In the 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) proposed a strategy to improve the US healthcare system. Identifying six aims, the report outlined the need for healthcare to be safe, effective, patient-centered, timely, efficient, and equitable. The need for healthcare practitioners to understand and address the specific mandates inherent to this policy applies to many areas of healthcare. The following case study will address the application of healthcare translation services to the communication and language assistance needs of people who are limited English proficient (LEP). The article is written to illustrate the practical identification and utilization of LEP services in telehealth. This article also serves as a case study for PART-I of our article series, which identifies and explains the leading federal and state laws requiring healthcare language services for practitioners who serve Medicare and Medicaid beneficiaries or those who work in federally funded settings.
Telehealth Implications of LEP
When working through telehealth to access new communities, providers and their employers can face ethical dilemmas when working with people who demonstrate limited English proficiency. To clarify the telehealth issues involved, a case study is offered for the reader’s consideration.
Dr. Fortier, a psychotherapist who conducts sessions via telehealth using a video conferencing tool. Dr. Fortier is a first-generation Anglophone whose first language is English.
A new client going by the name of Jorge, is a Mexican-American who primarily communicates in Spanish. Jorge has some understanding of English but struggles to express intricate thoughts or deep-seated feelings. Despite this, they decided to engage in therapy conducted in English, primarily due to the remote nature of the sessions and their fundamental grasp of the language.
As the virtual sessions unfolded, Dr. Fortier observed numerous inconsistencies in Jorge’s narrative, suggesting a deeper issue may be at hand. Jorge often wrestled with the words needed to convey their emotions and experiences in English accurately. This resulted in communicative gaps, misunderstandings, and a hindrance to their therapeutic alliance.
Evidence of Need for LEP Assistance
In one session, Jorge grappled with explaining a notably harsh depressive episode. The language barrier hampered their ability to articulate the magnitude of their feelings, leading Dr. Fortier to misjudge the severity of the situation. In another instance, Jorge tried to explain their anxiety triggers. However, due to language limitations, they shared a superficial account of their concerns, leading to a generic therapeutic strategy that failed to address their needs. Jorge then texted a reluctance to continue care.
Dr. Fortier called Jorge immediately that evening on the telephone, increasing the chance of reaching them. Jorge explained that therapy “isn’t working.” After realizing the shortcomings, Dr. Fortier suggested including a professional medical interpreter in their sessions. Jorge reluctantly agreed to try working with an interpreter to improve his chances of success.
Summary
These misunderstandings between Dr. Fortier and Carols damaged the therapeutic alliance and led to Jorge’ wish to terminate care serves to spotlight the vital role language plays in understanding and treating mental health issues. Recognizing
