Nearly 13.8 million Hispanics in the United States speak English "less than very well." This has important implications for the field of clinical neuropsychology. Patients who do not speak English fluently are being increasingly referred for neuropsychological services, and many of these individuals are assessed with the aid of language interpreters. However, whether or how the use of an interpreter has an effect on neuropsychological test scores is not known. For lack of a better alternative, it generally is assumed that the test data obtained through an interpreter are a valid indication of the patient's cognitive functioning, but with almost no empirical support, this assumption appears tenuous at best. The effect of an interpreter, in fact, could be substantial, making this issue all the more deserving of rigorous investigation. The primary objective of the current study was to determine whether using an interpreter to conduct neuropsychological testing of monolingual Spanish speakers had an effect on the neuropsychological test scores. Participants included 40 neurologically normal Spanish-speakers with limited English proficiency, ages 18-65 years, (M= 39.65, SD =13.91) who completed a 2-hour battery of verbal and nonverbal neuropsychological tests both with and without an interpreter. The condition of test administration was counterbalanced across participants and test score differences between the two conditions were compared. Results indicated that use of an interpreter significantly affected mean scores for some neuropsychological tests from the verbal modality. Also, variability in test scores generally was higher when an interpreter was used, significantly so for one verbal test. Results of this study contribute to the extant literature concerning the use of interpreters to facilitate neuropsychological testing of individuals with limited English proficiency. Specifically, they indicate that neuropsychologists should avoid interpreter use and refer patients to bilingual clinicians whenever possible. For situations in which this may not be a viable option, neuropsychologists should limit their test batteries to measures that require minimal reliance on the interpreter. Tests that rely almost entirely on interpreter skills for administration and scoring - such as the Vocabulary and Similarities subtests of the Wechsler Adult Intelligence Scale (WAIS) - should probably not be used. Larger confidence intervals should be used when interpreting observed scores from interpreter-mediated neuropsychological tests.

Limited English Proficient (LEP) patients are subject to low patient health outcomes due to limited health literacy. Cultural and linguistic barriers prohibit the obtainment and comprehension of health information and services. This systematic review will present the complications of healthcare experienced by LEP patients and will provide an analysis of interventions and policies that will be a gateway to better health outcomes for the LEP patient population.

BACKGROUND: Professional interpreters improve care for limited English proficient patients but are underused. Study Design: Mixed methods study evaluating effectiveness and implementation of a rooming protocol to screen patients for language needs and call interpreters OBJECTIVE: Examine barriers and facilitators to protocol implementation and effectiveness to increase interpreter use METHODS: Provider surveys explored baseline and post-implementation attitudes. Simple and multiple logistic regression analyses examined the impact of practicing in the pilot clinics versus comparison clinics on post-implementation responses. Medical Assistants and providers were interviewed regarding barriers and facilitators to implementation. Interview analysis used modified grounded theory. Trends in the number of telephone interpreter calls were examined to determine protocol effectiveness. RESULTS: Context themes included having established teams and workflows; transitioning to a new interpreter vendor; and challenges incorporating the workflow, including providers’ tardiness and clinic understaffing. Evidence themes included beliefs that the protocol improved the patient experience but otherwise mixed responses; preferring live interpreters; and limited buy-in to language screening. Facilitation themes included Medical Assistants needing more support. Providers in the pilot clinics versus comparison clinics had significantly higher odds of positive responses on post-implementation survey questions regarding satisfaction with care (OR 5.3) and communication (OR 6.7). Implementation did not increase the number of telephone interpreter calls in the pilot clinics. CONCLUSION: Ineffectiveness of the protocol was likely due to inconsistent implementation. The protocol may improve patient care but context limited implementation success. The limited buy-in to language screening raises questions about how to better identify patient language needs. / 2019-11-08T00:00:00Z

With the increase in federal funding for the 21st Century Community Learning Centers (21st CCLC) after-school program, more intricate evaluations are needed to assess the needs and successes of the programs. And with many programs targeting students of minority and limited-English proficiency (LEP) status, additional analyses should focus on these targeted populations. This study examines a regional 21st CCLC program with math and English standardized test scores (CRT scores) for students prior to participation and after two years of participation. These test scores were used to create a score change variable, which provides a unique approach to assessing after-school programs. Analyses indicate that LEP participants are the furthest behind and have the most to gain by participating in the program. Also, the type of activity participated in matters. Overall, participants benefit from both academic and enrichment activities, but LEP participants benefit most from academic activities and from higher participation. Site coordinators need to be aware of the different types of participants and structure programs accordingly.

After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.

Objectives To provide contemporary, national population-based estimates of complete tooth loss of older adults by English language proficiency. Methods We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants ≥50 years of age (n=10,452, weighted=111,895,290). Results The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%). After adjusting for education, complete tooth loss was less common among participants for whom Spanish was their primary, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42-0.76). Among those without complete tooth loss, dental visit in the past year were less common among participants with primary languages other than English as compared to those who only speak English. Discussion Research is needed to examine the relationship of aging, oral health, and access to care.

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Limited English proficiency (LEP) amongst non-English-speaking background (NESB) employees is a major concern for the Government, employers and unions in Australia. Due to their low levels of English proficiency, NESB employees are often unable to carry out effectively the required workplace tasks. In the current climate of rapid change in workplaces, as a result of Award Restructuring, NESB employees may also lack the communication skills necessary to undertake skill-based training and, therefore, be further disadvantaged. In light of these concerns, this study investigated the English learning needs of a group of NESB non-academic staff at the University of Canberra (UC). It established that there was a gap between their present levels of English proficiency and the levels required in their current positions. As a result, these employees are unable to engage effectively in all communication tasks required in the workplace. Following a detailed analysis of the current literature on the provision of workplace English training it is recommended that an English in the Workplace (EWP) program be provided at the UC for NESB non-academic employees. Specific recommendations are made regarding the design and implementation of the learning program.

Over 25 million Americans report limited English proficiency (LEP) since 2013, and this number has been steadily increasing over the past few decades as immigration to the United States continues to climb. Due to the expanding heterogeneity of the population, cultural and language barriers became more common in the healthcare field which led to worse patient outcomes, inappropriately ordering too many or too few tests, and decreased use of preventative services. This necessitated further resources and interventions to better accommodate individuals with LEP. In accordance with Title VI of the 1964 Civil Rights Act which was elaborated further in Executive Order 13166, federal agencies were required to provide language services to people with LEP. As a result, more medical institutions began implementing interpreter services. Despite these measures, there is lower-than-expected physician compliance with utilizing these services and considerable variability in services offered depending on the clinical setting. Not only does this perpetuate and potentiate the health disparities that this population already faces, but it can also negatively impact a patient’s agency as they do not have the proper resources to fully advocate for their health. Hence, it is integral to examine the potential reasons why the current infrastructure for interpreter services is still lacking and what can be done to optimize accessibility. This thesis will explore some of these limitations and then offer potential solutions that both institutions and medical professionals can implement in order to provide equitable care to patients with LEP. / Urban Bioethics