Return-Path: <nifl-fobasics@literacy.nifl.gov> Received: from literacy (localhost [127.0.0.1]) by literacy.nifl.gov (8.10.2/8.10.2) with SMTP id g6IFqMX06585; Thu, 18 Jul 2002 11:52:22 -0400 (EDT) Date: Thu, 18 Jul 2002 11:52:22 -0400 (EDT) Message-Id: <000f01c22e73$93f1a880$22ff6444@nv.cox.net> Errors-To: listowner@literacy.nifl.gov Reply-To: nifl-fobasics@literacy.nifl.gov Originator: nifl-fobasics@literacy.nifl.gov Sender: nifl-fobasics@literacy.nifl.gov Precedence: bulk From: "Kate Singleton" <katesingleton@cox.net> To: Multiple recipients of list <nifl-fobasics@literacy.nifl.gov> Subject: [NIFL-FOBASICS:577] Summit Summary: US ethnic/racial health disparities X-Listprocessor-Version: 6.0c -- ListProcessor by Anastasios Kotsikonas X-Mailer: Microsoft Outlook Express 6.00.2600.0000 Content-Transfer-Encoding: 8bit Content-Type: text/plain; Status: O Content-Length: 8531 Lines: 139 LONG POSTING Hello, Focus on Basics list subscribers. The following was written to be posted on the ESL list, but it contains information which may be of interest to a broader adult ed audience: Last week I was fortunate enough to attend the National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health in Washington, DC. The summit was put on by the US Department of Health and Human Services' (HHS) Office of Minority Health. Approximately 2,000 health care practitioners, health-related community-based organization representatives, and health educators attended from all over the United States. (To my knowledge, I was the only representative of adult education in attendance.) Much was discussed during the 3 day conference that pertains to adult immigrants and could impact our students and classes. I will summarize here some of the information I learned. Various workshops addressed the civil rights of immigrants, documented and undocumented, regarding access to health care. Below are brief explanations of some civil rights issues that affect immigrants. For further clarification, refer to the HHS Office of Civil Rights website at www.hhs.gov/ocr. · On language barriers: Deeana Jang, Senior Civil Rights Analyst of the HHS Office of Civil Rights clarified that federal law (Title VI of the 1964 Civil Rights Act and a guidance on its interpretation in 2000) prohibits discrimination by federal fund recipients (e.g. Medicaid, Medicare Part A payments) on the basis of race, color, or national origin. National origin covers people with limited English proficiency. The law covers state, county and local health and welfare agencies, hospitals, clinics, and other health care providers who receive federal money. These entities must ensure "meaningful access by LEP persons." This includes interpreting services, with options of providing bilingual staff, staff interpreters, contract interpreters, volunteer interpreters, or telephone interpreters. Patients should not be required to bring their own interpreters. This will hopefully prevent children from being in the awkward position of interpreting medical information on their parent's health, and will establish a professional standard for health interpreting. (Patients can bring their own interpreter if they choose their own over the one provided for them; however, it is the care provider's legal responsibility to provide one.) A tricky aspect of the law is that the type of language assistance a health care provider must offer is not set in stone; factors like size of the entity, size of the population served that speaks a given language, resources of the entity and the community, and the nature of the program or service provided are factored into determining the form of language assistance considered reasonable. Bottom line: While medical entities that receive federal funding may offer different forms of language assistance, it is the legal right of the limited English proficient person to have some such assistance provided. Patients should not be told they have to provide their own. If the law is not observed, people can report it to the HHS Office of Civil Rights without risk of INS being contacted. · On immigration status and use of public benefit programs: Dinah Wiley, also Senior Civil Rights Analyst at the HHS Office of Civil Rights, clarified that as a result of the 1996 changes to welfare laws, most legal immigrants cannot use TANF, Medicaid, SCHIP (State Children's Health Insurance Programs) or food stamps for 5 years after their immigration. Consequently, many families whose children are US citizens do not obtain SCHIP coverage for their children because the parents fear that it will impact their own immigration status, or, if they are undocumented, they fear their status will be revealed to INS through the child's application process. Children eligible for insured health care are not getting it. In the application process only the child's status is required. A child's use of SCHIP should not affect the parents' immigration status. Also, anyone that legally received benefits before the 1996 law change is not obligated to repay the government in order to have a green card. In practice, however, local benefits office or INS workers may not be educated on this fact. There have been cases investigated in which immigrants were told that in order to get a green card or readmission to the US, they had to repay public benefits that were legally obtained by a family member, because the INS worker did not understand the law. One workshop addressed various aspects of health literacy. The workshop was moderated by Carolyn Staley of the National Institute for Literacy. Andres Muro of the El Paso Community College Community Education Program spoke on how he helped his ESL program incorporate health into ESL classes. Below are points made by other speakers that may affect ESL learners and programs. · On collaboration between the adult education and health care fields: Cynthia Baur of the Office of Disease Prevention and Health Promotion (ODPHP) at HHS stated that, as one of its strategies to address the problem of low health literacy in the US, ODPHP is moving to increase collaboration between the two fields. Since health educators and adult ed often work with the same populations, the government feels that a combined effort may be more fruitful and economical. The government is in the process of clarifying what kinds of collaboration it will envision. It was apparent that members of the health care field are not aware that many adult educators already address health issues in the content of their lessons. This may be an opportunity to increase awareness of adult ed's work and to update curricula and materials in the areas of access to care, communication with health care providers, and general health awareness and prevention. · On literacy testing at the health care provider's office: One presentation promoted the use of a literacy test called the Test of Functional Health Literacy in Adults (TOFHLA). The TOFHLA was created by the health care field to be administered to patients by health care providers. The purpose of the test is to assess a patient's reading level to determine whether or not they are able to comprehend written medical instructions. Test administrators are not being given sensitivity training for working with adults of low literacy. As a teacher of basic literacy for 15 years, this information concerns me. The fact of being asked to take a test that no other person in the doctor's office is being asked to take could have a considerable negative effect on a person who is already feeling stigma over their lack of literacy skills. When asked if all patients entering a clinic would be tested, the presenter stated that it would be administered at the clinician's discretion, if he or she felt the person was consistently not following instructions. The fact that this is the only criterion for administering the test, and that it is subjective, is disconcerting. Other communication issues could be interfering and might warrant exploration before a test is administered. The test was created in English and has been translated into Spanish. There appears to be little consideration given to the fact that translating the test does not necessarily make it culturally appropriate for the wide variety of Spanish-speaking cultural groups in the US. Also, while the test is supposed to be given to English and Spanish speakers only, it is unclear whether all potential administrators will know not to give it to people who speak a different native language. Administering it to a person for whom it wasn't designed could have a negative impact on the patient and his/her treatment experience. While all participants in the conference would probably agree that the problems of racial and ethnic disparities in access to care and overall health are immense, the conference seemed to be an energizing, positive event for all. The federal government's clear expression of concern over the problem appeared to generate increased hopefulness for improvement. Many contacts were made, ideas shared and potential for collaboration discovered. It remains to be seen what this all will mean for adult ed and ESL in the future, but interest was certainly expressed in having us be a part of the solution. Kate Singleton katesingleton@cox.net Fairfax County (VA) Adult and Community Education
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