Newcomers may experience multiple challenges accessing health care, including systemic issues rooted in inequities. As described in our blog post What is Health Case Management?, service providers play a critical role in supporting clients to overcome challenges and advocate for their health. This blog post details tips for assisting clients with three specific challenges: transportation, interpretation, and competing demands. Download Switchboard’s information guide Problem-Solving Health Care Access Issues for tips on navigating other common challenges.
Transportation
Learning to navigate transportation can pose a challenge for newcomers seeking to attend medical appointments and arrive on time. Depending on the options available in their local area, clients can travel to their health appointments in several different ways, including:
- Walking to nearby clinics
- Taking public transportation (e.g., bus, subway)
- Using taxis or rideshares (e.g., Uber, Lyft)
- Getting rides from staff, volunteers, or community members (as allowable by the agency)
- Using state Medicaid transportation programs
Support clients as they learn to navigate public transportation. Consider having a service provider, cultural broker, volunteer, student intern, or AmeriCorps member accompany clients on public transportation to their primary health clinic—either as practice in advance or for the first appointment itself. Alternatively, if there is no time or ability to physically accompany clients to the appointment, you can talk them through the process using a map app, preferably with street photos.
Clients should have all the information about where they are going. For example, if a case manager assisted the client in scheduling the appointment, they should provide the client with a translated appointment sheet that lists the clinic name and address (including suite or room number), phone number, and transportation details. If the client will be using a state Medicaid driver, advocate for language access to ensure the driver does not cancel the ride or leave if they cannot communicate with the client about the location.
Interpretation
To receive quality health care, clients must be able to communicate effectively about their health. It is critical for service providers to work with health care clinics to determine their language capabilities. Title VI of the Civil Rights Act requires clinics receiving federal financial assistance to offer language access to individuals with limited English proficiency. However, this does not always happen in practice and can be challenging to enforce. Clients will likely receive the best care at clinics that willingly provide adequate interpretation and are comfortable with interpretation and translation for all clients.
Many clinics, federally qualified health centers (FQHCs), and hospitals will have access to interpretation—but with varying levels of comfort and usage. Ask the clinic manager or medical assistants about their interpretation access and experience. Depending on your relationship with the clinic, you could offer to train their staff on how to access and work effectively with interpreters.
Service providers may also offer additional medical interpretation training to their agency’s community interpreters. The partner health care clinic then pays for these interpreters to provide in-person interpretation during clients’ medical appointments. Clinics often find these interpreters more cost effective and better trained than alternative interpretation options.
Depending on a client’s location, service providers may be able to find a medical professional who speaks the client’s language. If this is possible, check with the client to ensure they are comfortable with this arrangement. The clinic may also have a staff member who speaks the client’s language. Once the staff member’s fluency has been confirmed, they must receive proper interpretation training before they are ever asked to interpret. This training would ideally be offered for free or subsidized for interpreters using grant funding or partnerships with clinics. This interpretation should ideally be limited to procedural conversations (e.g., assisting patients with registration and checking in). If support staff will be used to interpret for medical appointments, they should receive additional medical interpretation training.
If you identify a clinic with staff or providers who speak the client’s language but the clinic does not accept the client’s insurance, try meeting with the clinic to inform them of the need. Some clinics may be open to adding a new insurance provider.
Some service providers have successfully advocated with clients’ insurance companies to recruit an interpreter in a specific language by identifying the need. Providers can tell the insurance company the number of arrivals that will need interpretation in a particular language in the coming year.
If a health care clinic is concerned about the cost of interpretation, let them know that some clinics have successfully used the following approaches:
- Applying for grants to cover interpretation costs
- Advocating with their management that interpretation costs should be included in and covered by general operating budgets
- Using insurance reimbursements to cover some of the cost
To avoid or mitigate conflicts of interest and serious negative consequences, it is best practice to use trained interpreters whenever possible. Children under 18 should never serve as interpreters. Utilizing family members, untrained staff, or community members as informal interpreters is not recommended, as it may lead to risks such as:
- Miscommunication
- Patients not understanding complex medical terms
- Patients experiencing decreased health outcomes
- Legal ramifications for the clinic/medical providers
In the worst cases, communication errors have led to serious negative health consequences for patients, including injuries and death. Advocating for clients to have access to trained medical interpreters is thus crucial for their safety and overall well-being.
Interpretation access is one of the most difficult challenges to overcome. The goal is for health care clinics to work toward having:
- Access to quality interpretation (either in person, telephonic, or video)
- Each staff member trained on how to access interpretation services and how to work effectively with interpreters
- Staff who speak client languages, such as community health navigators, medical assistants, and health care providers. This may involve the clinic changing its recruitment strategy or expanding its training.
Service providers and community-based organizations can help health care clinics work toward these goals through advocacy, education, and partnerships. View Switchboard’s information guide Service and Health Care Provider Collaboration for more ideas.
Competing Demands
The resettlement period for refugees and other newcomers is extremely busy, with competing demands and scheduling conflicts between job readiness trainings, interviews, work, English classes, school, health appointments, child care, and more.
Work with clients (and, as relevant, their health care providers) to prioritize competing needs and be clear on the consequences of not addressing certain health issues. For example, not completing latent tuberculosis (TB) treatment could result in the risk of active TB or needing to restart treatment. Not completing vaccinations could impact clients’ adjustment of status or school enrollment for children.
For chronic issues and preventative health, emphasize the importance of regular follow-up with a primary care provider (PCP). Offer health education to provide clients with knowledge about what could happen in the future if they do not address their health in the present—including the potential for chronic conditions to lead to more serious health concerns (e.g., heart attacks, strokes, or cancer).
Coach clients on how to ask their employers for time off or how to schedule appointments at times when they are not working. In addition, help non-working family members become comfortable attending appointments independently so that their working family members do not have to take time off to accompany them. If a client has children, guide them on how to notify their children’s teachers when they will be missing school due to appointments and ask the health care clinic for a note to provide to the school as proof of the absence.
Additional Information
Transportation, interpretation, and competing demands on newcomers’ time are only three of the many obstacles clients and service providers must overcome to access health care. For more ideas, view Switchboard’s information guides Problem-Solving Health Care Access Issues and Service and Health Care Provider Collaboration.
