The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session B-6: Communication challenges for special populations: the elderly and people with mental illness

The Challenge of Incompetence

Especially in medical and mental health settings interpreters are likely to work with persons who are incompetent or who lack capacity to make decisions on treatment. Interpreting literature offers virtually no guidance on how to best address the challenges that arise when language and cultural differences are complicated by cognitive impairments. Persons with these impairments may include mental patients, children, the elderly, trauma victims, and those who are temporarily compromised. Working with members of these groups especially taxes interpreters' skills, and their understanding of their roles and core values.

Discussing the difficulties that may arise helps interpreters to be prepared when they actually face these situations. These discussions also can inform and shape training and policies regarding interpreting–not only with this special population but in everyday practice as well.

Questions of paternalism, beneficence, and social justice need to be faced. Do interpreters have a special responsibility to advocate for persons who are unable to make meaningful decisions? What is the effect of abdicating or refusing to advocate? How do legal and social mandates limit the options available to interpreters? Is it more important to focus on the process of interpreting or on achieving good outcomes? How is it decided what "good outcomes" are? How does interpreters' work as culture brokers impact on treatment? How do community interpreters deal with forced and involuntary treatment when they seek, as far as possible, to empower members of their community? These are not easy questions and may not have answers that are either definitive or satisfactory.

After relevant terms are defined we will take up these and other questions. The discussion should help participants to examine their views on roles, responsibilities, and ethics. It is hoped that these will lead to ongoing discussions and the development of literature addressing these situations.

Ben Karlin is a licensed interpreter working for the Missouri Department of Mental Health. Aside from his regular responsibilities at St. Louis Psychiatric Rehabilitation Center, he also co-chairs the department's Mental Health Interpreting Resource Project and consults with the Office of Deaf and Linguistic Support Services on policy issues. An English-American Sign Language interpreter, Mr. Karlin's background includes both educational and community interpreting.

Ben Karlin
Licensed Interpreter
St. Louis Psychiatric Rehabilitation Center
5300 Arsenal Street
St. Louis, MO 63139
Phone: 314-644—8270 Voice and TTY
Fax: 314-644—8115
E-mail: MFKARLB@MAIL.DMH.STATE.MO

Addressing Health Literacy in the Care of Ethnically Diverse Older Adults in a Primary Care Practice

Health Literacy and Health Disparities
Addressing health literacy of culturally diverse older adults is a major objective of Healthy People 2010. Nevertheless, efforts to systemically evaluate health literacy in clinical practices have not been described. Because significant health disparities in access to health care, service utilization, quality, and health outcomes continue among older adults from different racial and ethnic minority groups, innovative strategies are needed to address low levels of health literacy that impede preventive health behaviors. In addition, ethnogeriatric populations constitute the fastest growing segment of the elderly population. Therefore, identifying health literacy needs for these patients will grow increasingly important in clinical practice and preventive health services delivery.

Innovative Approach
A pilot study applied two unique innovative methods to effect health behavior change and improve primary care practice: 1) Participatory Quality Improvement (PQI)¹ that involves patients on improvement teams, and 2) the Multimethod Assessment Process (MAP)^2,3 that combines qualitative and quantitative data to understand primary care practices as systems.

Content of Presentation
The Pfizer Health Literacy Grant pilot study "Participatory Quality Improvement (PQI) as a Framework for Improving Health Literacy and Increasing Pneumococcal Vaccinations in Culturally Diverse Patients Ages 65 and Older" will be presented. An overview of MAP and PQI will be discussed, and components of MAP and PQI will be individually reviewed.

Resources
See Pfizer Health Literacy Grant Executive Summary in Resource Binder.

Dr. Fred Kobylarz (kobylafr@umdnj.edu) is an Assistant Professor and Assistant Director, Graduate Medical Education in the Family Medicine Residency Program at the University of Medicine and Dentistry — Robert Wood Johnson Medical School in New Brunswick, New Jersey. He is board certified in Family Practice and Geriatrics with a Certificate of Added Qualifications in Geriatrics. He was awarded a Bureau of Health Professions Geriatric Academic Career Award which focuses on cultural competency in Geriatrics. He is Principal Investigator in the Pfizer Health Literacy Grant 2001.

Jo Ann Kairys, MPH (kairysjo@umdnj.edu) is the Executive Director of the Center for Health Families and Cultural Diversity at the University of Medicine and Dentistry — Robert Wood Johnson Medical School in New Brunswick, New Jersey. She has extensive experience in all aspects of healthcare planning and operations management. She has expertise in clinical quality improvement program implementation and analysis and has been involved in numerous qualitative research survey projects. Ms. Kairys co-developed the Participatory Quality Improvement (PQI) methodology, which will be tested in multiple health care settings that serve culturally diverse populations. She is Co-principal investigator in the Pfizer Health Literacy Grant 2001.

Organization

Ceter for Healthy Families and Cultural Diversity
Department of Family Medicine
University of Medicine and Dentistry -Robert Wood Johnson Medical School
One Robert Wood Johnson Place
New Brunswick, NJ 08903-0019
Phone: 732-235-7641
Fax: 732-246-8084
Web: http://www2.umdnj.edu/fmedweb/chfcd/INDEX.HTM

References

1. Kairys J, Stroebel CK. Using participatory quality improvement (PQI) model to improve the health of communities. First Hand. Joint Commission Benchmark. 2001; 3(5):6-7.
2. Crabtree BF, Miller WL, Stange KC. Understanding practices from the ground up. J Fam Pract. 2001; 50(10):881-87.
3. Kairys J, Orzano, J, Gregory, P, et al. Assessing diversity and quality in primary care through the multimethod assessment process (MAP). Quality Management in Health Care. 2002;10(4):1-14.

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