc.org
www.nnaapc.org

Jeffrey Caballero, President
Association of Asian Pacific American Community Health Organizations
439-23 rd Street
Oakland, CA 94612
P 510-272-9536
F 510-272-0817
jeffc@aapcho.org
www.aapcho.org

Susan Dominguez, Project Coordinator
Association of American Indian Physicians
Street , California Chapter
2423 Camino Del Rio Suite 103
San Diego, CA 92108
P 619-683-2247
F 619-683-2012
susandomin@msn.com

Vincent Eng, Legal Director
National Asian Pacific American Legal Consortium
1140 Connecticut Avenue N.W. Suite 1200
Washington, D.C. 20036
P 202-296-2300 x121
F 202-296-2318
veng@napalc.org
www.napalc.org

Clayton Fong, Executive Director
National Asian Pacific Center on Aging
1511 Third Avenue Suite 914
Seattle, WA 98101
P 206-624-1221
F 206-624-1023
clayton@napca.org
www.napca.org

Vivian Huang, Policy Analyst
California Primary Care Association
1215 K Street Suite 700
Sacramento, CA 95814
P 916-440-8170 x238
F 916-440-8172
vhuang@cpca.org
www.cpca.org

Harry Lee, Executive Vice President
Federation of Chinese American and Chinese Canadian Medical Societies
890 Jackson Street Suite 303
San Francisco, CA 94133
P 415-982-9688
F 415-982-9689
harrylee@best.com
www.fcmsdocs.org

Gabrielle Lessard, Staff Attorney
National Immigration Law Center
3435 Wilshire Blvd. Suite 2850
Los Angeles, CA 90010
P 213-639-3900 x114
F 213-639-3911
lessard@nilc.org
www.nilc.org

Sarah Mercer, Legislative Analyst
Mexican American Legal Defense and Education Fund
926 J Street Suite 422
Sacramento, CA 95814
P 916-443-7531 x13
F 916-443-1541
smercer@maldef.org
www.maldef.org

Jeannette Noltenius, Executive Director
National Latino Council on Alcohol and Tobacco Prevention
1875 Connecticut Avenue N.W. Suite 732
Washington, D.C. 20009
P 202-265-8054 x15
F 202-265-8056
jnoltenius@nlcatp.org
www.nlcatp.org

Ruth Perot, Executive Director
Summit Health Institute for Research and Education
440 First Street N.W. Suite 430
Washington, D.C. 20001
P 202-371-0277
F 202-371-0460
rperot@shireinc.org
www.shireinc.org

Edwin Rivera, Policy Director
Latino Coalition for a Healthy California
1225 Eighth Street Suite 500
Sacramento, CA 95814
P 916-448-3234
F 916-448-3248
erivera@lchc.org
www.lchc.org

Frank Sharry, Executive Director
Irene Bueno, Board Member
National Immigration Forum
220 I Street N.E. Suite 220
Washington, D.C. 20002
P 202-544-0004 x16
F 202-544-1905
fsharry@immigrationforum.org
www.immigrationforum.org

Ernest Tai, Policy Director
Asian and Pacific Islander American Health Forum
942 Market Street, Suite 200
San Francisco, CA 94102
P 415-954-9973
F 415-954-9999
etai@apiahf.org
www.apiahf.org

Robert Uhrle, Executive Director
Advocacy Initiatives for Grassroots Access
355 Gellert Blvd. Suite 266
Daly City, CA 94015
P 650-991-5172
F 650-757-2075
pakiuhrle@aol.com

Marcela Urrutia, Policy Analyst
National Council of La Raza
1111-19 th Street N.W. Suite 1000
Washington, D.C. 20036
P 202-776-1722
F 202-776-1792
murrutia@nclr.org
www.nclr.org

Ellen Wu, Executive Director
California Pan-Ethnic Health Network
654-13 th Street
Oakland, CA 94612
P 510-832-1160
F 510-832-1175
ewu@cpehn.org
www.cpehn.org

KaYing Yang, Executive Director
Southeast Asian Resource Action Center
1628-16 th Street N.W. 3 rd Floor
Washington, D.C. 20009
P 202-667-4690
F 202-667-6449
kaying@searac.org
www.searac.org

Mara Youdelman, Staff Attorney
National Health Law Program
1101-14 th Street N.W. Suite 400
Washington, D.C. 20005
P 202-289-7661
F 202-289-7724
youdelman@healthlaw.org
www.healthlaw.org


FACILITATORS

Maria Echaveste
1026-16 th Street N.W. #501
Washington, D.C. 20036
P 202-737-1267
F 202-737-7750
mechaveste@aol.com

Tom Perez, Director of Clinical Law Program
University of Maryland School of Law
515 West Lombard Street
Baltimore, MD 21201
P 410-706-1053
F 410-706-5856
tperez@law.umaryland.edu
THE CALIFORNIA ENDOWMENT STAFF

Sakinah Carter, Program Associate
The California Endowment
21650 Oxnard Street Suite 1200
Woodland Hills, CA 91367
P 818-703-4193
F 818-703-3311
scarter@calendow.org
www.calendow.org

Alice Hm Chen, Health Policy Scholar in Residence
The California Endowment
101 Second Street, Suite 2400
San Francisco, CA 94105
P 415-343-0222
F 415-343-0220
San Francisco, CA
achen@calendow.org
www.calendow.org

Jai Lee Wong, Senior Program Officer
The California Endowment
21650 Oxnard Street Suite 1200
Woodland Hills, CA 91367
P 818-703-4193
F 818-703-3311
jwong@calendow.org
www.calendow.org

OBSERVERS

Deeana Jang, Senior Civil Rights Analyst
Office of Civil Rights
Department of Health and Human Services
200 Independence Avenue S.W. 5 th Floor
Washington, D.C. 20201
P 202-619-1795
djang@os.dhhs.gov

John Kim, Intern
Office of Civil Rights
Department of Health and Human Services
200 Independence Avenue S.W. 5 th Floor
Washington, D.C. 20201


APIAHF STAFF

Ignatius Bau, Deputy Director for Policy and Programs
Asian and Pacific Islander American Health Forum
942 Market Street, Suite 200
San Francisco, CA 94102
P 415-954-9951
ibau@apiahf.org
www.apiahf.org

Gem Daus, Legislative and Governmental Affairs Coordinator
Asian and Pacific Islander American Health Forum
1001 Connecticut Avenue N.W. Suite 835
Washington, D.C. 20036
P 202-466-6444
F 202-466-7772
gdaus@apiahf.org
www.apiahf.org

Jan Liu, Policy Analyst
Asian and Pacific Islander American Health Forum
942 Market Street, Suite 200
San Francisco, CA 94102
P 415-954-9952
F 415-954-9999
jliu@apiahf.org
www.apiahf.org


Jessica Shinn, Intern
Asian and Pacific Islander American Health Forum
1001 Connecticut Avenue N.W. Suite 835
Washington, D.C. 20036
P 202-466-6444
F 202-466-7772

 

 

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