Limited English Proficiency Training

Limited English ProficiencyThere is no single law that covers Limited English Proficiency (LEP). It is the combination of several existing laws that recognize and require compliance to LEP.

Additionally, Medicare and Medicaid both have a variety of regulations that also clarify the law(s) and outline our compliance requirements.

Limited English Proficiency• Title VI of the Civil Rights Act of

1964• The Americans with Disabilities Act• The Rehabilitation Act of 1973• Executive Order 13166 restated the

legal requirement for compliance

What regulations?• Limited English Proficiency (LEP)

• Americans with Disabilities Act (ADA)

LEP and ADAThere are two sets of regulations that govern working with clients who are not able to speak, read and write English well enough to effectively participate in their own care.

LEP covers individuals whose first language is something other than English.

ADA covers individuals who may know English, but have eyesight or hearing problems.

Both groups have the legal right to free language assistance.

LEPIt is the intent of GT Independence and the staff of all its divisions, to be both willing and prepared to help those for whom language may be a barrier to obtaining necessary services and assistance.

Limited English ProficiencyWho is covered by Limited English Proficiency requirements?

LEP is for EveryoneThe law says “persons,” which is obviously all encompassing and specifically includes illegal immigrants.

Understand that discrimination need not be intentional to break the law. We have a clear legal obligation to avoid it.

What is Discrimination?

Discrimination DefinedTitle VI of the Civil Rights Act of 1964 provides that no person shall be subjected to discrimination on the basis of race, color or national origin. We serve Clients whose expenses are paid for with Medicaid dollars, therefore we receive federal financial assistance. The courts have determined that discriminating against a person based on language is the same as discriminating against them based on nationality.

Translate or Interpret? That is the Question

Translation and InterpretationThey are not the same even though they are meant to accomplish the same goal.• Translation is the conversion of written

documents from one language to another.• Interpretation is listening to one language and

re-stating what was said in another language• Translation is written• Interpretation is verbal

Translators and Interpreters must be Competent

Improperly translated documents or poorly interpreted conversations can lead to confusion and misunderstandings.

The goal is to provide clear concise information about services in a language or format the Client can understand.

Translation is not EasyWhile it is fairly simple to translate a word from one language to another, getting that translation to give the sentence the same meaning is quite the opposite. Consider the sentence “The bus didn’t pick me up.”• In English this sentence implies that the bus was

at fault because it didn’t arrive at the pick-up point.

• In Spanish this sentence translates to “I didn’t get on the bus” implying that the bus was present but the rider refused to get on.

This is America…speak English

After all, isn’t English the official language of the USA?

Limited English Proficiency“You are in America, speak English.” is a discriminatory statement.English is not the “official” language of the United States, in fact, there is no official language in this country. While English is very common it is not a legal standard. We cannot force Clients to communicate in English, it is illegal.Clients may communicate in any language they feel comfortable with, it’s the law.

Limited English Proficiency• All clients are equal.• Clients have a choice to speak which

language they want.

How much Assistance should we give Clients?

While we strive to treat all clients equally, when it comes to the types of assistance outlined by LEP and ADA we must take into consideration each client as an individual insuring that we provide assistance to the extent needed.

Additionally, we must allow the individual to choose the type of assistance they receive.

Remember, clients have the choice to speak any language they wish and we are required to provide assistance in that language.

Language assistance, to whatever extent it is provided, must be free to the individual receiving it.

Limited English ProficiencyCan’t we have the client bring along a relative or friend that already knows the language? Why do we have to provide the Interpreter?

Limited English ProficiencyNO! You must never suggest a client bring an interpreter with them. This is specifically forbidden. The law says that we must provide the individual with a competent interpreter free of charge.

Limited English Proficiency• Children or Minors

• Friends

• Other Clients

Remember….Minors or children cannot be expected to understand the terms used in many of the services we provide or equally important, the concept of confidentiality, therefore they don’t make good interpreters. This may also apply to family members or friends of the client.While other clients may understand terminology and confidentiality, allowing another client to act as an interpreter is clearly a breach of confidentiality and HIPAA.

Those trained in the work of Interpretation/Translation

OK…Then who CAN we use?

Who should be Used to Translate/Interpret?

Remember anyone providing these services must be competent. Interpreters must be competent in both the language spoken by the client and English. • The Interpreter must be competent in the

terminology appropriate to the occasion. • The Interpreter must be knowledgeable of and

committed to confidentiality requirements as required by HIPAA guidelines and GT Independence standards.

It’s an emergency…

Let’s define an emergency

• Medical Emergencies• Accident Scenes• Urgent changes to

services

• Scheduling conflicts • Non-Urgent changes to

services• Routine explanation of

services

Emergency Situations:

Non-Emergency Situations:

To be an emergency the situation must require immediate need for assistance and that need would have to involve some injury or risk of injury.

It is an emergency—Who can I use?

Once you determine that the situation is an actual emergency you may use anyone available to communicate and interpret for the client. However some guidelines still apply.

Documenting an Emergency Situation

Clearly document any instance when you believe the circumstances warranted use of an interpreter whose qualifications you have not verified. What made it an emergency?REMEMBER:•Time•Date•Details•Who was used to interpret

LEP and Client Choice• What if my client insists on a certain

person to interpret? Can I force them to use the person I provide for them?

LEP and ClientPerson Centered Planning requires client choice. Did the client agree to this interpreter?Clearly document every time and any occasion when a friend of the client or a family member is used as an interpreter. Did the client make the decision and did they make it after being clearly informed that they have a legal right to free language assistance?

We don’t have any foreign language clients

REALLY???

Are you sure about that?It is a common misconception to think that because an agency does not have any clients (they know of) who need language assistance, they are not denying anyone’s legal right to access. It is difficult to imagine a service area in any state with no potential clients who would need language assistance to have equal access to services. The fact that many agencies are not aware of anyone is most likely evidence of unintended barriers to access rather than evidence of the lack of need. The legal requirements to provide language assistance are based on who is in your service area, not who is on your current client list.

If the Client can’t speak my language how will I know what assistance they need?

Excellent Question!I Speak cards help determine which language a person speaks. These card have a request for assistance in English on one side and the client’s chosen language on the reverse side.

Limited English ProficiencyLanguage help is not just for people who speak another language, but for people with poor hearing and limited eyesight as well.

Things to remember• An interpreter is always free to the client.• It’s best to use an interpreter, but a client can

insist on having their family interpret.• A client cannot use another client to interpret,

unless it is an emergency.• In an emergency anyone can act as an

interpreter, but you must document why it was an emergency.

• Assistance is not limited to individuals who speak an different language. Eyesight and hearing problems can result in the need as well.

GOT QUESTIONS?Your trainer will be happy to answer any questions you may have today. During the course of your employment with GT Independence please direct your questions to your Supervisor or Team Leader. They will assist you in making the best decision in specific situations.

Please complete the LEP Quiz and return it to your trainer.

Thank you for participating in this LEP training.

LEP QUIZ