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Telehealth services can increase equitable healthcare or exacerbate disparities. Telehealth services needs grew exponentially during the pandemic: the number of Medicare visits handled through telehealth increased 63-fold, from 840,000 in 2019 to 52.7 million in 2020. Behavioral telehealth visits also increased 32-fold. And while telehealth provides many advantages, it also exemplifies health disparities. Those who are limited English proficient (LEP), have lower rates of digital literacy or don’t have Wifi are at a disadvantage when it comes to telehealth. In order to create more equitable healthcare, health plans need to create intentional strategies to address the gaps in telehealth to make it a more equitable healthcare option. Addressing these gaps can benefit for healthcare organizations and their members: Telehealth is here to stay, so how can healthcare companies increase telehealth equity? The National Committee for Quality Assurance (NCQA) produced a white paper called The Future of Telehealth Roundtable, which covers opportunities and solutions to reduce health disparities in telehealth. One of the three areas they cover is “tailoring telehealth use and access to individual preferences and needs.” This area includes things like language barriers, digital literacy, and comfort level, and it provides a big opportunity to increase equity for LEP patients and their families. The roundtable participants emphasized the importance of putting the patient first and prioritizing their preferences. Here are eight ways healthcare organizations can address telehealth inequities regarding preferences. For a more equitable telehealth experience, use a patient’s preferred language. This means translating content such as technology instructions and support materials, and providing an interpreter during the telehealth visit. Provide language access along the entire patient journey, including the: Language access should also include ensuring that content is culturally and linguistically appropriate. To guide health and healthcare organizations in advancing health equity, the U.S. Department of Health & Human Services created Culturally and Linguistically Appropriate Services (CLAS). CLAS is a set of 15 action steps that organizations can use as a blueprint to reduce health care disparities. Content that isn’t just translated, but also takes into account one’s culture, helps provide an equitable healthcare experience. It can include targeted information like statistics on the specific culture instead of general information or providing pictures of people who look like the culture you’re targeting. Read the CLAS guidelines for more information. Equitable healthcare can also stem from making the process easy for anyone regardless of their current capabilities. A patient’s decision to participate in a telehealth appointment is connected with their level of confidence in using technology. From basic tasks like downloading an application and opening a browser to more advanced needs, a patient has to know a variety of ways to use technology. Provide the best and most equitable possible telehealth experience by translating any digital literacy instructions, such as: If you plan to provide an interpreter, make sure any guidelines are also translated and communicated with the patient before the telehealth appointment. Also, if video resources are part of the pre- or post-visit, include voice-overs in the preferred language and translated captions. Consider running a multilingual self-audit once all these resources are in place to find and address any issues before implementing the resources. Those with disabilities face different challenges with telehealth. For example, a person with vision impairment may not be able to view the website clearly or a person who is deaf or hard-of-hearing may require sign language capabilities or closed captioning. Making equitable telehealth technology functional and accessible to those with disabilities increases the quality and functionality for everyone. Having features like closed captioning; a website that follows web accessibility guidelines to include white space, plain language, etc.; and providing written guidance on telehealth accessibility will make a telehealth experience better for everyone. Know the limited English proficient (LEP) community organizations and resources available to patients in their preferred language, and direct them to those resources when appropriate. Resources could include in-person services where patients can learn more or get support, online recorded videos, print materials, government services, and other supportive initiatives. Pre-visit paperwork can be confusing and time-consuming for anyone. Then imagine struggling with a language barrier. Providing accurate and complete information is a must for any patient. Analyze your pre-visit paperwork to make sure the language is clear. You can follow the U.S. plain language guidelines for language support. Also, consider if intake questions are culturally appropriate, so it doesn’t dissuade someone from answering or getting health services. Questions that ask about ID numbers or other questions that might involve legality status should be avoided if possible. Ensure patients understand their privacy rights by providing translated HIPAA statements and privacy policies. Make sure your platforms are also HIPAA-compliant, as technology changes have sparked needs for adjustments. For example, the Office of Civil Rights (OCR) issued a Telehealth Notification in 2020 in response to the COVID-19 pandemic. This notification helped the health care industry quickly expand the use of telehealth services. Continuously monitor and adjust the process to positively impact patient-centered care for equitable healthcare. One way to do this is to provide a survey after a telehealth experience. Just like product and service reviews online, reviews can enable you to improve the process and adjust as things like technology evolve. Telehealth services have many advantages, but they also face health inequities. However, healthcare organizations can implement strategic initiatives to reduce these inequities. One of the areas is putting the patient first and prioritizing their preferences. We provide translation and interpretation services in more than 150 languages. We’ve helped numerous healthcare companies, including some of the largest providers in the nation, provide meaningful and equitable healthcare access for immigrants, provide HIPAA-compliant services for language access and accessibility compliance, and improve their communications. For more information about our language services, contact us at info@avantpage.com or (530) 750-2040.

While students whose first language is English can focus on learning school materials, Limited English proficient (LEP) students have to learn the school materials and the language simultaneously, which can be a big challenge for students. And the COVID-19 pandemic further exacerbated disparities for these students and their families. “Roughly 5 million public school students are ELs (English Learners), accounting for about 10 percent of the K-12 population.” Source To reach these students and reduce educational disparities, educators may need to re-evaluate how they are meeting language access for LEP students and their families. In this blog, we’ll look at how the pandemic affected LEP students, the value of families on a students’ education, and ways to use language access to improve student outcomes. Many children and families struggled when the COVID-19 pandemic brought schools to a halt in 2020. Technology, digital literacy, and language differences affected children across the US. Those with a language barrier faced additional challenges. Here are just some of the many challenges LEP children and families faced during the pandemic. Approximately 19 million Americans, which is 6% of the population, don’t have access to broadband internet service at threshold speeds. People living in rural areas make up one-fourth of this group. And although broadband service is better in densely populated areas, these areas have a high concentration of poor students whose families can’t afford it. In addition to internet connectivity issues, when the 2020-2021 school year began, schools and families scrambled to find computer devices for children, and the supply chain couldn’t keep up. Besides the technology challenges, language barriers were evident with digital literacy. While children across the US were impacted by the learning challenges caused by the pandemic, English learners were disproportionately impacted. When the instructions for parents to help their children were in English only “Language access for parents to help them was also an issue…parents didn’t necessarily have the digital savvy, or the instructions in languages they understood, to be able to help students.” Furthermore, according to a report by the Department of Justice: Research has shown that when families take an active role in their children’s education, children “have better academic performance than children with less engaged families.” However, one of the many barriers to family engagement is “Language and cultural differences that make communication with schools intimidating or challenging.” “Children whose families take an active role in their children’s education—even if that merely means communicating that school matters—have better academic performance than children with less engaged families.” Source + Toolkit Another way to achieve successful family engagement is to make the school welcoming and friendly to families. In the next section, we’ll describe ways that schools can accomplish this through language services. Schools can encourage family involvement in many ways and help reduce the barriers that might be preventing engagement. that has important information about LEP services, such as available resources and how to get language support. Translate the slide deck into the local threshold languages, publish it digitally and print it, and then share it with those families who need it. that describes how language services are free and encouraged. Post these around the school. Make sure to include basic instructions on how to connect to live classes through zoom or other ways, how to get into whatever school program you might use, and other standard technologies. meaning that the messaging makes sense for each target culture. And avoid tools like Google Translate – these tools don’t account for cultural context, local language nuances, and specialized terminology. at school events, parent engagements, and other live events. Including parents in important events is key to instilling trust and participation by the students. Promote these services when communicating about the event. into the process for highly localized and contextual translations. Someone who speaks the language and lives in the community will be to validate localized content. —whether it’s via multilingual emails, texts, social media, phone calls or otherwise. If they use their phones or computers to get information, consider creating and localizing a separate website with easy access and visibility to translations for resources and information like this one. If they regularly consult social media, such as the school’s Facebook page, then ensure that you provide multilingual versions of the posts. for check-ins with the student and/or family to ask if they need help with anything. By being proactive and opening the door to questions, you might be surprised at how it encourages the relationship and participation between the families and the school, ultimately improving the student’s outcome. Have a template translated in each needed language that asks if the parent/student can take a call with an interpreter at a specific date and time, and provide instructions on how the process will work. You can schedule an interpreter for blocks of time by language to maximize process efficiency. from limited English proficient communities. The survey information will help you learn from your efforts and improve over time. Every person, location, language, country, culture, and interaction will all be different. Use feedback and firsthand knowledge to create innovative solutions that will promote equity in education and improve the chance of each students’ success. LEP students face plenty of barriers in education. Having family support and encouragement leads to better outcomes. Families should feel welcomed, and providing high-quality translated content and interpreters is important in welcoming families. However, using translation tools like Google Translate won’t cut it—these translations may come across as confusing or even rude in some languages. That’s why it’s important to partner with an experienced translation agency. How can we help you with language access? Contact us at info@avantpage.com or (530) 750-2040.

Diversity, which includes differences in race, ethnicity, sexual orientation, religion, language, geography, gender, and more, is crucial to the US, as the US was founded on the idea that all people are created equal. In addition, diversity provides new ideas, experiences, and perspectives, and people can learn from each other. From a business and organizational perspective, diversity leads to better problem-solving due to having different ideas, resulting in better business decisions and higher-performing outcomes. Josh Bersin of Forbes states, “Companies that embrace diversity and inclusion in all aspects of their business statistically outperform their peers.” In addition, companies with a diverse workforce are 35% more likely to achieve more financial gains than those without a diverse workforce. Immigrants are a big piece of the diversity pie. Supporting immigrants is important for humanity, supporting our economy, and foundational to our country. Immigrants contribute to our economy in many ways, including labor force, business, and population growth. Some cities in the US are making strides in making diversity, and immigration specifically, a part of the way they operate. We’ll look at some things that the city of Cleveland, Ohio is doing to promote diversity and ways in which organizations can expand and improve language access as support for immigrants. Immigrants contribute to local economies in a variety of ways; these are just some of the many ways. The city of Cleveland is working towards diversity through many actions. Here are some ways in which the city is working towards diversity. Cleveland, Ohio is one of the over 300 non-profits and local governments that have partnered with Welcoming Network, “a network and a movement driven by the conviction that communities make better decisions when residents of all backgrounds, identities, and perspectives are meaningfully engaged.” Have key influencers and stakeholders get involved with non-profits, committees, boards or other initiatives to inspire and encourage diversity. For example, three Cleveland representatives out of a nationwide board of 23 individuals are on the Board of Directors for non-profit Creating Healthier Communities: Kevin Clayton, the Vice President of Diversity, Inclusion and Engagement for the Cleveland Cavaliers; Alan Nevel, SVP of Metro Health System; and COO Teleange Thomas of JumpStart. Look for grants that promote equity in Social Determinants of Health (SDOH) among immigrant populations. For example, in Cuyahoga County, the Beulah Park-Euclid Beach Connector Trail will be built thanks to funds from the Outdoor Recreation Legacy Partnership (ORLP) program. The trail will be built along the lakefront of Lake Erie for nearly half a mile to provide a trail for underserved communities. This funding from the ORLP program will continue to expand our communities’ connections to urban green spaces, where children can play, families can connect, and a love and appreciation for the outdoors can be nurtured.” Cleveland has a program called Landed: Stories of Newcomers that captures the stories of immigrants, first-generation Americans, and other newcomers living in Northeast Ohio to try to mend the divide between people in the community. It showcases people from other countries through a podcast where they talk about their experiences. The Cleveland Language Access Service (LAP) Plan, which is a plan to ensure equal and effective access to city services for Limited English Proficient residents, followed other successful city LAPs. These LAPs included Minneapolis’ Minneapolis in Any Language guide, Chicago’s Bridge the Language Gap guide, and other resources such as www.lep.gov. These cities have invested a lot into language services and realized the benefits. Language access is one of the important things you can provide to immigrants to promote equity. And while language access is a cost, it’s also an investment in your local economy. In working with a language service provider, you can strategize how to maximize the process. To expand and improve language access, consider the following ideas. Supporting diversity benefits communities, businesses, and organizations. As observed through the example of Cleveland, diversity can be viewed and accomplished in many ways. To provide language access for immigrants and other limited English proficient individuals, work with a professional language service provider. For more information about language services, contact us at info@avantpage.com or (530) 750-2040. We’re here to support efforts to increase diversity.

Healthcare is one area where limited English proficient (LEP) individuals may face inequities in getting high-quality care due to language roadblocks. One federal agency, the Centers for Medicare & Medicaid Service (CMS), has made health equity the first pillar in their 2022 strategic plan. The plan has nine health equity goals and has charged their programs with integrating health equity into their core work. While the Centers for Medicare & Medicaid is a federal agency, they “call on private sector partners to engage with this health equity strategy to sustain long-term action.” While it may be challenging to conceptualize health equity and put it into action, the CMS strategic plan lays out nine specific goals with examples of how they’re putting these goals into action. Language access is a core component of providing equitable health care and can be a part of these goals. In this blog, we’ll look at five of the nine CMS goals, how language access supports these health equity goals, and ways you can implement language services.
All kinds of data exist to help companies better understand their demographics and patient KPIs that evaluate preferences, usage, satisfaction levels, health outcomes, etc. Data helps to understand where the needs are and where your organization currently is to then create a blueprint for action. Here are just some of the many available resources: Your language service provider (LSP) is another invaluable resource. An LSP has a broad range of data based on service type, region, language, and more. For example, our AvantPortal powered by AvantData gives our clients smart linguistic usage insights such as: The dashboards help capture historical data so our clients can predict needs and provide additional information for decision-making. Reach out to your LSP to see how they can help provide you with data. Language access is more than having translated content to support services—it also means making the content culturally and linguistically appropriate. The aim is to improve the end customer experience by providing language access to programs, services, and information targeted to specific groups, not just generic information. For example, suppose you’re trying to promote an educational piece about the danger of sun for skin cancer for the Latino community. In that case, you’d provide culturally relevant information such as statistics of skin cancer in Latinos—not Caucasians – as Latinos “do face rising melanoma rates, but still actually have a lower rate of developing melanomas than their white peers.” This measure isn’t just for CMS—the U.S. Department of Health & Human Services created a set of 15 action steps called Culturally and Linguistically Appropriate Services (CLAS) for health and healthcare organizations to advance health equity and reduce health care disparities. Although it may be tempting to use internal employees for translations to save money, that quite likely won’t be the highest-quality option for many reasons. For example, many healthcare organizations who even have dedicated staff linguists run into inconsistencies such as terminology that can slow down the translation process and reduce the quality. This organization enlisted Avantpage to partner on employee assessments for quarterly evaluations, creating recommendations, and helping with the increase of output production. “Does identity play a role in how we translate? The short answer is yes. As we go about the work of translation, we bring far more than the skills we’ve learned. We bring a lifetime of experiences along with attitudes that were formed in childhood and beyond. We come to our work with assumptions and biases embedded in the cultures of our families and communities beyond what we may realize. The way in which we render words in a target language is affected by our histories, perspectives, and biases, whether we’re aware of them or not.” Words Matter, Identity Matters  The Hidden Costs of Using Bilingual Employees for Translation However, if you work with an LSP, you’ll gain access to their networks of highly qualified individuals, employees, and technologies, which will provide the best opportunities for high-quality translations. For example, if you require interpreter services, an LSP can use their resources to provide interpreters with a medical background, who have certifications, etc. As a result, an LEP patient in a hospital should communicate better, leading to a better healthcare outcome. LSPs can also provide quick turnarounds that internal employees may not be able to do. For example, Notice of Action (NOA) or Notice of Appeal Resolution (NAR) letters require a quick turnaround. An LSP will have the resources to meet these needs. Many communities have programs that offer connection through parks and recreation services, special events, daily services, etc. These types of programs provide community participation, equity, and social/networking opportunities, leading to more connection and fulfillment. Translating program materials that bring awareness to events and promoting these materials makes these opportunities available for everyone. An LSP can provide not just translators, but also community reviewers—local individuals to help micro-localize your content by targeting highly specific groups of people. Reviewers create content that is sure to resonate with the end user. Applying any CMS initiative to your organization should get you closer to closing the gaps in health care. To take it a step farther, one way to reach LEP communities is to do multilingual outreach with your language offerings. So instead of just translating your educational content and putting it on your website, you can give hard copies to local organizations for them to disperse, mail your hard copies to LEP communities or hire bilingual representatives to go out in the community. These kinds of proactive actions will help your target audiences learn about who you are and what services you offer, and in turn, help to raise awareness and health literacy. Much work is needed to advance health equity. We support our clients in advancing health equity by providing nuanced and linguistically appropriate translation and language services. We want to help all end customers improve their health literacy and experience by providing our clients with high-quality language services for health care programs, services, and information. To learn more about how we can help you with your language service needs, contact us at info@avantpage.com or (530) 750-2040.

In government agencies, procurement (also known as purchasing) can choose between different types of bidding for proposals (RFPs) from vendors for their services. A low-cost bid looks only at the cost of a service and no other factors. With a best-value RFP, the government employee requests information about important components for that service and then scores the RFP based on their value to select the winning bid.  While a low-cost RFP gets the job done for the lowest prices, it can come with risks. It’s important to ask the right questions and know what to look out for. It’s also important to understand how to weigh evaluations and the risks when choosing low-cost over best value. It can be tricky when procurement officials manage the RFP process across many services since each one is unique and has different requirements. We made this quick guide that you can share with local procurement for language services to help them navigate the RFP process for language services.  There are risks to understand with low-cost language services. Bidders for low-cost bids are going to need to cut costs to provide competitive prices. Usually, those cuts will be seen in quality, time or management. As a result, low-cost RFPs become “a race to the bottom,” which puts pressure on the language service industry to provide quality services at a sometimes unreasonable price. Language service providers do this in a variety of ways:  Low-cost bids can also be risky for a variety of reasons.  A best-value bid has a lot of benefits since it takes more factors into account besides just budget. It also weighs scores according to the agency’s needs. As a result, the agency chooses a partner based on who they believe has the most relevant experience and can provide the best value, while the vendors compete on what differentiates their services and their team, rather than on how low they can price their services.  Some ideas of what to include in an RFP for language services include:  When customizing the scoring for the agency’s needs, the benefit is that you get the best match to meet your language access goals. Consider which components should be weighed more heavily than others. Make inclusions and exceptions based on your agency’s needs. Common scoring areas include:  Low-cost bids might look great on paper due to saving money, but they can have opportunity costs that negatively impact the communities you serve and your organization. Some of those opportunity costs can mean you:  Consider a best-value bid for a holistic approach to language services. A best-value bid ensures that the perceived value matches what your organization and its multilingual audience members need.  For more information about the RFP process for language services, contact us at interpret@avantpage.com or (530) 750-2040. 

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 info@avantpage.com 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 info@avantpage.com 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 info@avantpage.com 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 info@avantpage.com 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 info@avantpage.com 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 info@avantpage.com 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 info@avantpage.com or (530) 750-2040.