Ensuring Equitable Pain Management and Addiction Treatment for Limited English Proficiency Patients

Communication between patients and care teams about medical, behavioral health (including substance use), and social service needs is essential to ensuring equitable, quality care and cultivating trusting relationships. For patients who speak English less than "very well," also known as Limited English Proficiency or LEP, the inability to communicate effectively and confidently with care teams is a significant barrier and undermines the ability to build trust in providers and the health system as a whole. In the area of pain management and substance use disorder treatment, these disparities are exacerbated by the lack of language-appropriate care, leading to untreated or undertreated conditions.

Health centers provide meaningful access to services for LEP patients

In 2018, 23.64% or more than 6,700,000 Federally Qualified Health Center (FQHC, also known as Community Health Centers) patients were best served in a language other than English. As recipients of federal funding, health centers are required to provide meaningful access to services to millions of LEP patients.

When health centers become language accessible, they enact policies and guidelines that fulfill their legal obligations to guarantee LEP patients receive equal access to information and services in their preferred language. This includes pairing bilingual staff with LEP patients, providing professional or contractor translators, and offering patient education, medication information, forms, and resources in multiple languages.

Language justice considers a patient's cultural background

Language justice recognizes the right of every person to speak, understand, and be understood in the language they prefer and in which they feel most articulate and powerful. "While language access is a critical component to equitable communication and care, and works around language barriers, language justice goes beyond language access to break these barriers," says Devorah Keller, MD, MPH Director of Clinical and Quality Improvement, National Health Care for the Homeless Council (NHCHC).

Language justice also gives deep consideration to a person's culture. Cultural humility, together with language, is central to people's interactions within the health care system. "Culture and language inform how people perceive their own health and wellbeing and what they value and prioritize in their health journey," says Kate Gleason-Bachman, MPH, RN, Clinical and Quality Improvement Nurse Manager, NHCHC. Cultural and linguistic experiences can influence whether a person will enter care at all or continue after their first encounter.

Five Steps to Becoming a Language Justice-Centered Organization

"Language justice must be an intentional, consistent, and sustainable practice," shares Gleason-Bachman. "It is not easy, takes time, and financial and staff resources. However, it is achievable and will significantly benefit patients, care teams, and all health center staff."

Earlier this year, NHCHC and the National Association of Community Health Centers (NACHC) led an Equity in Substance Use and Pain Management learning community comprised of ten health centers and two primary care associations that explored the role of language as a potential driver of inequities. Through the learning community, participants identified and delved into strategies to move health care delivery in pain and substance use treatment towards a language justice approach. During the learning community's final session Laura Guzman, JD, Executive Director, National Harm Reduction Coalition recommended health centers take these immediate steps to becoming language justice centered:

• Gain an understanding of the language continuum. Educate all staff on language justice and the language continuum. Organizations fall into one of four categories: Language Exclusion, Language Tolerance, Language Access, or Language Justice.
• Identify where your organization currently lies in the language justicecontinuum. Conduct a language justice organizational needs assessment to understand the linguistic needs of the people you serve and their communities, and how you are currently supporting them. Use your findings to inform your health center's plan for moving along the continuum towards language justice.
• Offer comprehensive translation services. Provide professionally trained medical translation services and multilingual patient education resources across all medical, behavioral health, and social service lines. Create a physical space that is multi-lingual/multi-cultural for people who speak languages other than English. Emphasize linguistic inclusivity in communication with board members, leadership and community outreach.
• Foster collaboration and empowerment among community members. Engage diverse groups, communities, and stakeholders to support your health center's language justice goals. Consider hosting health fairs or conducting outreach services at locations in the community that are easily accessible, culturally and linguistically supportive, and offer a familiar and comfortable setting.

Language justice is a cornerstone of health equity, particularly for marginalized populations dealing with chronic pain and/or substance use disorders. Without it, true equitable care cannot be achieved.

To learn additional strategies for ensuring equitable, high-quality, compassionate, and patient-centered care for all health center patients experiencing pain and substance use disorders download Increasing Equity in Pain Management, Substance Use Disorder Treatment, and Linkages to Care - NACHC.

Filed under topic(s): Behavioral Health, Immigrant Patients, Patients, Substance Use