Articles

To Assist You in Connecting Your Patient,
Who has a Chronic Illness or Special Needs, and their Family
With Appropriate Services and Resources

Colorado Medicaid Helps Primary Care Practices
Improve Their "Medical Home-ness"
 
CCHAP Alert: New Medicaid Reform Strategy
 
Traditional Asian Health Beliefs and Healing Practices

What You Need to Know About CHP+
Eligibility, Enrollment and Claims Denials

Ongoing Services
- Announcing an Interactive Cross-Cultural Communications Website
  Designed Especially for Healthcare Professionals
- Language as a Communication Barrier in Medical Care for Hispanic Patients
  Plus A Spanish Course For Providers
- Postpartum Depression Screening For Mothers And Training For Your Practice
- Child Psychiatrist Available to Provide Conferences for You In your Office
- The Cross-cultural Curriculum for the Department of Pediatrics
  The syllabus is now available for you and your practice
- Child Psychiatry Telephone Consultation on Medicaid Children
- Integrating Developmental Screening In a Pediatric Practice
- Medical Spanish Training For Your Office Staff

^{Download Newsletter Twenty-Seven}

To Assist You in Connecting Your Patient,
Who has a Chronic Illness or Special Needs, and their Family
With Appropriate Services and Resources

 
To Assist You In Connecting Your Patient with a Chronic Health Condition or Special Needs
And Their Families
With Appropriate Services and Resources
 
Call 1-877-731-6017
 
Fax: 303-733-3344
 
Email: providerhelpline@familyvoicesco.org

The PROVIDER RESOURCE HELPLINE assists providers in identifying appropriate services and resources for children with chronic illness or special needs and for their parents:

• Specialized services, resources, programs, medical equipment, therapies
• Parent/patient education about chronic illness / special needs
• Parent/patient support services
• Case management
• Care coordination
• Help in finding funding for uncovered services

Examples:

• You are seeing a new patient (new to Colorado) who is an infant with 22q Deletion Syndrome, congenital heart disease, cleft palate and an oxygen requirement of undetermined etiology. Parents want to link up with all of the support services and a parent group like they had where they used to live.
• A child with multiple developmental delays also has behavioral problems. The parents are not sure they are getting all the help their child is entitled to and they want a parent support group and they are asking for counseling.
• A parent with a disabled child wants your help in applying for some sort of waiver that you aren’t familiar with.
• One of your patients has heart disease and is failing to thrive. Surgery can’t be done until the child is larger. You need someone to weight the child each week, provide feeding guidance and support the parents.

Hours of operation:
 
          Monday thru Friday from 8 AM to 4 PM
          Voicemail available 24/7
 
We can provide the information to you or your staff for you to give the patient....
Or we can work directly with the patient and family.....your choice.
The helpline will provide follow-up to your office on how the patient and family are doing

If the information on appropriate resources is not immediately available, we will research your question or case and provide the information to you and the family as soon as possible in whatever manner you and the family wish (via phone, fax, or email).

When contacting us, please provide us with the following information:

1. Your provider office and PCP name
2. Name of Child
3. Date of Birth
4. Medical Condition / Primary Disability
5. Type of insurance
6. Resource or service requested
7. Who should we contact with information?
8. Family Contact Information
9. How is it best to provide information back to you: phone, fax, email or voicemail

TO DOWNLOAD A REFERRAL FORM CLICK HERE
 
Next time you see a child with any chronic health problem or a special needs child, call us to see how we can help.
 
Questions about the hotline? Call 1-877-731-6017

The Provider Resource Helpline Is Sponsored By

Family Voices and CCHAP

CLARIFICATION:

Contact Erlinda or Lorena with CCHAP at 720-744-5552 (phone) or 303-751-9048 (fax) when you are only concerned about socio-economic issues like food stamps, housing, Medicaid eligibility, legal aid, abuse, etc. Contact the hotline for clinical referral needs.

- contents - newsletter archive - home -

Colorado Medicaid Helps Primary Care Practices
Improve Their “Medical Home-ness”

 
The Colorado Department of Health Care Policy and Financing (HCPF) manages the largest health plan for children in Colorado (Medicaid and CHP+). They are leading the way by promoting quality medical homes for Colorado’s children. HCPF, with input from scores of community organizations, including the Colorado Chapter of the AAP and the Colorado Academy of Family Practice, developed standards of care for Medicaid and CHP+ children. These standards have been published in previous newsletters (click here). These standards were derived from the AAP’s definition of a medical home. The commercial health plans are sure to follow.

HCPF (Colorado Medicaid and CHP+) is asking primary care practices that take care of Medicaid and HCP+ children to participate in a self-assessment of their “Medical Home-ness.” This practice self-assessment tool is the Medical Home Index (short form), developed by the American Academy of Pediatrics. We have described it in previous newsletters. HCPF will provide technical assistance staff to help your practice in completing the Medical Home Index, interpreting the results and in deciding what your practice might be interested in further assessing or improving. This assistance is free.

To schedule a time to do the Medical Home Inventory and receive this assistance, please contact Joy Carter (administrative assistant at CCHAP) at carter.joyce@tchden.org or 720-777-1818

How Well Is Your Practice Doing As A Medical Home?

The Medical Home Index (MHI) is a validated self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family-centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting. It is a way of measuring and quantifying the "medical homeness" of a primary care practice. The MHI is based on the premise that "medical home" is an evolutionary process rather than a fully realized status for most practice settings. The MHI is a nationally validated tool that measures a practice's progress in this process.

What can the MHI do for your practice?

• You can identify your practice’s strengths
• You can identify what aspects of a medical home you would like to build on or improve
• It gives you a clear starting point
• It allows you to measure your progress
• It promotes the conversation among all providers and staff about what you want the practice to be
• It is a great way for a practice to begin a quality improvement process, because it creates buy-in among all staff
• It will improve care
• It will help you improve patient- and parent-satisfaction.
• Health plans are going to be requiring something like this within a few years. Get a head start on it, now

You can learn more about the MHI by visiting the National Center of Medical Home Initiatives website www.medicalhomeinfo.org

The National Center for Medical Home Implementation supports medical home implementation in order to ensure that all children and youth, including those with special health care needs, have the services and support necessary for full community inclusion.

- contents - newsletter archive - home -

CCHAP Alert: New Medicaid Reform Strategy

The Colorado Department of Human Services is publishing a Request for Information (RFI) regarding their proposed reform of Medicaid program. As explained on the HCPF website:

“The Department is currently proposing a comprehensive reform of the Medicaid program which will shift priorities from the system to the clients and providers. This reform began with the report, "Colorado Medicaid Managed Care Strategy Analysis and Recommendations," by Deborah Van Houten, a consultant to the Department in 2008. The Department is also relying on input from managed care organizations, clients, advocates and other stakeholders, and will move forward with a health care delivery system changing from a traditional fee-for-service model to a regional, outcomes-focused, whole person-centered, coordinated system of care for clients in fee-for-service Medicaid.
 
This work continues the expansions and moving toward the goals of the governor's Building Blocks to Health Care Reform plan.
 
The Accountable Care Collaborative (ACC) is part of the Medicaid reform effort, and is envisioned to consist of a statewide data and certification organization and a number of regional care coordination organizations. These regional organizations will be charged to offer care-coordination services and to support the local participating providers and clients in the regions. In exchange for the additional clinical support, providers will be asked to offer increased access to clients (extended office hours, some same-day appointments, etc.) and to begin to use state-supplied health information technology.
 
The Accountable Care Collaborative Request for Information (RFI) will be posted in April 2009 in order to get more information from stakeholders to further develop the model. The Request for Proposals will go out later in 2009, and the Department will implement the program in April 2010 starting with 60,000 clients. If the program can demonstrate success, it could be expanded in later years. All aid categories would be enrolled in the program proportionally, with the exception of children who would be eligible for enrollment only on and after July 1, 2010.”  Quote from HCPF Website

 
The Colorado Chapter of the American Academy of Pediatrics (AAP) and CCHAP will be developing a response to the RFI during the month of April. We will keep you informed as the process progresses and will ask for your opinions as we develop a response to the RFI. CCHAP sees Health Care Reform and Medicaid Reform as important steps in improving children’s health care and wants to be sure that children’s needs are treated as a priority within the plan.

- contents - newsletter archive - home -

Traditional Asian Health Beliefs and Healing Practices

 
By Marcia Carteret © Copyright 2008

          Article Subheadings In Order

          Background of Traditional Medicines
          Health Beliefs and Clinical Care
          Beliefs and Practices Briefly Described
          Coin Rubbing, Moxibustion & Cupping

This newsletter introduces our community of readers to some of the basic concepts behind the traditional medicines and healing practices of Asian cultures. People belonging to these Asian cultures are accustomed to relying on distinct health practices and beliefs that are significantly different from those of native born Americans and other immigrants. As patients’ health beliefs can have a profound impact on clinical care, it is important for American medical professionals to be familiar with the concepts introduced here.

This topic is expansive, so links for further study are embedded throughout the article. We will be focusing on the health beliefs and practices of people from Southeastern Asia (i.e. Vietnam, Thailand, Cambodia, Laos, Burma as well as East Asian countries (i.e. China, Japan, and Korea. A brief explanation of the interrelatedness of the primary traditional medicine practices if followed by a brief description of each.

East Meets West

 
In the 17th century, traditional Vietnamese and Chinese practitioners began identifying their medicine as Dong Y to distinguish their medicine from the Western colonial medicine. Similarly, people in the West began to use the term “Oriental medicine” to differentiate Eastern medical practices from Western ones. Today, the terms Eastern medicine and Asian medicine are more commonly used in this country, and perhaps they are the better terms. The use of oriental has shifted to refer to home furnishings, carpets especially, and certainly in the field of cross-cultural communications, the word oriental is never used as a category of culture.

Many Americans quickly associate Chinese herbal remedies and acupuncture with Eastern “alternative” medicine, but are largely unfamiliar with other common practices from across Asia. The philosophies of health and illness causation at the root of Eastern medicines are even less understood and just as important. Traditional Chinese medicine, or TCM, is the best known Asian medicine practiced in the U. S., but it is not the only traditional medicine worthy of our attention. Traditional Vietnamese medicine (TVM) actually evolved together with traditional Chinese medicine and arguably the development of the two are so-intertwined that it is impossible to separate them. However, there are differences. Closely related to both are Japanese and Korean traditional medicines. Historically speaking, many societies in Eastern and Southeastern Asia have been part of the Chinese cultural sphere due to trade, migration, and occupation. Thus it is safe to say that the healing traditions of most Asian cultures are intertwined to some extent, much as their religious philosophies are.

Health Beliefs and Clinical Care

 
The greatest challenge for Western healthcare professionals once they’ve grasped the basics of different cultural remedies and treatments is to understand the beliefs and attitudes about sickness that drive these ancient practices. Health beliefs can have a profound impact on the clinical care of Asian patients in the United States, affecting the accuracy of health histories and compliance with treatment recommendations from Western providers. Because the principles behind the Western medical model are so different from those of Eastern medicine, it is difficult for American providers to shift gears when talking to Asian patients and consider a mind-set where health is seen as a state of balance between the physical, social, and super-natural environment. Western medicine tends to approach disease by assuming that it is due to an external force, such as a virus or bacteria, or a slow degeneration of the functional ability of the body. Disease is either physical or mental. The Eastern approach assumes that the body is whole, and each part of it is intimately connected. Each organ has a mental as well as a physical function. Perhaps a melding of the two belief systems would be ideal, but it isn’t easy in hectic settings or crisis situations to bring such divergent belief systems together during medical consultation and care.

Beliefs and Practices Briefly Described

 
Traditional Chinese Medicine
TCM is inextricably linked to Chinese Cosmology, a as system of beliefs that can be summed up as follows: all of creation is born from the marriage of two polar principles, Yin and Yang. Examples are earth and heaven, winter and summer, night and day, cold and hot, wet and dry, inner and outer, body and mind. These pairs of opposites are connected via a circular harmony. The yin and yang symbol is helpful in representing this concept. Harmony means health, good weather, and good fortune, while disharmony leads to disease, disaster, and bad luck. The strategy of Chinese medicine is to restore harmony. Each human is seen as a world in miniature, and every person has a unique terrain to be mapped, a resilient yet sensitive ecology to be maintained. Like a gardener uses irrigation and compost to grow robust plants, the doctor uses acupuncture, herbs and food to recover and sustain health.

Read More: Anatomy in Traditional Chinese Medicine
http://www.healthy.net/scr/Article.asp?Id=1278&xcntr=3
http://www.orientalmedicine.com/meridians-pathology

Chinese Herbal Medicine
Herbal medicine is an important part of Traditional Chinese Medicine (TCM). Herbs are prescribed holistically according to the patient's individual condition (not only on the basis of current symptoms). Herbal medicines are used to regulate the natural balance of the body and restore health. They come in the form of pills, powders, tinctures and raw herbs taken internally or as balms for external use. Chinese herbal medicine has been used for centuries to treat most health conditions and as a preventative dietary supplement. They can also be used safely in conjunction with many western therapies. Diagnosis is made by talking to the patient, looking at physical characteristics and employing the ancient arts of tongue and pulse diagnosis.

Japanese Herbal Medicine
Kampo is Japanese herbal medicine, which has a long history of clinical application. Kampo uses precisely measured herbs to treat illness, based on the skillful use of well-known formulas, valued for their impact on clear as well as vague conditions. (Kampo does not use rare or endangered plant or animal products). The distinguishing feature of Kampo is it's method of diagnosis through abdominal palpation. Kampo medicine is based on the theory that diseases arise because of a disharmony in the flow of Qi (Chi). By stressing prevention, Kampo helps the patient to maintain good health according to natural principles.

Read More: http://en.wikipedia.org/wiki/Kampo

Tibetan Medicine
It is known as gSo-ba Rigpa in Tibetan, meaning 'the science of healing'. The basic principle is to balance the three principal energies of the body. The practitioner employs the ancient tools of pulse diagnosis and urine analysis, to find the root causes of disease. Treatment is carried out through diet, lifestyle adjustments and herbal medicines grown naturally in Tibet and the Himalayas. Tibetan Medicine is based on Buddhist principles and the close relationship between mind and body.

Read More: http://www.tibetanmedicine.com/html/explanation.html

http://www.chinatravel.com/facts/traditional-chinese-medicine/tibetan-medicine.htm

Traditional Vietnamese Medicine
The distinguishing feature of TVM is the emphasis on nourishing the blood and vital energy, rather than concentrating on specific symptoms. TVM views building up the blood and energy as the key to good health. The main treatments employed by TVM are herbal medicine, acupuncture, and moxibustion.The cornerstone of its theories is based on the observed effects of Qi (energy) in the body. Qi can be inherited from one’s parents or it can be extracted from food. It is also blood and "fuel" gathered and stored by the body.

http://ethnomed.org/clin_topics/viet/trad_viet_med.html

Acupuncture
Acupuncturists insert tiny needles into specific points on the energy channels of the body, to promote healing and stimulate the free flow of energy in the body and mind. It is used to treat many conditions including muscular pain, headaches, asthma, gynecological problems, digestive complaints, as well as anxiety and depression. Acupuncture is also useful for preventative health care.

Moxibustion, Coin Rubbing & Cupping
Moxibustionis a therapy utilizing moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or process it further into a stick that resembles a (non-smokable) cigar. They can use it indirectly, with acupuncture needles, or sometimes burn it on a patient's skin.
http://en.wikipedia.org/wiki/Moxibustion

Coin Rubbingin Chinese is called Gua Sha, or literally "to scrape away fever.” It is an ancient technique used to scrape away disease by allowing the disease to escape as sandy-looking objects through the skin.” The Vietnamese term for this practice is cạo gió (pronounced "cow zaw"), meaning roughly to "scrape wind." It is also used in Indonesia.
http://en.wikipedia.org/wiki/Gua_Sha

Cupping Fire, or simply cupping, is a form of traditional medicine found in several cultures. It involves placing glass, plastic, or bamboo cups on the skin. This technique, in varying forms, has been found in the folk medicine of China, Vietnam, the Balkans, Iran, Mexico, Russia and Poland. In traditional Chinese medicine (TCM), cupping is a method of applying acupressure by creating a vacuum next to the patient's skin. The therapy is used to relieve what is called "stagnation" in TCM terms, and is used in the treatment of respiratory diseases such as the common cold, pneumonia, and bronchitis. Cupping is also used to treat back, neck, shoulder, and other musculoskeletal pain
http://en.wikipedia.org/wiki/Fire_cupping

Conclusion

 
This brief introduction to traditional medicines of Asian cultures no doubt leaves many questions unanswered and so it seems appropriate to invoke Ben Franklin’s caution, “a little learning is a dangerous thing.”  This article is meant to assist clinicians by providing a general framework, a baseline for learning.  No hard and fast rules about interacting with Asian patients and families are being offered. Becoming fully familiar with the normative cultural values affecting interactions with patients from different cultures is a process that takes time and experience. Using the links provided for further study, consulting colleagues from other ethnic groups, and speaking to interpreters and community members are all ways to learn more about the practices and health beliefs one encounters that are different from one’s own. It is also important to learn to ask patients questions in a culturally sensitive way, understanding that fear of making mistakes in communicating with them blocks the exchange of vital information.  There have been instances where practices such as coining and cupping have been misinterpreted by conscientious healthcare workers and reports of child abuse made in error. Thorough efforts at communication might have prevented these erroneous reports which traumatized families.

A cross-cultural mindset requires understanding one’s own health beliefs and behaviors first and then applying that baseline of understanding as a means of making effective comparisons across cultures. Clinicians should keep in mind that individuals subscribe to group norms to varying degrees. Factors such as socio-economics, education, degree of acculturation and English proficiency have an enormous impact on an individual’s health beliefs and practices. Searching out and really trying to understanding the individual patient is crucial.

(The following website was referenced for several definitions of beliefs and practices http://www.kailashcentre.org/about-oriental-medicine.html)

- contents - newsletter archive - home -

What You Need to Know About CHP+ Eligibility, Enrollment and Claims

CHP+ Enrollment
If a member is accepted onto CHP+, coverage will begin either on the date of the postmark on the envelope containing the original, complete, CHP+ application or the date the complete application is delivered to CHP+ or one of its satellite eligibility sites. This process may take up to 45 days.

Verifying Eligibility and PCP Assignment
The provider is responsible for verifying eligibility when rendering services. A member’s enrollment with the State Managed Care Network may be verified by any of the following means:

• Logging on to the Colorado Access Web site and utilizing the Eligibility Search (please see the Introduction to this manual for more information on the Colorado Access website).
• Logging on to the State Web Portal at: https://sp0.hcpf.state.co.us/Mercury/login.aspx.
• Verifying member enrollment on the monthly Colorado Access Membership report. Lists of members assigned to specific PCPs are generated during the first five (5) working days of the month and are available on the Colorado Access Web site (www.coaccess.com). New members are designated with an asterisk (*).
• Calling Customer Service at (303) 751-9051 or toll free 1-800-414-6198.

Claims Submission
Please submit claims to:
          CHP+ Claims
          PO Box 17470
          Denver, CO 80217-0470
Colorado Access acts as the administrative services organization for the State Managed Care Network. All claims for services rendered to members enrolled in CHP+ are processed by Colorado Access, with the exception of non-accident related dental claims, which are processed by Delta Dental, and pharmacy benefits, which are managed by Caremark. CHP+ participating providers must follow the State Managed Care Network’s claims filing procedures. All explanations of benefits (EOBs) and payments will be issued by Colorado Access.

Timely Filing
Unless otherwise stated in contract, CHP+ providers must submit claims within 180 calendar days from the date on which services were rendered.
Should your claim be denied for timely filing, upon appeal, Colorado Access will accept the following documents as proof of timely filing:

• Another health plan’s explanation of benefits (EOB).
• An electronic/EDI claim submission acceptance report.

Claim Resubmissions
Providers may resubmit denied claims for reprocessing within 180 days of the date of service or 90 days from the date of the last denial recorded on a voucher.

Resubmission Process

1. Send a photocopy of the original claim, clearly marked “Resubmission” on the face of the claim or newly completed claim form. The resubmission must be newly dated and signed with an authorized signature. Attach a copy of the voucher listing the originally submitted claim as denied.
2. If one or more items on an original claim have been paid and other items denied, a legible photocopy of the original claim may be used to resubmit denied lines.
3. Correct the appropriate information clearly and accurately.
4. Adjust total charges to reflect the amount being resubmitted.
5. Mail all resubmitted claims the claims address listed in this manual.
   
   We will research the resubmission and adjudicate the claim according to the newly resubmitted information. Once adjudicated, the claim will appear on your voucher with a corresponding EOP code outlining the reason for payment or denial. Claims may be re-submitted if they are sent within 180 days of the date of service.

Please note: It is not necessary to submit an appeal if the claim is resubmitted within timely filing.

You may find this and other important information in the CHP+ State Managed Care Network Provider Manual. The Provider Manual can be obtained by visiting www.coaccess.com and go to the “For Providers Section”.

This articel provided by Colorado Access.

- contents - newsletter archive - home -

Announcing an Interactive Cross-Cultural Communications Website
Designed Especially for Healthcare Professionals

dimesionsofculture.com

 
Register now! Click the link above and get full access
with your own secure login and password!

A Website to Support On-going Training for Healthcare Professionals in Colorado

Because culture can have important clinical consequences, this website is devoted to supporting the self-development of healthcare professionals in basic cross-cultural communication competencies that impact health outcomes for patients. In place of the typical "diversity training" approach, practical communication strategies are emphasized that can be put to use immediately in private practices, clinics, and hospital settings.

An Interactive Website for Building a Learning Community
 
The content of this cross-cultural communications website focuses on reinforcing key concepts presented in cross-cultural communication trainings by Marcia Carteret. Additionally, this site presents the opportunity for physicians and staffs in multiple healthcare settings to interact with one another through threaded discussions. Because nothing can replace real life experience in the learning process, a virtual learning community will make it possible to share true stories and post useful questions while culture and medical experts facilitate discussions.
Website Features
Listed here are the pages that currently make up dimensionsofculture.com. Please note that some pages require a login and password because only select groups of healthcare professionals, including all CCHAP pediatric practices, will have full access to the “community” pages.

Public Pages

• Home Page
• Greetings from the Site Editor
• Culture Calendar- Monthly religious and cultural holidays
• Culture Quest – Information about cultural happenings in our community, as well as statewide and nationally.

Healthcare Community Pages (Login/Password Protected)

• Newsletters – Monthly articles addressing key cross-cultural communication topics written by Marcia Carteret and other guest contributors.
• Interactive Forums– an interactive on-line community dialogue between healthcare professionals about communicating with patients from different cultural backgrounds. 
• Provider Profiles– An ongoing series of profiles introducing some of the dynamic and culturally diverse doctors working in the CCHAP network of pediatric practices
• Culture Ambassadors – A panel of representatives from cultures around the globe, with a strong focus on the cultures most heavily represented across out state.

This website is designed to meet the needs of the healthcare community served by Colorado Children’s Healthcare Access Program. If you are a participating CCHAP provider or staff member and have suggestions for the website, please contact Marcia Carteret at mcarteret@gmail.comor 720-777-3124. Your comments and suggestions will help make dimensionsofculture.com an effective tool for learning and community building.

- contents - newsletter archive - home -

Abe Grinberg MD, FAAP MPH
   

Language as a Communication Barrier in Medical Care for Hispanic Patients
 

           Communication with patients and their families is essential in providing quality medical care. Cultural and language barriers create a void in the delivery of safe health care, customer satisfaction and quality of care. The public debate on how to bridge cultural and language barriers has a long history. The use of formal interpreters and translators is associated with the ability to eliminate these barriers; however, the ability to communicate directly with health professionals in a common language is associated with an increase level of trust in medical settings.

           There are 7 important points to have in mind when addressing cultural and language barriers with the Hispanic patients and their families:

1. The number of people speaking a language other than English at home and the number of Americans Limited in English Proficiency (LEP) in the United States is significant. It is expected that the total number of people in these two groups will continue to increase at a faster rate than the one of the general population in the USA. About two thirds of them are Spanish speaking individuals (₁) (₂).
2. Multiple studies document that quality of care can be seriously compromised when Spanish LEP patients need but do not get translation and interpretation services (₃) (₄).
3. Studies also document that the quality level of interpretation offered by bilingual providers and professional hospital interpreters is high. However, the quality of interpretations offered by hospital employees who are not professional interpreters, family members, relatives, friends, and ad-hoc translators are many times incorrect and of poor quality (₅).
4. Interpretation errors are common. About 60% of the errors have potential clinical consequences. Even professional interpreters commit significant errors about 50% of the time (₅).
5. Patients, who interact with a bilingual provider, frequently rate them as more friendly, respectful, and concerned when compared to those who interact with a translator or interpreter. Patients and families who are taken care by a provider who speaks their own language frequently have a more accurate recall of critical information about the encounter than those who interact with a provider who uses a translator or an interpreter(₆)(₇).
6. There are data that suggest that the length of hospital visits, the incidence of any testing, the cost per visit and the number of hospital admissions are decreased in those patients who interact with a provider who speaks their own language when compared to those providers who use a translator or interpreter during the course of the medical encounter (₈). 
7. There is evidence that courses in Medical Spanish can help health care professional achieve fluency in Spanish at the functional level and promote cultural awareness that strengthen communication skills. The promotion of such courses is associated with decreased interpreter use and increased patient and family satisfaction (₉).

          Bear in mind that Hispanics embrace people when they make an effort to speak their own language. They tend to be tolerant and have a tendency to develop relationships that are based on friendship and respect. You will make them fill comfortable and help them feel that you are concerned about their medical care.
 
          “Dele a un hombre un pescado y él comerá por un día. Enséñele cómo pescar y comerá por el resto de su vida” (Lao Tzu. Filósofo Chino).

1. 1. Flores Glenn. 2005. The Impact of Medical Interpreter Services and the Quality of Health Care: A Systematic Review. Medical Care Research and Review 62: 255-299
2. Colorado Alliance for Immigration Reform. U.S Immigration Data, Projections and Graphs. Retrieved: October 2, 2008. http://www.cairco.org/data/data_us.html
3. Flores, Glen., Abreu, Milagros., Schwartz, Ilan., and Schwartz, MD, and Hill, Maria. (2000). The importance of language and culture in pediatric care: Case studies from the Latino community. The Journal of Pediatrics. 137 (6): 842-848
4. Flores G. Language Barriers to Health Care in the United States. NEJM 2006; 355:229-23
5. Flores G., M.B. Laws., S.J. Mayo., B. Zuckerman., M. Abreu., L. Medina and E. J. Hardt. 2003. Errors in clinical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 111: 6-14
6. Baker, David W., Hayes, Risa., and Puebla Julia. 1998. Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients. Medical Care. 36(10):1461-1470 
7. Seijo, R., H. Gomez and J Frienderber. 1995. Language as a communication barrier in medical care for Hispanic patients. In. Hispanic Psychology_Critical issues in theory and research, edited by A.M. Padilla, 169-181. Thousand Oaks,Ca: Sage.
8. Hampers, L. C and., McNulthy, J.E. 2002. Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department. Arch Pediatr Adolesc Med. 156:1108-1113.
9. Suzan S. Mazo., Louis C. Hampers., Vidya T. Chande. Steven E. Krug. (2002).Teaching Spanish to Pediatric Emergency Physicians: Effects on Patient Satisfaction. Arch Pediatr Adolesc Med 156: 693-695

Course in Medical Spanish customized for pediatric care providers. Once a week for 12 weeks (2 hour class), includes also 6 month internet access to “Spanish for health care course”. Flexible schedule to accommodate participants’ preferences; Classes take place at the providers’ office for groups of 8-12 students.
$ 389 dollars per student. Includes 6 month internet access to the on line training course.
          Contact: Abe Grinberg MD (720) 748-7669.
          abe@bilingualmed.com my web-site www.bilingualmed.com

- contents - newsletter archive - home -

Postpartum Depression Screening For Mothers
And Training For Your Practice

Postpartum Depression is a significant public health issue affecting 1 out of 8 new mothers. In Colorado, it is underidentified and undertreated. The Rose Community Foundation has funded Dr. Brian Stafford and The Kempe Center¹s Postpartum Depression Intervention Program to provide Free Medical Education and On-Site assistance to practices in the Denver Metropolitan area in order to assist their identification, education, treatment, and referral for women with this condition. Practices will receive a free talk as well as a free tool kit and fliers and brochures to assist them. This provider education is paired with a public awareness campaign on this issue titled, 'Oh baby, this isn¹t what I expected.' Interested practices or practitioners should contact the Kempe Center at 303-864-5845 or Dr. Brian Stafford at tafford.brian@tchden.org to schedule the on-site pre-clinic or lunchtime training.

- contents - newsletter archive - home -

Child Psychiatrist Available to Provide Conferences for You In your Office

Rick March, MD is a child psychiatrist at the Mental Health Center of Denver.  He is available to provide teaching on a variety of child Psychiatry topics (below) in your office.  He is also willing to discuss cases with you, as well.  Please contact him to take advantage of this wonderful opportunity.
He can be reached at Rick.March@MHCD.org

Here are some of the topics he can cover for you.

• Diagnosing Depression in Children and Adolescents
• SSRI’s and Black Box warnings
• Suicide and self-abuse
• Diagnosing Bipolar Disorder in Children and Adolescents (including differential diagnosis)
• Atypical Antipsychotics
• Mood Stabilizers and Antidepressants
• Pediatric Psychopharmacology and the FDA
• Kid with ADHD who don't get better on stimulant medication
• Psychosis in Children and Adolescents

And, remember there is a child psychiatrist on call available by phone for your Medicaid children…..

- contents - newsletter archive - home -

The Cross-cultural Curriculum for the Department of Pediatrics
The syllabus is now available for you and your practice

There is a syllabus available on the CCHAP web site that covers a variety of topics related to cross cultural health care.   Click Here to view the entire curriculum or visit www.cchap.org/cchc-syllabus/. The following topics are covered:

Demographics of Colorado’s Children

Health Disparities among Colorado’s Children

Health Disparities
              Poverty
              Genetics 
              Environmental exposures 
              Life style behaviors 
              Provider’s ability to understand/accommodate the patient’s / parent’s culture
              Provider’s ability to communicate well with families
              Patient’s / parents limited English proficiency
              Patient’s / parent’s limited health literacy 
              Disimination

What can Providers do to improve outcomes?

Race, Ethnicity and Culture (Definitions)

Cross-cultural Communication 
              Generalization versus stereotyping 
              What providers need to know about culture? (Dimensions of culture) 
              Basics of cross-cultural communication

How to communicate with and help families with Limited English Proficiency

How to communicate with and help families with Limited Health Literacy

The Cross-cultural Health Care toolkit 
              Keys to success in cross-cultural communication 
              LEARN mnemonic 
              Cross-cultural health care Review of Systems

Case Studies

Examining our Own Personal Biases

8 Steps You Can Take to Enhance Your Skills in Cross-cultural Health Care

The Institute of Medicine’s Guidelines

The CLAS Standards (Guidelines for organizational change)
  
References

- contents - newsletter archive - home -

Child Psychiatry Telephone Consultation on Medicaid Children

The Behavioral Health Organizations and the Mental Health Centers in the greater metro area have very generously made available telephone consultation by child psychiatriststo help providers in CCHAP – affiliated practices manage their  Medicaid children with complicated mental health issues or complicated medication regimens.   These child psychiatrists are also willing to come visit your practice to get to know you and even to discuss cases.   We are very grateful for this very generous support for your Medicaid children.

Denver County – Rick March, MD – 303-504-1520
Jefferson County – Don Bechtold, MD – 303-432-5172
Adams, Arapaho and Douglas Counties - Joe Pastor, MD – 303-853-3888
 

- contents - newsletter archive - home -

Integrating Developmental Screening
Into a Pediatric Practice

• The Colorado Assuring Better Child Health & Development (ABCD) project has received a three year grant to provide training and technical assistance to providers to implement a “validated” developmental screening tool at well child visits for infants/toddlers birth to five.
• The ABCD project is partnering with CCHAP to provide training and support to pediatric practices to implement developmental screening.
• Medicaid will reimburse $34.00 to providers if you use a standardized, validated developmental screening test at an EPSDT visit.
• The Colorado Chapter of the AAP supports the ABCD project.
• Early detection and intervention improves outcomes.  Many delays in children’s development are missed in the first 4-5 years of life without a standardized, validated screening test. 
• The most time-efficient tool is one in which the parent completes a questionnaire.
• To comply with 2010 recertification guidelines by the American Board of Pediatrics, documentation will be required to show levels of involvement in practice improvement initiatives. By implementing the use of a “validated” developmental screening with a sensitivity and specificity rating of 70% or greater like the ASQ or PEDS, practices are taking steps to integrate quality improvement into their practices.
• What providers are saying about implementing either the ASQ or the PEDS parent questionnaire developmental screening tools:
  •  
    • It takes 1-2 minutes for an MA, LPN or RN to score.
    • It takes less than a minute of the provider’s time if the MA, LPN or RN scores the questionnaire.
    • In many instances, it reduces the length of the visit.
    • It helps providers concentrate on the concerns/priorities of the parents.
    • It reduces the number of concerns that come up as you are walking out the door at a well care visit.
    • It improves patient satisfaction.
    • It promotes positive parenting practices.
    • It increases provider confidence in decision-making for when to refer a child for further developmental evaluation.
• Eileen Auer Bennett, the Colorado State ABCD Coordinator and her team are available to assist providers in getting started. Training and technical assistance will be provided to practices to implement a standardized tool such as the ASQ or PEDS. Support will also be given to office staff on how to incorporate a standardized developmental screening tool into the current office work flow.

For more information, please contact:
            Eileen Auer Bennett
            720-333-1351
            ileanben@yahoo.com

The Ages & Stages Questionnaire (ASQ) is a well respected screening tool.  It has the best sensitivity and specificity.  It is standardized across various common minorities.   Health care providers have identified the following advantages:

• Parent completed—Parents are partners in their child’s
  assessment and intervention activities.
• Serves as a talking guide with parents identifying a
  child’s strengths as well as things the child is not
  doing yet.
• Practical—Scoring takes 1-2 minutes and can be done
  by paraprofessionals.
• Cost-efficient—May be photocopied repeatedly.
• Scoring is simple—Only three responses:
  1. Sometimes, occasional or emerging response from
     child = 5 points
  2. Yes, child performs specified behavior = 10 points
  3. Not Yet = 0 points
• If the child’s total score falls in a shaded area of the bar
  graph for any developmental area, further diagnostic
  assessment is recommended.

• Developed out of four cross-validation studies on a
  nationally representative sample of families.
• Uses parent concerns or judgments about the child’s
  development and behavioral status.
• Easy to score—two minutes to elicit and interpret.
• Enables health care providers to determine the need to
  refer and where.

Visit www.pedstest.comto view and order the PEDS tool online.

- contents - newsletter archive - home -

Spanish Interpretation Training for Pediatric Practices

An assessment of each individual’s skill level will be done during a 5-10 minute phone call prior to first telephone conference/class.  Maria will contact you to schedule this initial individual telephone call upon receipt of your registration email.  A certificate of completion will be given after completion of all 6 sessions. The faculty is Maria Soto, a certified Spanish interpreter and trainer with International Language Services.

- contents - newsletter archive - home -

Copyright 2009 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter Twenty-Seven, March 2009