What is required when providing health care services to patients/clients who have Limited English Proficiency?  Title VI of the Civil Rights Act prohibits discrimination on the basis of national origin. Title VI and Department of Health and Human Services regulations, 45 C.F.R. Section 80.3(b)(2), require recipients of Federal financial assistance from HHS to take reasonable steps to provide meaningful access to Limited English Proficient (LEP) persons. See A Practice Guide to Implementing the National CLAS Standards for more information and resources.  Additionally, federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing.  These laws include:

  • Section 504 of the Rehabilitation Act of 1973 – applies to federal health care services and facilities; and health care providers who are also recipients of federal financial assistance, usually provided by direct funding (such as federal Medicaid funds) or by grants (such as a federal research grant).
  • Title II of the Americans with Disabilities Act – applies to all public (state and local) health care providers.
  • Title III of the Americans with Disabilities Act – applies to all private health care providers.

Additionally, the U.S. Department of Health & Human Services Office for Civil Rights (OCR) and the U.S. Department of Justice Civil Rights Division recently issued Guidance on Nondiscrimination in Telehealth: Federal Protections to Ensure Accessibility to People with Disabilities and Limited English Proficient Persons.

Many practices have developed ways to provide these services during an office or hospital visit, but what happens when you are providing care by telehealth?

  • Things to consider when weighing your options:
    • Video interpretation, when possible, will be a better option than audio only because the majority of communication is done nonverbally!
    • Allow two to three times more time for the appointment!
    • Select a trained and qualified healthcare interpreter fluent in both English and the target language, particularly one who has undergone training in the area of telehealth interpreting.  Some patients will insist on using family members or friends. Don't be afraid to push back.  Here are just a few reasons for using a trained and qualified healthcare interpreter:
      • They understand medical terminology, including the language surrounding diagnoses and treatment - a necessity in healthcare settings.
      • They uphold the highest standards in professionalism and ethics, including an understanding of the laws and regulations around confidentiality and privacy.
      • They do not have emotional ties with the patient and are able to maintain greater neutrality, making them less susceptible to biases in their interpretation that may impact decision-making.
      • They are trained to understand the difference between their role as interpreter and their role as cultural broker.
    • Here are a few resources you may want to review:

What are some best practices for telehealth interpretation?   A team at Wake Forest University in collaboration with the Northwest Area Health Education Center has developed a 25 minute self-directed module for medical students on how to successfully work with interpreters during a language-discordant virtual visit. Read about their findings: Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth.  The entire training module may be found and downloaded from the Appendices section of the article and includes:

  1. Module Instructions.docx
  2. Equitable Care in Telemedicine folder
  3. Facilitator Guide for Alternative Teaching Options.docx
  4. Interpreter Room for Improvement Example.mp4
  5. Interpreter Better Example.mp4
  6. Working With Interpreters in Telehealth.pptx
  7. Tips for Best Practices With Interpreters Handout.docx
  8. Postsurvey.docx

The National Center for Farmworker Health has developed this webinar and handout on "Best Practices for Phone & Virtual Interpretation":

For best practices in using ASL interpreters for deaf and hard of hearing patients, please visit our Telehealth and Disabilities page!

Additional Resources: