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In the US, everyone has the right to language access. Having language access for those with Limited English Proficiency (LEP) or other communication challenges helps to reduce disparities within social determinants of health and provide equal opportunities for those who have historically been marginalized. Over time, laws have been put in place to address language access. Some of the federal laws that pertain to language access include: So where does a language access plan fit in? A language access plan is a policy that an organization creates to discuss how they intend to provide language services to those individuals who are: A language access plan is a blueprint for an organization to outline and share its strategic approach for meaningful communication with those who need additional language services. It can include creating materials in other languages, interpretation and/or other communication paths. Some organizations, such as schools, healthcare providers, and government agencies, must provide a language access plan. For other organizations that provide services for LEP communities or individuals with other communication challenges, having a language access plan is a benefit and guidance for these services. While there isn’t a single method to follow, we have identified common components. We’ll share those in this blog. Based on publicly available government agency plans, organizations typically include the following components. The first section is usually a needs assessment that explains how an organization will assess the language assistance needs of the communities it serves. An organization can analyze these needs in a variety of ways: Based on the findings, the organization will gain insights and predictions to help the quality and breadth of its necessary linguistic reach. A designated language access coordinator(s) is one who will be responsible for the language assistance needs, such as: In addition to the language needs section, this section lists community leaders, stakeholders, and groups that work with LEPs or LEP communities. These organizations can be useful to get feedback, assess quality, determine priorities, get data about experiences, and more. Provide names of advisory committees, working groups, forums, resource sharing, and partnerships with other agency networking options to gain insights, information, tactics, and pool resources. Add information dissemination methods that reach multiple channels in print, digitally, onsite or otherwise. Participate and partner with organizations, programs, events, public meetings, key community stakeholders, social media, and more to ensure the communities have the information. Provide ways in which you plan to clearly track the quality of the language assistance. This can be done in a variety of ways, including an internal audit with reports; reviewing data from the LSP regarding complaints, timeliness of the deliverables or other success metrics; having the community stakeholders review content; or interagency/working groups review content to make sure the translations are accurate. In addition, provide how to onboard, gather customer feedback, track data, establish partnerships, maintain linguistic assets, and more. Describe how you’ll track language service usage over time, primary and secondary languages, and initial data intake from LEP individuals. In addition, know what tracking systems are available to you through overarching or interagency organizations. Additional line items that we’ve seen but less frequently include: The contents of a language access plan vary, as it’s really an individualized document for an organization. However, the components that we’ve shared in this blog post are quite common. An LSP can be a partner and consultant in helping you develop and execute a language access plan. An LSP can help you strategize about making your plan more efficient, saving you money and time, reducing risks, and increasing service quality. So take advantage of what your LSP, plus your resources and network, can offer. To learn more about how we can help you with your language service plans, contact us at [email protected] or (530) 750-2040.

Based on standard hearing exams, one in eight people in the US aged 12 years or older has hearing loss in both ears. This number equals 13 percent of the population or 30 million people. The Americans with Disabilities Act (ADA) requires title II (state and local governments) and title III entities (businesses and non-profit organizations that serve the public) to communicate with people who are deaf or hard-of-hearing. Subsequently, interpreting services are required in all kinds of industries, including courts, government, hospitals, and various smaller businesses and organizations. Deaf services for language access are more than just getting a sign language interpreter though—it is a complex world of access for those who are deaf or hard-of-hearing, and many different aspects are at play that go into pairing an interpreter and a person who needs sign language interpreting. In this blog, we will look at the different types of sign languages and deaf services that provide communication access, and what’s important to know when determining meaningful access for individuals. Like spoken languages, sign languages have developed organically through different groups communicating with each other. As a result, a single sign language isn’t used universally. In fact, somewhere between 138-300 different sign languages are used worldwide. Here are some of the more common types of sign languages used in the US. American Sign Language is most commonly used in the US and in anglophone Canada. Based on French Sign Language, ASL is thought to originate in the 1800s, making it a fairly new language. It’s a visual language with its own grammar and syntax, allowing for multiple word orders to represent a concept. Signed Exact English is a signing system that strives to be an exact replication of English. While ASL might have word order changes, Signed Exact English follows standard English order and rules, so it’s very linear. Tactile signing is a way of communicating using touch for those who are both deaf and blind. One person signs while the other places their hands on the signing person’s hands to feel what’s being communicated. Tactile signing is also known as “hand over hand” or “hands-on signing.” As with any language, different sign language terms may vary according to localized regions. For example, the sign for pizza varies across regions within ASL. Many sign languages are used throughout the world. Some are taught formally, while others may arise out of more natural contexts (such as Nicaraguan Sign Language). As a result, sign languages are seen as completely distinct languages. For those who schedule services for people who are deaf or hard-of-hearing, consider the following. Although ASL is the most common sign language in the US, not all individuals who are deaf or hard-of-hearing use ASL. That’s why it’s important to find out a person’s preferred language—if someone doesn’t use ASL, then providing an ASL interpreter won’t be helpful. Some examples include: In addition to the type of language service, the method of delivering the service is also very important. For example, some people may prefer in-person services while others prefer remote. The ideal scenario would be to provide the preferred type of sign language and the delivery method. Knowing second and even third preferences would also be beneficial in case the first preferences aren’t available. In addition to individual interpretation needs and preferences, other accessibility services for individuals who are deaf or hard-of-hearing also exist. CART, also known as real-time captioning, allows a provider to transcribe spoken words into text and then display them computers, mobile devices or screens. CART can be used in a variety of ways, such as events, training, classrooms, workshops, meetings, and more. Not only does it help individuals who are deaf or hard-of-hearing, but it also helps those who may struggle to hear in loud places and Limited English Proficient individuals. Remote CART can also be streamed to an internet browser for remote communication needs. C-Print is similar to CART, but it uses a QWERTY keyboard. The service provider uses software to type full and abbreviated words, and the software finds full words for the abbreviations. C-Print allows individuals to type responses, making the communication two-way. When seeking out an interpreter, consider these scenarios and preferences. Depending on certifications and skills paired with an individual’s preferences, these interpreters work with a person who is deaf and the organization to facilitate communication–most often using ASL. These interpreters are specially trained with personal knowledge of the deaf community, added resources, and more to work with a hearing interpreter as a team. They have firsthand knowledge of the deaf culture and can work with individuals who are children, use home signs, use sign languages from other countries, and more. CODA interpreters have grown up using sign languages, typically in tandem or even before using spoken English. They have nuclear family awareness about deaf culture and language. These technologies can be leveraged when individuals understand written English, but do not have a way to communicate through signs. Sign language interpreters can obtain a variety of certifications. These certifications show rigorous understanding of ASL through testing that helps to ensure the quality of interpreters and thus the integrity of the communications. The nationally recognized certifications include NIC (National Interpreter Certifications), CDI (Certified Deaf Interpreter), and others available on the RID website. In addition, Board of Evaluation of Interpreters (BEI), Educational Interpreter Performance Assessment (EIPA), and others may have formalized processes for certain uses or regions. The Registry of Interpreters for the Deaf, Inc. (RID) is the national organization that issued certifications for sign language interpreters. However, in 2016, they placed a moratorium on certifications as a way to address systemic issues with testing, and that moratorium is still in place today. Currently, the only nationally issued certification through RID is the National Interpreter Certification (NIC). There are already too few sign language interpreters, and the RID moratorium presented another issue. Since 2016, not many interpreters have been added. This can make scheduling last-minute sign language interpreters difficult, so plan ahead when you have a need for an ASL interpreter. We recommend using the information provided here to help get as much information from an individual about their needs before scheduling an interpreter. Also, be sure to schedule as far out as possible to ensure you can meet the needs. We provide remote interpretation services for all kinds of industries and environments. To learn more about our remote interpreting technology, see this video. For more information, contact us at [email protected] or (530) 750-2040. Let us help you provide the best language services.

California lawmakers approved the Voter’s Choice Act (VCA) in 2016, known as Senate Bill 450. The VCA “modernizes elections in California by allowing counties to conduct elections under a model which provides greater flexibility and convenience for voters.”¹ The VCA expands the options for how, when, and where voters can cast ballots in an attempt to provide more accessible voting options and increase voter participation. With options such as voting on weekends and voting at any center in the voter’s county, as well as by mail without requesting a mailed ballot in advance, voters have additional opportunities to be heard. In addition, the VCA provides accessible multilingual materials. In this blog, we’ll dive into some of the details of the VCA and provide resources for interested parties. The following are key components of VCA: Voters will no longer need to request a mailed ballot in advance. Instead, counties will mail a ballot to every registered voter 28 days before Election Day. Voters can then mail the VBM ballot, drop it in a ballot drop box or return it to a vote center. Vote centers will replace traditional polling places. Voters may vote at any vote center within the county instead of being tied to a single polling location. Voters can vote in person, drop off their VBM ballot, receive a replacement ballot, register to vote, and get help with voting through material in multiple languages and using accessible voting machines. Voters can drop off their ballots in ballot boxes postage-free starting 28 days before Election Day at various drop-off locations. Counties are required to hold education workshops with community groups, including organizations focused on limited English proficient communities and those with disabilities. In an ongoing effort to develop best practices and ensure a smooth transition to VCA, the Secretary of State works with various community groups and election administrators. They’ve established a taskforce of election experts and administrators, as well as disability and language experts, to provide input on VCA implementation. The VCA’s goal is to increase voter turnout by providing more flexible options for voters, and in turn, creating a more “successful” (accurate, full participation, and results) election. The VCA creates more accessible voting for individuals, which can increase turnout and encourage participation from community members that could otherwise be further marginalized by physical disabilities, language access, and educational awareness. In addition, the Election Administration Plan (EAP) process gives the public opportunities to provide input to shape the voting process based on community needs. Although the VCA came about before the pandemic in 2020, the VCA helped modernize the election process to meet remote lifestyle preferences. Every county that plans to follow the VCA model must create an election administration plan (EAP) and follow an open, public process for revisions and approval. The county must develop the EAP in consultation with a Language Accessibility Advisory Committee (LAAC) and a Voting Accessibility Advisory Committee (VAAC). Once the plan is drafted, the county will submit it to the Secretary of State for review. After approval, the county must post the plan and translated versions in a format that’s accessible for people with disabilities. Here are existing EAPs. The VCA is an optional law, so counties can decide whether they want to follow the new voting model. As of April 2022, the following 28 of 58 counties have been or will be transitioned to the VCA in 2022: As of February 2022, two additional counties are currently under local review and are awaiting board approval. The language and disability requirements are outlined in the code and are also summarized in this checklist. To verify the languages assigned by the Secretary of State, review this memo. For newer updates, check here. The LAAC and VAAC provide input to the Elections Office for these voters. Translating election materials requires precise, timely work using language that’s often tied to the election process and not often used in everyday communication. The English content can be difficult to understand for a native speaker, let alone for those who are limited English proficient. As a result, it’s usually best to use a translation provider with experience in multilingual election translation work. They should have glossary management, terminology management, and resources and processes to make the work run smoothly. A Voter’s Choice Act research team conducted a study to identify key successes, challenges, and lessons learned from the five initial counties that implemented the VCA model. The team put together several briefs on the results of the study on topics such as: Access the briefs here. In addition to all the best practices briefs, the League of Women Voters of California Education Fund has created a Voter’s Choice Act Toolkit for interested counties. Proponents of the VCA foresaw benefits including potential increased voter turnout due to more voting options. As a result, more and more counties are adopting the VCA model. We’ve been translating election materials for over 25 years, and we know what it takes. We have content resources to get you started, experienced translators to translate the content, and efficient designers to produce the final output. Let us handle the translation part of the election process, so you can focus on the other aspects of elections. Contact us at [email protected] or (530) 750-2040.

Providing language access to election materials helps to ensure more equitable elections in the U.S. If a person has a hard time understanding a ballot, that person will be less likely to vote. Unfortunately, this leaves a portion of the limited English proficiency (LEP) population out of the voting process – and being able to vote is a right for every person in our country.   However, election materials can be very confusing, even for those whose native language is English. The content and questions are often written in a roundabout and lengthy way, which makes it difficult to understand. In addition, the verbiage is unique to the election process, using terms that aren’t used in everyday communication. Now imagine translating that confusing content – it’s a challenge, to say the least.  Although it’s a challenge, it’s definitely an achievable goal. As a language service provider (LSP), we’ve been working with local and state governments on multilingual election materials for more than 20 years. We want to help others be as prepared as possible to produce the best translations. Based on our experience, here are 10 tips (plus a bonus tip!) to help you plan for translations of election materials.  Section 203 of the Voting Rights Act Amendments of 2006 outlines the U.S. Census Bureau’s Director’s factors in determining language access. Section 203 was updated on December 8, 2021.  Check to see if there are any new language requirements from your Secretary of State per the latest census data. For example, the state of Washington recently released that there’s a new requirement for King County to provide voting information in Spanish based on the new Section 203 language determinations.   Look at the census results for your area and review growing areas to anticipate new threshold languages (this guide can help you with your threshold languages). To let the community know about the translated content, create in-language pieces for local news, TV or radio outlets. You can also publish in-language in local community newsletters or magazines and find community organizations to partner with to spread the outreach and information dissemination.  The Glossary of Election Terminology, produced by the U.S. Elections Assistance Committee, contains around 1300 terms and phrases used in the administration of elections. The glossary is translated into 20 languages. You can use these terms and translations as a starting point, but be aware of differences or additions between your glossaries and local communities.  Create a calendar with dates and deadlines:  Although dates may change, you’ll at least have something that you and your LSP can work from.  Make a clear list of team members and their responsibilities, and share it with the team and your LSP team. Determine if there will be a single primary contact for working with your LSP or if you need further integration with team members. Include who will be making decisions and who just needs to be copied on translation-related communications.   In addition to your written translation needs, consider additional services that you may need, such as interpreting, ADA and WCAG compliance for your website, etc. Have a brief meeting with your LSP to strategize about these needs.   Most content will need some formatting, called desktop publishing (DTP). Since languages vary in length, the translated content will most likely need some DTP work to make it look correct. For example, tables may need to be expanded or the number of blank pages may need to be altered so the printed version looks as it should. If you have a project that requires heavier DTP work, include this time on your translation calendar.  If you have internal reviewers, train and prepare them staff on what they will be looking for and how to request edits. The ASTM STD. F 2575-14 Standard Guide for Quality Assurance in Translation is mainly used in the U.S. and will give you a good starting point to discuss the quality assurance process with your LSP.   Using translation tools will improve the quality of the translation. A glossary contains important terms with their preferred translations, plus acronyms, abbreviations, organization names, and proper nouns. A style guide lets translators get visibility to your county’s linguistic and stylistic preferences, such as the audience and proper tone. These important linguistic resources increase the overall quality and consistency of your documents, and save you time and money in the long run.   If you plan to revise your vital documents (including registration documents or other standard forms) before the next election, update them as early as possible. Also, make sure each one has translations ready. You may need to update some to incorporate new or changed terminology, or create translations for new documents.   Sign up for e-updates from your local state Secretary of State for changes in regulations, updates, free resources, and deadline reminders. Here’s a link to the California Secretary of State. Signing up will help you stay on top of changing requirements.  Every voice needs to be heard. While translating election materials may be a challenge, following these tips will enable you to be as successful as possible.   Given our extensive experience in government and election translations, we can help you save time and money while helping you connect with voters in any language. Let us make the translation aspect of your election season swift, economical, accurate, and completely stress-free. We can offer suggestions, guidance, and information for putting together a comprehensive, cost-effective translation program to serve your election needs. Contact us at [email protected] or (530) 750-2040. 

The Americans with Disabilities Act (ADA) and Section 508 of the Rehabilitation Act of 1973 are civil rights laws protecting those with divergent abilities. We’ll cover what these laws are and examples for accessibility and language access. The ADA is a civil rights law that prohibits discrimination against people with disabilities. The law, which President George H.W. Bush signed in 1990, provides guidelines for how organizations must communicate with those who have disabilities and covers several areas including: “requires access to electronic and information technology provided by the Federal government… Federal agencies must ensure that this technology is accessible to employees and members of the public with disabilities to the extent it does not pose an “undue burden.” Section 508 speaks to various means for disseminating information, including computers, software, and electronic office equipment. It applies to, but is not solely focused on, Federal pages on the Internet or the World Wide Web.” Source While there’s clear crossover between the two, as ADA requires accommodations in physical spaces, digital media, websites, and more, Section 508 specifically lays out regulations in the areas of: policy & management, acquisition, content creation, design & develop, testing, and training tools & events. Organizations who need to follow a stricter guideline like Section 508 can do so following exactly defined areas. If you need specific help identifying regulations within your organization, your HR department should assist. It may mean looking at your communications and how they relate to language access – English or other languages, large print, contrasted colors, captions, braille, reader-friendly screen, and more. Here are some examples of what organizations need to follow. Many organizations still take a reactive approach when it comes to accessibility and translations. Being reactive means not providing language or accessibility support and including a statement (or not) that a person can request this support. Proactive means making an effort before the request to provide accessibility. For example: Here’s an example of a website that’s reactive and one that’s proactive.  This website has a page that talks about accessibility assistance and provides an email address where you can reach out for help. However, the webpage isn’t translated, there aren’t links to high contrast or large text, and there’s no apparent screen reader assistant or alt text. Whitehouse.gov is a good example of a proactive (and required) website: Every page includes high-contrast and large text options. The ADA and Section 508 were created to assist those with disabilities and cover a wide range of requirements. We provide accessibility and website localization services to help organizations be proactive and compliant. For example, we helped a California health plan provider localize their website into their threshold languages and ensure compliance with California government code section 508 and WCAG accessibility standards. Read more about it. Our accessibility services include providing a thorough report on areas that aren’t meeting compliance as well as fully or partially implementing our findings. In addition, we can provide website localization into more than 150 languages. For more information, contact us at [email protected] or (530) 750-2040.

To reduce disparities within social determinants of health (SDOH), everyone needs equal access to opportunities and information. And for those with Limited English Proficiency (LEP), language challenges can contribute to many SDOHs. Healthcare is one of many areas where LEP individuals may face language roadblocks. For example, recent research pointed out that more language access to information dissemination could help to reduce healthcare inequities. The study found that communities that fell in the CDC’s social vulnerability index (SVI) were hit harder by COVID-19. The SVI measures demographic data such as English proficiency. The research showed that “counties with high populations of non-English speakers were found to have higher rates of both COVID-19 incidence and mortality.” More timely health information for LEP communities could help to reduce health inequities. Yet while “having” language access is without a doubt very valuable to diverse communities, organizations need to promote that it’s available and accessible before the need arises. For example, if you’re hosting a community event, and you translate the invite, but then don’t share it in places where your audience can see it, how are LEP community members going to know about it? Anticipating language access via outreach can lead to higher participation of diverse community members ultimately resulting in a more accurate representation of our American people. Let’s look at different levels of language assistance and ways to be proactive with multilingual outreach. As a language service provider, we see various ways that companies and organizations provide language assistance. They don’t translate content unless someone asks them. For example, their website and documentation are in English only, and there’s no mention that translations could be available. They don’t proactively translate content, but they do offer a place where you can ask for translations. For example, they might have a page that says if you’d like to request language access or accommodations, do so here. This type of company has translated content plus ways to request translations. For example, their website is localized, so a person can select the Spanish version. As a result, this audience will get a better understanding of the available services. This group has translated content, and they also spread awareness that they’re a source of information for diverse communities. For example, a company may contact a local Latin American Association to share a flyer containing information about their services or an upcoming event in Spanish. Having proactive translations with multilingual outreach: For example, climate change affects how we live our lives and the quality of our lives by way of pollution and more. But if climate change information isn’t actively shared in all languages, how are all people expected to know, understand, and contribute to change? And since the impacts of climate change are long-lasting and steps to revert it aren’t immediate, it’s more important than ever for people to know about it and pass down information to future generations. Sophia Kianna, a 19-year-old climate activist, is fighting the accessibility gap in climate change resources in the U.N. Kianna is a founder of Climate Cardinals, an international nonprofit that translates documents related to global warming. When Kianna visited her parents’ homeland of Iran, she saw how people knew little about climate change and decided to do something about it. “Climate change is disproportionately affecting the middle east and temperatures there are rising more than twice the global average,” she explained. “I decided to translate climate information to teach them because I realized there was very little information in Farsi which is their native language.” source Here are 8 ways to be proactive with your translation strategy to reach others. It goes without saying that you must translate your website! Many people first look for information online, so make sure you translate your website into your threshold languages. Create bilingual or multilingual emails. Or take it one step further and segment your emails to go out in the language your audience prefers. Like emails, create bilingual or multilingual social media posts. You can also create translations of the English version. Translate your outreach mail, flyers, brochures, and other print materials into your threshold languages to have available or pass out in tandem with English versions. Create multilingual invites with the clearly marked type(s) of language assistance that you’ll provide for the event. If you have bilingual individuals in the field who can talk one-on-one, you can strategically place them and hire those with skills that match local threshold languages. If you have multilingual content, whether that content is in the form of email newsletters, bulletin boards, groups, forums, etc., find opportunities to share it with local communities. For example, see if you can put flyers about your upcoming gathering in a place where your audience frequently gathers. If you produce critical and timely information, such as hurricane evacuation procedures, translate this content for your LEP communities. If this information is only accessible in English, LEP individuals are at a safety risk. Make sure that translations are available and provide translated instructions for where they can find them. Here’s a resource on how to best connect with your Spanish-speaking audience during an emergency. Translating content is undoubtedly a step in the right direction in helping LEPs reduce health disparities. Taking it to the next level by proactively seeking ways to get that information in front of the right audience will have an even greater impact. After all, taking an approach to language access that’s proactive will better serve everyone and contribute to a more inclusive society. To learn more, here’s a resource for strategies for outreach to families with LEP. Translating everything at once or every time something new comes up can be overwhelming. A language service provider (LSP) can help strategize ways to help you with your translation plan–things like identifying your threshold languages and reducing costs and workload while still maintaining best practices. At Avantpage, we provide translation and localization services, interpreting, accessibility services, and more. To learn more about our services, contact us at [email protected] or (530) 750-2040.

The COVID-19 pandemic has changed many aspects of healthcare. One of those aspects is routine doctor visits. While many health issues still need to be handled in person, others can be done online through telehealth services (also known as telemedicine). Telehealth lets you talk to your healthcare provider live over the phone or video chat, send and receive messages using a secure online system, and use remote monitoring for updates.   Telehealth services have grown exponentially during the pandemic. A study by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that the number of Medicare visits conducted through telehealth appointments increased 63-fold, from 840,000 in 2019 to 52.7 million in 2020. Also, the number of behavioral telehealth appointments increased 32-fold. Telehealth is here to stay.   Telehealth offers many advantages, but it also highlights the gaps in language access, digital literacy, and Wifi accessibility, and thus health disparity, that can impact the health of those with limited English proficiency (LEP). While healthcare organizations may not be able to address some technology issues, they can implement language access solutions in telehealth and the patient journey overall.  Telehealth has advantages and disadvantages for healthcare organizations and patients. Advantages include:  Disadvantages include: 
Let’s look at one of these barriers: digital accessibility for those with language needs. Unfortunately, this barrier can exacerbate disparities in the healthcare system. For example, one primary care clinic that usually had 14% non-English speaking patients noted that the numbers dropped to 7 percent when operating only as telehealth during the pandemic.    Healthcare organizations won’t be able to make internet access more accessible, but they do have options for improving language services. So how can healthcare organizations close equity gaps when addressing blocks in telehealth and digital access?  For healthcare appointments, providers need to meet language access laws. This includes telehealth, which poses some changes to the new landscape such as accessing remote interpreters, digital literacy, technology, and (Personal Health Information) PHI security.  Providing interpretation services, whether they’re through video remote interpretation (VRI) or over-the-phone (OPI), is critical for improving language access. Healthcare providers should have established language agencies with the set up for appointments and last-minute needs. A language service provider (LSP) can help strategize your needs to efficiently meet video appointments and larger volume calls.  To improve healthcare literacy through language, consider patient touchpoints with your organization. The patient journey starts with searching for providers, having an initial appointment, and aftercare, including self-administration of care, and all the touchpoints in-between. When you think about the patient journey, ask yourself these questions:  If you identify areas that need improvement with language, consider strategizing with your LSP. For example, perhaps you should localize your website or create language voice options on your phone system, and your LSP can help you with that. 
Determine the Best Solution(s) for Your Patients’ Needs 
One language scenario may not be enough to fulfill your patients’ needs. Given the disadvantages that we described earlier, and as COVID-19 continues to challenge traditional healthcare solutions, healthcare organizations may have to more than one language strategy for given scenarios. 
Technology Considerations
For example, telehealth appointments may not be the best solution in some cases. With VRI, consider the following factors to have a successful meeting: 
Consider other telehealth options where video conferencing technology won’t be as much of a challenge. For example, some LEP patients may be more comfortable over the phone than on video. The AHA 2022 Environmental Landscape showed that of the 27% of Medicare beneficiaries who participated in telehealth visits, 56% were over the phone, 28% were video, and 16% were both.   Of course, some types of topics are better for telehealth than others. Here are some examples.  Lastly, consider language factors, such as requests by the individual for a specific language and method, complexity of the meeting such as multiple participants which can be confusing on video or phone with interpretation, the digital literacy of all participants, limited hearing by participant(s), sign language users (meaning OPI isn’t a possibility), and more.   Telehealth services are going to continue to grow. To reduce health disparities in language, healthcare companies can provide interpreters, address language needs along the patient journey, and evaluate the best solutions for your patients. We provide VRI and OPI services for healthcare organizations and other industries. To learn more about how we can help you, contact us at [email protected] or (530) 750-2040. 

When you have a health decision to make, do you feel fully informed and armed with the knowledge to make a decision? Do you understand what the doctor told you? Interpreting basic health information, especially when it’s a serious issue or you’re feeling pressured for time, can be incredibly difficult and have a direct impact on your health outcome. Having knowledge and understanding of a health issue is part of health literacy. Other factors include education level, language, health behaviors, and the health systems that are accessible.   Health literacy varies greatly across the U.S. In a study by UnitedHealth Group, even in counties with the highest health literacy, 15-27 percent of the population has limited health literacy. In the counties with the lowest health literacy, 36-59 percent have limited health literacy. Higher health literacy leads to better health outcomes, since people can make informed, educated decisions. Better health outcomes and informed decision-making lead to lower costs for healthcare organizations over time as people can catch problems early, use preventative care, follow post-care properly, and more. In fact, according to the UnitedHealth Group study, improving health literacy could save over $25 billion a year and prevent nearly one million hospital visits. For example, Medicare beneficiaries with higher health literacy had: Healthcare organizations must consider health literacy as health costs rise, demand in healthcare is overloaded, and a labor shortage means limited resources to match the demand. One of the factors of personal health literacy is language. If someone is limited English proficient (LEP), healthcare organizations need to consider the gap caused by language barriers and lack of language access. While we all might face health literacy issues, the LEP population may be impacted twofold by the same health literacy issues because they have an added struggle of language understanding and access. For example, a study from BMC Women’s Health found that Spanish-speaking Latinas recovering from breast cancer reported less shared decision-making compared to English-speaking Latina or white patients. In addition, their health-related quality of life and quality of care was worse because of the language barrier. So what can healthcare organizations do? LEP individuals have historically been marginalized, directly impacting health outcomes and leading to part of the health disparity gap that we now face. Stronger relationships between providers and patients and better communication can improve health outcomes. Here are some things that healthcare providers can do. Have qualified interpreters set up and ready to avoid using ad hoc interpreters. Research has shown that ad hoc interpreters are associated with lower health outcomes and quality of care, as well as higher costs. As shown in these articles and studies, set up professional interpreters, so you don’t end up in an ad hoc interpretation or no interpretation situation. Also, include in-person, video, and phone options, as you may have situations that work for each and others that might not be appropriate. In one hospital, the mortality rate for Latinx children in the pediatric intensive care unit (PICU) had a 3.7-fold higher mortality risk than White and African American children. The research controlled covariates such as illness severity, age, sex, insurance status, and diagnosis. The hospital was able to drop the mortality rate to a comparable level through a comprehensive effort of: A patient family educator (or Community Benefits Manager, Outreach Manager, and other similar titles) is a professional appointed to a patient who helps walk the patient (and family) through treatments, options, etc. in plain language and focuses on that relationship from a relatable educational standpoint. That person advocates for the patient’s needs and helps the patient overcome obstacles. A bilingual patient family educator can help a patient overcome the language barrier by translating medical information into easier-to-understand language, and can share helpful resources (such as Medicare Resource sheets that are already translated into a variety of languages). It can be easy to forget to break down your communication into plain language for general audiences as a medical professional. In addition to trying to understand what’s being said, a patient may be in a state of surprise or confusion, so a patient may not be thinking clearly. Therefore, speaking in plain language is a crucial aspect of communication to consider, especially when speaking to an LEP patient, who has an additional language barrier to overcome. Also, ask about a patient’s understanding, and offer additional ways of reaching out, asking questions, or getting more information through websites, booklets or pamphlets. Along with communicating in plain language, look at ways to drive patient satisfaction along each step of the entire patient journey. Ensure patients are nurtured from before the appointment to follow-up services to after-care through translated communications. Provide them with language services in the language they need before any interaction occurs.  Having your website in threshold languages is very important for your LEP patients. To better understand your community’s language needs, look at your health data and Google Analytics. Your localized website will open doors for patients. Improving health literacy leads to better health outcomes and reduced costs for healthcare organizations. To help improve health literacy for the LEP population, health organizations can provide regular interpreters, hire patient family educators, explain concepts in plain language, provide patient-centered care, and localize their website. We can help you with your language needs, including building a language plan, interpretation, translation, and threshold languages. For example, we have a  secure, on-demand, telehealth interpreting platform for short-term or multifaceted solutions. Contact us at [email protected] or (530) 750-2040 to learn more.

Based on Title VI of the Civil Rights Act, everyone is permitted the right to receive Federal financial assistance and not be discriminated against race, color or national origin. Laws have been passed at the Federal, state, and local levels to ensure equal access to services by people with limited English proficiency (LEP). In the case of legal settings, language access is critical and should not be a reason for legal outcomes. Part of the language access that needs to be provided is via document translations. A “vital document” is one that needs to be translated for use to maintain equity for all people. And a document doesn’t mean just a document – it can also be in the form of videos, online content, etc. The US Department of Health & Human Services (HHS) defines vital documents as “documents that affect access to, retention in, or termination or exclusion from a recipient’s program services or benefits.” Examples include applications, service benefits, written tests, and many more. In some situations, such as when recipients receive Federal financial assistance from the US HHS, those recipients must take reasonable steps to support the LEP population. Recipients include organizations such as hospitals, managed care, universities, and many others. In some situations, guidance may not be available as to what’s considered a vital document, so it’s up to the individual organization to determine what’s vital and should be translated. The goal is to ensure that language access does not affect someone’s understanding, decision, the timeframe of replies and actions or any other aspects of legal proceedings. And what languages should you translate into? If you’re in a regulated industry, each organization has its own requirements for threshold languages, which are languages that you must translate documents into based on the local communities. If you’re working with a client who doesn’t fall into threshold languages, you’ll still need to provide language access to accommodate the individual. In this blog, we’ll cover how to identify a vital document, provide some examples, and share how you can partner with a language service provider (LSP) to meet your document translation needs. According to the California DOJ, a document is vital “if it contains information that is critical for obtaining services or providing awareness of rights, or is required by law.” For translation purposes, the DOJ has specifically defined the following documents as vital in legal settings: These guidelines should help you determine if something is considered vital. It might be clear whether you should consider some documents to be vital, while others might be more challenging. In the case of vital documents for legal purposes, here in California, the Judicial Council of California (JCC) suggests considering three areas: criticality, frequency, and usability. If you’re trying to determine whether a document is vital, ask yourself the following questions based on JCC’s factors: These questions should provide some guidance on whether you should consider a document to be vital. Based on the results of your analysis, you may also want to create a translation priority list to make sure that the most critical documents get translated. Once you’ve decided what’s vital, the next step is to get the document(s) translated. Translating legal content is a specific skill that requires experienced, professional translators, so there’s no doubt that it can become costly. That’s why it’s best to prioritize your translations projects and strategize your approach with your LSP so that they can meet your translation requirements in the most cost-efficient and organized manner possible. We’ve been working with legal content for 20+ years. During this time, we’ve helped our clients reduce their costs over time by using these tools and following best practices. AvantMemory is a workflow to track progress, track files, and assign translators, all in real time. All linguists can access the same translation memory and terminology online in real time and share comments with each other. It also leverages the repetition of words, which means more consistency and reduced costs since you’re not translating the same words and phrases over and over. Using a style guide can increase consistency across your content, thus ensuring high-quality translations. Having a clearly defined translation memory, terminology, and style guide as part of the translation workflow can help your LSP easily understand your translation preferences, which in turn can reduce turnaround time and improve quality. There are about 6,500 languages in the world, and 66% of the world’s population speak one of these 12 native languages. But that doesn’t mean that your target audience speaks these languages. Plus, translating into all of these languages would be costly. So instead, work with your LSP to understand your needed threshold languages and other cost-saving tactics that will help you direct financial resources to where it matters the most. There’s no need for separate business systems. We can integrate our multilingual tools and technologies into your existing IT framework. We match your current processes and needs through our integrated solutions, and we put systems in place that will be more sustainable and autonomous, thereby saving you time and headaches. Emergency translation needs do come up. By acknowledging in advance that these situations do occur, we’ll get you set you up so we’re prepared for your projects. Then when there’s a last-minute need, we’ll take care of your project so there’s no slowing down in getting your rapid-fire translations (rush translation) when you have a tight deadline. It may not always be easy to determine what’s a vital document. The goal is to make sure that language access doesn’t affect someone’s understanding of any part of legal proceedings. We’re here to help strategize and translate your vital documents, as well as advise on your threshold languages. With our tools and best practices, we can help you save time and money in the long run. For more information, contact us at [email protected] or (530) 750-2040.

Patients and families with limited English proficiency (LEP) face disparities in healthcare treatment, resulting in lower-quality care and poorer health outcomes. Disparities in healthcare occur in LEP communities due to language barriers on all sides of interactions. Additionally, race and cultural difference contribute to healthcare disparities. Therefore, healthcare organizations need to provide meaningful services to their LEP members to help decrease health disparities. One of the ways healthcare organizations can begin to address disparities is by gathering data to help drive decisions. The National Committee for Quality Assurance (NCQA) is helping companies address and close inequities gaps in healthcare. They created the Healthcare Effectiveness Data and Information Set (HEDIS), a set of standardized performance measures that companies can use to identify areas to close gaps in quality. Ultimately, this information can be presented to LEP members so they can compare health plans. At Avantpage, we help companies bridge worlds through language, understanding, and compassion. One of the ways we do this is to provide language services for companies aiming to improve their HEDIS results. These services include interpretation, translation, accessibility, and more. For example, it’s been shown that using professional medical interpreters “is associated with decreased health disparities for patients with LEP, improved patient comprehension, fewer medical errors, and greater patient and clinician satisfaction compared to use of ad hoc interpreters, such as family members or bilingual staff.” We can provide companies with this type of interpretation via our OPI and VRI platform, and through comprehensive translation services meeting culturally and linguistically appropriate standards. Let’s take a deeper look at addressing disparities through HEDIS and how you can work with your language service provider (LSP) to gather data and strategize about improvements. NCQA was created to improve healthcare quality. Their three core ideas to drive work in health equity are: NCQA created HEDIS as a first step in a multi-year process for sustainable movement to reduce health disparities. HEDIS is an optional standard with 191 million people enrolled in plans that report HEDIS results. The standards include 90 measures of data tracking across the following six domains of healthcare: For example, the “effectiveness of care” domain includes measures such as prevention and screening, diabetes, behavioral health, and many more. For 2022, NCQA updated HEDIS to include race and ethnicity as a portion of the measures to gain additional data about inequities in race and ethnicity in healthcare. For example, Health Net, LLC, gathered data to improve cervical cancer screenings for Chinese members ages 24-64, as the historical data showed that this group experienced lower rates than other groups. The first step is to collect truthful data to shed light on areas needed for improvement and gain a transparent understanding. From there, you can cross-reference HEDIS to key health areas and identify outcomes for continual improvement. We’d recommend doing the following to learn more about HEDIS. You can purchase the HEDIS standards for internal use in your organization. These standards will help guide you in collecting data. By participating, you can improve your healthcare services to better meet your diverse target populations. Become a HEDIS Users Group (HUG) member to get the latest information and engage with other HEDIS members. NCQA generates various reports and research to help you identify ways to improve your healthcare offerings. NCQA has various certifications to validate accuracy and support your organization. Read more about how you can obtain one or more certifications. Your LSP can collect your data as a step towards meeting HEDIS standards. Your LSP will also have access to a lot of data based on locale, industry, service, and languages. You can use your LSP as a consultant to better understand and leverage that data for strategizing the best efforts to increase quality continuously. You can also leverage the strategy for your language access plans. For example, a health care provider wanted to understand employee success data for continuous quality improvement. Their goal was to work towards higher equity. We worked with them to create employee assessments as a continuous and proactive measure of language success. Learn how they used the quarterly employee assessments to ensure their staff translators’ improvement, consistency, and quality. Additionally, here are some other ways to work with your LSP. Ask your LSP to provide data about your past language services. Use this data to strategize about ways to work towards improvement in equity. Ensure your services and communications meet linguistic and cultural needs by reviewing the Culturally and Linguistically Appropriate Services (CLAS) standards. Your LSP can guide you. Consider customizing language services for added benefits for your organization. Your LSP is like a support system to lean on. For example, when All Plan Letter (APL) passed early in 2021, it required new languages for a variety of healthcare plans. We helped these companies address the new requirements. Your LSP can help you navigate your potential needs to prepare you for all language scenarios. For example, have remote interpreting available for last-minute needs so you’re not caught having to use an ad hoc interpreter and risking the quality of the communication. Learn about our secure, on-demand, telehealth interpreting platform. Take data into your own hands. With our new AvantPortal releasing in 2022, you will have access to a dashboard of valuable data that’s also customizable. Data can help you make business decisions and understand how you’re using language services. Consult with your LSP on customized needs to fit your organization. Contact us today to learn how you can optimize your language plans and ask questions. NCQA established HEDIS to help healthcare organizations close the gap in healthcare inequities. Standards like HEDIS enable LEP healthcare members to review what healthcare companies are doing to improve and experience higher quality care. Your LSP can provide resources, expertise, and language services to help you get started. To learn more about how we can help you with the HEDIS standards, contact us at [email protected] or (530) 750-2040.

A language access plan is a document that describes how an organization plans to provide services to individuals who are non-English speaking or have limited English proficiency (LEP). A language access plan helps to facilitate and articulate an organizations’ needs, budgets, and ensure civil rights over a period of time. While the content may vary, a language access plan usually includes subjects such as: As the new calendar year is approaching, you may be planning or finishing up your plans, including your yearly budget requests. This is a great time to involve your language service provider (LSP) with your plan. Working with your LSP to strategize about your plan can make your organization more self-sufficient, save you money and time, mitigate risks, increase service quality, and overall, see a higher ROI. So just as you’d create a marketing strategy, you should also create a language access plan strategy with your LSP. You may have some ideas about how to save time and money on translations, which is a great start, but your LSP is the expert and can provide invaluable advice and insight. An LSP is in a particularly advantageous position to help strategize your organization’s language needs, so together, you can maximize your investment in translations and bring awareness of your plans to your LSP so they can support you for the year. You can consult with your LSP or contract their services to create or modify a comprehensive language access plan. Let’s look at how an LSP can help. An LSP knows how organizations create and manage language access plans. Depending on your location, your LSP may also know the region and what other organizations in that area are doing for specific language requirements and language pairs.  An LSP can also help you better understand vital documents and what’s required for your specific threshold languages, as well as identify any holes in meeting compliance requirements or providing recommendations for risk management. They can also recommend where to focus and where it might be acceptable to skimp to save funds for critical areas.   An LSP will also be up-to-date on trends with plans as well as federal and local laws. They’ll also know what others have done recently with success, and on the flip side, what hasn’t worked as well. For example, in 2018, the California Voting for All Act (Assembly Bill (AB) 918) expanded language requirements from county-level to precinct level. Since we work on language services for elections with over half of California’s counties, we were able to help notify current customers of the new requirements.  Ultimately, an LSP’s guidance should enable your organization to become more self-sufficient and autonomous. And the less time you need to spend on details throughout the year, the more you’ll save since time is money.  An LSP can review your services and budget, and strategize with you about where your funds should go to maximize your return on investment. In addition, an LSP can see where there might be other options than what you’ve laid out, and ways in which you can spend less money or meet goals in different ways.  For example, we met with a company that provided healthcare services and plans. The company had a full-time website developer on staff, so we didn’t need to implement the translated website content or accessibility changes that we recommended. Instead, we provided reports and reviews so that the website developer could implement the changes, which we also prioritized for the implementation. As a result, they were able to update their website into new languages and meet accessibility needs, while strategizing their profit making use of already available resources.   If you’re relatively new to preparing a language needs plan, or even if you’ve been doing them for a while, it always helps to get refreshed data for planning purposes. The 2020 census provided an update on who we are as a country. This information will help guide those who work with the LEP population.  We can take that one step further. We can take your data, analyze it, and prepare it with the latest data and local needs. And if you use our language services, we can use data from past years to make the data even richer and identify patterns of use for predicted needs in the future.   No matter how well anyone plans, emergencies do arise. And when these situations occur, you want a partner in your LSP not just to help get you through it, but also to provide options and confidence in the ability to deliver.  In one such case, we helped the Riverside, California County Registrar of Voters when they had to adjust their operations for an emergency for the US 2020 Presidential Election due to the COVID-19 pandemic. As the 4th most populous county in California, Riverside County needed to revise all of their election materials before the election in a short timeline. They leveraged our Customer Portal to manage the logistics of translating and formatting materials in five languages (over 140,000 words), resulting in content that we delivered on time and within budget.   One of the last, but most important parts, of implementing a language access plan is to train your internal staff on the processes and procedures. In other words, what do the day-to-day services and interactions look like? Is your team prepared?  For example, let’s say you have an over-the-phone interpretation option. However, if a staff member doesn’t know that option is available, or if they need a code to dial into the service they don’t have, that person may use Google translate to get through the situation, resulting in a poor or even wrong interaction.  Make sure all the bases are covered. For example, we can help your staff learn what to do for language requests, how to understand language needs, what to do during a language complaint, how to identify a language, how to create policy posters, etc.   Creating a language plan on your own is a great start, but incorporating the consultative services of an LSP will provide the expert trends, experience, and data to make it more successful. Any upfront costs can ultimately save time and money in the long run. So instead of thinking about your LSP as just a service provider, think of them as a strategist, consultant, and partner. Working with an LSP upfront can also help your language plan framework for the years to come.  To learn more about how we can help you with your language service plans, contact us at [email protected] or (530) 750-2040. 

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”
- Martin Luther King Jr. One of the social determinants of health is healthcare access and quality, which includes having access to healthcare, health insurance, and health literacy. Health literacy is how patients understand and retain healthcare information to make informed decisions and take action. Receiving healthcare education has a direct impact on a patient’s health outcome. Part of health literacy is language preferences, which is a crucial component of a healthcare interaction. When language preferences aren’t addressed during a clinical encounter, data shows that the quality of care can be low, unsafe, and costly. For healthcare to become more equitable, healthcare companies must provide content in the preferred languages of the current and potential customer base. To help with inequities in healthcare, improve the quality of services, and achieve health equity, the U.S. Department of Health & Human Services created a set of standards called Culturally and Linguistically Appropriate Services (CLAS). This standard was created for health and healthcare organizations to: Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs (CLAS Standards). The CLAS Standards provide guidance in three main areas: The goal is to help healthcare organizations remain respectful of diverse cultures and languages, which in turn can increase member retention and grow the member base, and ultimately, improve health equity. At Avantpage, our goal is to improve lives and bridge worlds through language, understanding, and compassion. We help organizations ensure their content and communication is created and reviewed with CLAS standards in all areas of our language services, from interpreting to translation to accessibility. Let’s take a look at language needs and ways you can apply the CLAS Standards. As much as culture and language can be tied together, they also need to be considered separately. It’s the combination of the two that provide the most appropriate and comfortable experience. Creating something culturally appropriate means having it make sense for a target member’s culture. Here are some examples. Since culture is highly socio-based, it can also be different in different locations, like a big city versus a rural area, and change over time. To nail what’s culturally appropriate, you should involve experienced linguists with a strong cultural understanding of your audience. Having something linguistically appropriate means making the language appropriate and linguistically correct by looking at various of aspects of the language, such as the language itself, the voice used such as formal or informal, and the intent or messaging. Here are some examples. Again, experienced linguists will review content for appropriate translations. So, what do some of the CLAS Standards look like in healthcare applications? Here are some examples. Interpreting requires implementing culture and language while speaking to a member. Using professional and qualified interpreters is a must so that the interpretation is accurate and appropriate, and doesn’t leave any room for confusion or miscommunication. For example, a doctor’s office recording states in English that they’re open Monday through Friday from 8AM – 5PM except for Tuesdays and Thursdays between 12PM-2PM. If the phone interpreter fails to mention when the office is closed, it could result in the individual showing up when the office is closed. As we pointed out in the example about reaching a Muslim audience, you have to fit a culture’s expectations. Marketing a flavor such as bacon to an audience that does not typically eat pork products might not resonate with your audiences - especially on religious and fasting holidays. You have content to translate into the target language, but the formatting from the source language doesn’t work with the target language. For example, you have a table that compares healthcare plans. The text in the table is at maximum capacity, so there’s no more room. When you translate that text, it has no room to expand, so it might overlap other text, making it difficult or impossible for target audiences to fully comprehend the content. As we previously described in the HubSpot article, the Japanese translator added content to the Japanese translation to meet the audience’s cultural needs. Accessibility has to be comprehensive. If you have a website with alt text for images to help readers and the ability to enlarge text, that’s a great start. However, if the colors aren’t highly contrasted, then the website isn’t fully accessible.  The CLAS Standards emphasize the importance of being both culturally and linguistically appropriate in your services, and while these two are separate, they need to be reviewed and function together. Since culture and language include such a diverse array of possibilities, change over time, and are highly nuanced, it’s best to partner with a language service provider (LSP) to get it right. An LSP will help you target your messaging for the audiences that best match your organization. An LSP will also have the network capabilities to fully employ people with the relevant skill set, experience, and cultural understanding to provide meaningful messages that resonate with your target audiences. As a result, you can attract potential members and better support your current members. Bit by bit, we can all help healthcare become more equitable and improve the quality of healthcare services. To learn more about how we can help you with the CLAS standards, contact us at [email protected] or (530) 750-2040.