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| Each health and human services organization shall provide language assistance to: |
| • persons with limited English proficiency (LEP); |
| • persons with hearing and vision impairments; |
| • people with disabilities which, impede their ability to communicate effectively. |
| Limited English proficiency refers to people who cannot speak, read, write or understand English at a level that permits them to interact effectively with health care providers and human services agencies. Minnesota requires that counties use their best effort to assign clients with limited English proficiency to bilingual staff who speak their language.[121] Such staff know the programs, communicate directly without potential conflicts arising from interpreter use, and are more cost effective. |
| In addition to state requirements, federal standards for persons with limited English proficiency (implemented by Minnesota in 2001) require that organizations provide sufficient language assistance, free of charge, so that an LEP client has meaningful access to their services. Each health and human services organization shall ensure that the LEP client can communicate effectively. The steps taken by an organization must ensure that the LEP person “(1) is given adequate information, (2) is able to understand the services and benefits available, (3) is able to receive services for which he or she is eligible, and (4) can effectively communicate the relevant circumstances of his or her situation to the service provider.” [122] |
| Federal standards for people with disabilities are defined in the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. Both provide similar prohibitions against discrimination on the basis of disability and require organizations to provide language assistance such as sign language interpreters for hearing impaired individuals or alternative formats for vision impaired individuals. In developing a comprehensive language assistance program, each health and human services organization must be mindful of its responsibilities under the ADA and Section 504 to ensure access to programs for individuals with disabilities. [123] |
| Counties in Minnesota are required to assist limited-English proficient people who are not literate in their primary languages to the same extent it would help an English speaker who does not read English.[124] For individuals who are not literate in any language, for those who speak non-written languages, and for people with sensory, developmental, and/or cognitive impairments, organizations must provide notice of the availability of oral or audio-visual translation of written materials. [125] |
| Each health and human services organization must establish language assistance programs[126] comprising an assessment of language needs, oral interpretation, translation, notice of assistance, staff training, monitoring, complaint resolution, an LEP coordinator, and mental health clinical assistance. |
| Organizations assess the following: []127 |
| An organization identifies the non-English languages likely to be encountered in its program and estimates the number of LEP persons who are eligible or entitled for services and the number likely to be directly affected by its program. This can be done by reviewing census data, client utilization data from client files, and data from school systems and community agencies and organizations. In Minnesota, school districts collect data on what languages are spoken in students’ homes. |
| Organizations ask applicants, as part of the intake process, to identify their preferred language and their need for interpreters. Organizations record this information in the client’s file in a manner that makes it readily available to providers at all points of contact. |
| Organizations assess the points of contact in the program or activity where language assistance is likely to be needed. |
| Organizations assess the resources that will be needed to provide effective language assistance for each client. |
| Organizations identify the location and availability of resources for each client and note it in the client’s file. |
| Organizations identify the arrangements that must be made to provide language assistance resources for each client in a timely fashion. |
| Each health and human services organization shall arrange a variety of options for oral interpretation. The available options must be of sufficient quantity and quality to serve their LEP clients. While the option chosen may depend upon the number of clients who speak a particular language and upon the organization’s resources, some form of interpreter services must be made available to each individual with limited English proficiency, regardless of the size of the individual’s language group in that community. |
| Each organization ensures that it uses persons who are competent to provide interpreter services. Competency does not necessarily mean formal certification as an interpreter, though certification is helpful. On the other hand, competency requires more than self-identification as bilingual. The OCR Guidance standard for competency contemplates: |
| • demonstrated proficiency in both English and the second language, |
| • orientation and training that includes the skills and ethics of interpreting, with particular competence in maintaining confidentiality, |
| • fundamental knowledge, in both languages, of any specialized terms or concepts peculiar to the organization’s program or activity, |
| • sensitivity to the LEP person’s culture, |
| • a demonstrated ability to accurately convey information in both languages. [128] |
| Interpreters used in the delivery of services can further demonstrate the following abilities. The competent interpreter: |
| • accurately and completely relays the message between the client and the provider by converting the message expressed in one language into the equivalent in the other; |
| • uses the interpretation mode that best enhances comprehension and encourages direct communication between the client and the provider; |
| • reflects the style and the vocabulary of the speaker, including level of formality and use of slang as well as the emphasis and degree of emotion of the speaker; |
| • ensures that the interpreter understands the message by asking for clarification or repetition if unclear; |
| • remains neutral where there is conflict between the client and the provider; |
| • does not project his or her own values onto the client and identifies and separates personal beliefs; |
| • identifies and corrects his or her own mistakes; and |
| • addresses cultural based miscommunication by identifying instances in which cultural differences between the client and provider have the potential to seriously impair communication. [129] |
| Except in an emergency, friends and family members may not be used as interpreters and organizations can establish an absolute prohibition against use of minor children as interpreters. Use of such persons could result in a breach of confidentiality or reluctance on the part of individuals to reveal personal information critical to their situations. In a medical setting, this reluctance could have serious, even life threatening, consequences. Using children undermines family authority, making a parent dependent on the child. In addition, family and friends usually are not competent to act as interpreters, since they are often insufficiently proficient in both languages, emotionally biased, unskilled in interpretation, and unfamiliar with specialized terminology. Any organization that requires, suggests, or encourages an LEP person to use friends or family as interpreters may expose itself to liability under federal civil rights law. [130] |
| Each organization can make the following arrangements to secure interpreter services, in descending order of preference: [131] |
| • hire bilingual staff, including service providers and those who regularly come in contact with clients; |
| • hire staff interpreters for frequently encountered languages; |
| • contract for interpreter services for languages less frequently encountered; |
| • make formal arrangements with community volunteers, making certain they are competent in the language; |
| • use telephone interpreter lines for languages rarely or unexpectedly encountered. This cannot be the only language assistance available. |
| Each organization shall ensure that written or audio-visual materials routinely provided in English to applicants, clients, and the public are available in commonly encountered non-English languages. It is particularly important to translate vital documents, such as: |
| • letters with information specific to a client regarding participation in a program, |
| • notices pertaining to the reduction, denial or termination of services or benefits, |
| • notices of the right to appeal, |
| • notices that require a response from the client, and |
| • notices advising LEP persons of the availability of free language assistance. |
| The OCR Guidance defines the population threshold for requiring translations as the level “where a significant number or percentage of the population eligible to be served or likely to be directly affected by the program needs services or information in a language other than English to communicate effectively.” Civil rights enforcers will determine the extent of an organization’s obligation to provide written translations “on a case by case basis, taking into account all relevant circumstances, including the nature of the (organization’s) services or benefits, the size of the (organization), the number and size of the LEP language groups in its service area, the nature and length of the document, the objectives of the program, the total resources available to the (organization), the frequency with which translated documents are needed, and the cost of translation.” [132] |
| While federal guidance does not establish a strict numerical threshold, OCR Guidelines provides a “safe harbor.” An organization that meets the following minimum standards may have confidence that it is in compliance with civil rights law. It defines the safe harbor as follows: |
| (a) For each language group that constitutes 10 percent or 3,000, whichever is less, of the population of persons eligible to be served or likely to be directly affected by the program, organizations must provide translated written material including vital documents. |
| (b) For each language group that constitutes 5 percent or 1,000, whichever is less, of the population of persons eligible to be served or likely to be directly affected, the organization must, at a minimum, provide translated vital documents. Translation of other documents, if needed, may be provided orally. |
| (c) For each language group that constitutes fewer than 100 persons eligible to be served or likely to be directly affected, the organization need not translate written materials but must provide in the primary language of the client written notice of the right to receive competent oral translation of written materials. |
| Minimally, translations must be performed by a trained and demonstrably-qualified person. Preferably, each organization checks quality of translations by performing back-translations, review by target-audience groups, and periodic updates. It’s important to note that, in some cases, verbatim translation may not accurately or appropriately convey the substance of the original English materials. |
| Each health and human services organization shall establish several methods to notify LEP persons of their right to language assistance and the availability of such assistance free of charge. Notification methods in Minnesota focus on 10 “primary languages” of Arabic, Hmong, Khmer (Cambodian), Lao, Oromiffa (Afaan Oromo) [spoken in parts of Kenya and Ethiopia], Russian, Serbo-Croatian (Bosnian), Somali, Spanish, and Vietnamese. The state has established a methodology for adding new languages. |
| Notification methods may include language blocks, language identification cards and posters, translations of applications, instructions, and other materials, signage, and telephone assistance: [133] |
| Organizations may use four approved “language blocks” to notify limited-English proficient clients that free language assistance is available in appropriate non-English languages. These notices are inserted into brochures, booklets, outreach and recruitment information, and other materials that are routinely disseminated to the public. Organizations must either translate such materials or otherwise ensure that the information and materials are meaningful and accessible. |
| The DHS language block is a graphic block of text that informs readers, in 10 languages, how they can get help with understanding the information in a particular document at no cost to them. The DHS language block is now available in four approved versions, as follows: |
| “Attention. If you want free help translating this information, ask your worker.” |
| “Attention. If you want free help translating this information, ask your worker or call the number below for your language.” |
| “Attention. If you want free help translating this information, call the number below for your language.” |
| “Attention. If you want free help translating this information, call ________ [insert the organization’s name and/or phone number here].” |
| The Minnesota Department of Human Services must provide for translations of the language block into additional languages as their speakers grow in number. [134] |
| The language blocks include separate telephone numbers for each of the specified languages. (See Appendix H.) A person speaking that language must answer the phone during regular business hours, with voice mail backup. |
| The multilingual referral lines are not an interpreter service. Rather, they refer callers to bilingual persons who help to make contact with the appropriate county or state agency. When a caller calls one of the multilingual referral line numbers, the caller will be asked his or her name, the reason for the call, and the name of the county of residence. The multilingual referral line operator then leaves a message with a pre-designated contact person at the county or state agency as appropriate. It is the responsibility of the county or state agency to return the call with an interpreter or bilingual staff member. |
| The second and third versions are for use with DHS documents only. Counties cannot use these versions of the language block on county-generated documents. |
| The first and fourth versions of the language block are appropriate for counties to use on county-generated documents. To obtain one of these language blocks, contact Lisa M. Nelson, LEP Coordinator in Management Services, at 651-282-5082 or by e-mail at lisa.m.nelson@state.mn.us. |
| Each organization may use language identification cards and posters which allow LEP beneficiaries to identify their language needs to staff and which allow staff to identify the language needs of applicants and clients. To be effective, the cards must invite LEP persons to identify the language they speak. This must then be recorded in the LEP person’s file. |
| The Minnesota Department of Human Services has developed and distributed “I speak” cards and posters to applicants, clients, members of the public, counties, and community agencies that allow LEP clients to identify their preferred language to organization staff. The palm-sized cards say, for example, “I need a Hmong interpreter” in both English and Hmong. English speaking staff can see from reading the English message that they must arrange for the services of a Hmong interpreter. Posters say: “Free interpreter services are available. Please ask someone at the front desk.” The message is displayed in a variety of languages which allows clients and applicants to point to the language he or she speaks. This alerts the receptionist to arrange for an interpreter. “I speak” cards and posters are currently available in the 10 languages identified in Section 17.4. |
| Each health and human services organization shall translate application forms and instructional, informational, and other written materials into appropriate non-English languages or otherwise make the information in those documents meaningfully accessible. Counties must develop translation plans to translate and make available any county-produced materials that are routinely provided in English to the public.[135] Other health and human services organizations can do the same. |
| DHS has translated a number of forms into 10 languages and has completed a department-wide assessment of what it considers “vital documents”[136] for translation. The translated documents are available at: http://edocs.dhs.state.mn.us |
| In addition, managed care organizations under contract with the state to provide Prepaid Medical Assistance Program (PMAP) services must provide clients with the Certificate of Coverage, describing benefits, in 10 primary languages. [137] |
| Each organization may post signs in regularly encountered languages in waiting rooms, reception areas and other initial points of entry. These signs inform clients and applicants of: |
| • their right to free language assistance services, |
| • the availability of conflict and grievance resolution processes, |
| • directions to facilities and services and an invitation to clients to identify themselves as persons needing language assistance. |
| Each organization may establish uniform procedures for timely and effective telephone communication between staff and LEP persons. This can include instructions for English-speaking employees to obtain assistance from interpreters or bilingual staff when receiving calls from or initiating calls to LEP persons. Other assistance is available: |
| Telephone interpreters. Over-the-phone interpretation services are available in 140 languages from Language Line Services (formerly the AT&T Language Line) 800-752-0093 or http://www.LanguageLine.com |
| Each organization disseminates its language assistance policy to all employees likely to have contact with LEP persons and institutes periodic training of employees. Training can promote: (a) employees’ knowledge of LEP policies and procedures, (b) skills in working effectively with in-person and telephone interpreters, and (c) understanding of the dynamics of interpretation among clients, providers, and interpreters. Such training can be part of the orientation for new employees. An organization may find it useful to maintain a training registry that records the names and dates of employees’ training. |
| Each organization must monitor its language assistance program at least annually to assess: |
| • the current makeup of limited English proficient populations in its service area, |
| • the current communication needs of LEP applicants and clients, |
| • whether existing assistance is meeting the needs of such persons, |
| • whether staff is knowledgeable about policies and procedures and how to implement them, |
| • whether sources of and arrangements for assistance are still current and viable. |
| Organizations may want to seek feedback from clients and advocates. |
| Each organization adopts and publicizes pre-judicial procedures for resolution of complaints regarding the provision of language assistance. For example, some communities have trained professional and volunteer mediators who may be willing to work with LEP complaints. |
| Each organization appoints a senior-level employee to coordinate the language assistance program and monitor its performance. |
| Bilingual mental health staff and interpreters shall be certified or otherwise have formally demonstrated their linguistic competence. Use of family members as interpreters, especially children, can be strictly prohibited. |
| Telephone interpreters can never be used in a mental health clinical encounter. [138] |
| Interpreters and translators working with LEP clients and families can be supervised by linguistically competent mental health professionals. |
| Training is provided to all service providers in the use of interpreters for LEP clients. Training can emphasize linguistics and culture. |
| Restricted or residential settings must have the capacity to communicate effectively with monolingual, non-English speakers and individuals with culturally different or unique communication styles. |
| Mental health organizations develop and annually update a directory of paid trained interpreters who are available within 24 hours for routine situations and within one hour for urgent situations. |
| Most of the Language Assistance standards described here are enforceable under federal and state law because a client’s lack of English proficiency can have the effect of limiting clients’ access to important public services to which they may be entitled. |
| For clients with LEP, each public and private health and human services organization can consult: |
| • Minnesota Department of Human Services Bulletin, #00-89-4 (Dec. 28, 2000), which directs each county human services agency to develop and implement a written limited English proficiency plan to ensure compliance with federal law; |
| • Regulations under Title VI of the Civil Rights Act of 1964 (regulatory cite is: 45 CFR Part 80; statutory cite is: 42 U.S.C. 2000d et seq.); |
| • Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons With Limited English Proficiency, published by the Office of Civil Rights, Federal Register, Vol. 65, No. 169, August 30, 2000, pp. 52762 through 52774. All entities that receive federal financial assistance from the Department of Health and Human Services, either directly or indirectly, through a grant, contract or subcontract, are responsible for implementing this policy guidance; |
| • The Substance Abuse and Mental Health Reorganization Act, which requires services to be bilingual if appropriate, at 42 U.S.C. Section 290aa(d)(14); |
| • Regulations issued by the Centers for Medicare and Medicaid Services (CMS) (formerly HCFA), which require that evaluations for the mentally ill and the mentally retarded be adapted to the cultural background, language, ethnic origin, and means of communication of the person being evaluated, at 42 CFR section 483.128(b); |
| • U.S. Department of Justice regulations, under 28 CFR Part 42.405(d)(1), describes circumstances under which a federally-assisted program must translate documents into non-English languages. |
| For clients with disabilities, organizations can consult: |
| • The Americans with Disabilities Act and |
| • Section 504 of the Rehabilitation Act of 1973. |
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