Engaging presentation discussing the challenges and best practices for LLD populations, delivered by Sahra Noor, CEO of People's Center Health Center.

1. SAHRA NOOR, CEO
KEYNOTE PRESENTATION:
CHALLENGES AND BEST PRACTICES FOR LLD POPULATIONS
JUNE 6, 2015

2. People’s Center Health Services
 Nonprofit, community-directed health center
 Internationally recognized for serving large number of
Somali/East African immigrants
 Reputable, culturally competent provider
 Federally qualified/funded to serve uninsured
 Certified patient-centered health care home
 10,000 patients, 36,000 visits annually
 Celebrating 45 year anniversary

3. Diversity in Minnesota
 According to Census
2010, Minnesota is
becoming increasingly
diverse
 Home to largest Somali,
Tibetan and Hmong
population in North
America
 Large Russian, Korean,
Vietnamese and
Cambodian community
 Growing Karin population

4. Refugee Arrivals to MN by Region of World 1979-2014
0
1000
2000
3000
4000
5000
6000
7000
8000 1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Numberofarrivals
Southeast Asia Sub-Saharan Africa Eastern Europe
FSU Middle East/North Africa Other
Source: Refugee Health Program, Minnesota Department of Health

5. “Other” includes Afghanistan, Belarus, Cambodia, Cameroon, Cuba, DR Congo, Ecuador, El Salvador, Eritrea, the Gambia, Honduras, Iran, Kenya, Liberia,
Moldova,
Nepal, Russia, Rwanda, Sierra Leone, Sri Lanka, Sudan, Tanzania, Ukraine, and West Bank
Source: Refugee Health Program, Minnesota Department of Health
Somalia, 1130
(46%)
Burma, 838
(34%)
Iraq, 191 (8%)
Bhutan, 77
(3%)
Ethiopia, 59
(2%)
All Others*,
171 (7%)
Primary Refugee Arrivals 2014

6. Country of Origin by County of Resettlement, 2014
0
100
200
300
400
Hennepin
Somalia
Iraq
Bhutan
Ethiopia
Other
0
100
200
300
400
500
600
700
800
900
Ramsey
Burma
Somalia
Bhutan
Iraq
Ethiopia
Other
0
50
100
150
200
250
Stearns
Somalia
Iraq
Kenya
0
20
40
60
80
100
Anoka
Iraq
Somalia
Afghanistan
Other
N=451
N=1,272
N=275 N=155
Refugee Health Program, Minnesota Department of Health
Source: Refugee Health Program, Minnesota Department of Health

7. Secondary Refugee Arrival Notifications to Minnesota 2014
Somalia, 789
(94%)
Iraq, 26 (3%)
Burma, 13
(1%)
All Others, 13
(2%)
N=841
Source: Refugee Health Program, Minnesota Department of Health

8. Imagine!

9. What we know
 Language barriers contribute to health
disparities
 Poor access to care
 Poor adherence to treatment and follow up
 Increased prevalence of chronic disease
 Poor interpretation has severe
consequences
 Under or over diagnoses
 Misdiagnoses
 Poor use of limited health resource
 Life threatening surgical and medical errors
 Legal risk to provider, healthcare
organization
 Loss of trust

10. Challenges: “Meaningful Access”
 Title VI of the Civil Rights Act of 1964 prohibits discrimination
based on race, color, or national origin by any entity that
receives federal financial assistance.
 Focus is on “meaningful access” and federal programs
 How is it defined and by whom?
 Person receives and understands program information?
 Person can effectively communicate with service provider?

11. Challenges: Code of Ethics
 In small, emerging
communities, lines
get blurred.
 Professionalism
 Boundaries
 Respect Vs.
Advocacy
 Confidentiality
 Autonomy
 Community
“expert” Vs.
neutral/impartial
role

12. Challenges: Workforce
 Limited access to bilingual or qualified interpreters
 Limited job opportunities (mostly freelance)
 Complex system to navigate
 Changing workforce dynamics, shortages
 Reputation

13. Challenges: Reimbursement
District of Columbia and
13 states) are providing
reimbursement.
• Hawaii
• Iowa
• Idaho
• Kansas
• Maine
• Minnesota
• Montana
• New Hampshire
• Utah
• Vermont
• Virginia
• Washington
• Wyoming

14. Challenges: Training/Mentoring
 Limited language training programs exist in many states
 Interpreter training programs have grown over the past years
nationally.
 Over 70 programs advertise program including major
universities, but not any offering languages spoken by the
new African, Asian, Eastern European refugees and
immigrants.
 Very few prepare graduates for health related interpreting
 Limited formal peer to peer mentoring or support for new
medical interpreters.

15. Best Practices: Professional role

16. Best Practices: Cultural Brokering
 Most effective interpreters are those who not only interpret
language but cultural context and meaning.
 Visuals
 Metaphors
 Community-Healthcare Connections
 Explain cultural/ geographical norms
 Nonverbal cues

17. Best Practices: Grow Talent
 Focus on Human Capital
 There will always be limited number of individuals in the community
who have the “gift” and willing to do the hard work of being a medical
interpreter.
 We need to retain and grow the talent we already have while
encouraging another generation to pursue it as a career, not a job.
 Appeal to heart, not the head or pocket
 Best interpreters are those who have the compassion, yet have the
skills required to do the job
 While it may not always be paid job, medical interpreting can be a
rewarding, challenging job.

18. Best Practices: Technology
 Leverage Technology to:
 Educate patients
 Increase access
 Reduce impact of talent gap
 Reduce Cost
 Emerging tools:
 Smart Phone Apps
 Mobile VRI
 Phone interpreting devices
 Translation software

19. Best Practices: Hybrid Roles
 We need to think outside the box.
 Emerging models:
 CHW/Interpreter
 Transport/Interpreter
 Care Coordinator/Interpreter
 Educator/Interpreter
 Utilize the skills of a medical interpreter and combine it with
other critical roles in health care.
 That way we can ensure patients and families receive
affordable high quality care.

20. Policy Change
 Payment Reform
 Sustained legislative advocacy for payment
reform so all states can provide reimbursement
 Expand reimbursement to non-governmental
insurance
 National Certification/Registry
 There is momentum. Let’s capitalize on it.
 Let’s raise the standards, together
 Accountability/Consumer Protection
 There has to be consequences for poor access
to language services and poor interpreter
conduct besides losing a job.

21. All about the Triple Aim

22. Thank you!
 Contact:
Sahra Noor
Email: noors@peoples-center.org
Tel: 612-332-4973
Website: www.peoples-center.org