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Communication in Minority Language Situations - HSO 11012:2018 (E)

Communication in Minority Language Situations Draft for Public Review - Version 1 HSO 11012:2018 (E)

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Publication Terms of Use (Draft for Public Review) The standard was developed in compliance with Health Standards Organization (HSO), Standards Council of Canada (SCC) and International Society for Quality in Health Care (ISQua) standard development requirements. All HSO standards are developed through a rigorous process that includes a comprehensive literature review, consultation with a standard working group or advisory committee comprised of experts in the field, and evaluation by client organizations and other stakeholders. Intellectual property rights and ownership This publication (“Publication”), and all content contained herein, is owned by HSO and/or its licensors. It is protected by copyright and other intellectual property rights in Canada and around the world. For clarity, HSO claims and grants no rights in the documents identified herein as “Resources”. 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Although the intended primary application of this publication is stated in its Scope, it is important to note that it remains the responsibility of the users of the standard to judge its suitability for their particular purpose.Cette ébauche de norme pour consultation publique est disponible en version française et anglaise. Version history and Maintenance: Draft for Public Review Version 1 – Periodic Standard Type: Organization Competency ICS: 11.20.10 © 2018. Health Standards Organization and its licensors. All rights reserved.

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Communication in Minority Language Situations Voting Members The following were members of the Technical Committee on Communication in Health Services at time of approval of the Draft for Public Review:

Name

Organization

Position

Location

Interst Category

Gisèle Lacroix

N/A

Patient

Calgary, Alberta

Dounia Najahi

N/A

Patient

Montreal, Quebec

Audrey Fournier

N/A

Patient

Carmen Millar

N/A

Patient

Yellowknife, Territoires du Nord-Ouest Dollard des Ormeaux, Quebec

Patient/Family Member Patient/Family Member Patient/Family Member

Dr. Aitor Montes Lasarte

Osakidetza (Basque NHS)

Family Physician

Galdakao, Spain

Product User

Grace Eagan

Access Alliance Multicultural Health and Community Services

Business DevelopmentLanguage Services

Scarborough, Ontario

Product User

Janine Doucet

Centre cardiaque du Nouveau-Brunswick Summerset Manor

Executive Director

Product User

Dana Mohr

Winnipeg Regional Health Authority

Tharcisse Ntakibirora

Toronto Central Local Health Integration Network

Regional Manager, French Language Services French Language Services Coordinator

Saint John, New Brunswick Summerside, Prince Edward Island Winnipeg, Manitoba Toronto, Ontario

Policy Maker

Angela Sasso

Critical Link International

President

Policy Maker

Elizabeth Abraham

WHO Europe

Gilles Vienneau

Société Santé et Mieuxêtre en français du Nouveau-Brunswick

Task Force on MigrantFriendly and Culturally Competent Health Care Directeur général

Vancouver, British Columbia Toronto, Ontario

Moncton, New Brunswick

General Interest

Dr. Gwerfyl Roberts

School of Healthcare Sciences University of Ottawa

Senior Lecturer

Bangor, Wales

General Interest

Postdoctoral Fellow

Ottawa, Ontario

General Interest

Société de l’Acadie du Nouveau-Brunswick

Retired President

Petit-Rocher, New Brunswick

General Interest

Program Manager

Montreal, Quebec

Gayle Lamont

Dr. Chad Hammond Jeanne d'Arc Gaudet

Director

Patient/Family Member

Product User

Policy Maker

Policy Maker

Management Amy Pack

Health Standards Organization

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Acknowledgement This voluntary Standard was commissioned by Société Santé en français and was supported through funding by the Government of Canada (Health Canada). Société Santé en français is a Canadian leader who, in close collaboration with the Santé en français networks in each province and territory, provides better access to quality French-language health programs and services. Such efforts improve the state of healthcare of all Francophone and Acadian communities living in minority communities. Société Santé en français 223, Main St., Office L396 Ottawa, Ontario K1S 1C4 Canada

Preface This is the first draft of the first edition of HSO 11012:2018 (E), Communication in Minority Language Situations. It is intended to align with other HSO health service providers’ standards applicable to healthcare institutions offering services in minority language situations. The standard criteria are grouped into three sections based on these functions:   

Communication and language services Governance, leadership, and workforce Engagement, accountability, and organizational culture

The draft standard for public review specifies requirements for these healthcare institutions to deliver quality health services to patients and families in linguistic minorities. The content was prepared by the HSO Technical Committee on Communication in Health Services, under the authority of HSO Standards Steering Committee.

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HSO 11012:2018 (E) Communication in Minority Language Situations 0 Introduction HSO’s Communication in Minority Language Situations Standard (hereafter referred to as “the standard”) aims to improve access for Canada’s two official linguistic minorities (French outside of Quebec and English inside of Quebec) to safe, high-quality health services and social services across the continuum of care. The standard aims to promote the active offer of bilingual language services. An active offer service in health care is an open invitation to the public to use one of Canada’s two official languages (French or English) when communicating with or receiving a service from a health care organization (Active Offer, Office of the Commissioner of Official Languages). Where a consolidated effort to actively offer bilingual services is made and bilingual staff are not available, the standard aims to ensure a qualified interpreter is provided. Ultimately, the goal is to encourage access to quality health care for Canada’s official linguistic minorities. Miscommunication is an issue that cuts across concentrations, settings (e.g., hospital, care home, hospice, community), workforces (e.g., nurses, social workers, general practitioners, volunteers) and geographies. Miscommunication in the health care sector can be life-threatening. Official linguistic minority groups encountering communication challenges are more likely to experience adverse events, longer hospital stays and decreased satisfaction (Bernard et al., 2006; Flores, 2006; Meuter, Gallois, Segalowitz, Ryder, & Hocking, 2015; Schyve, 2007). Further, linguistic barriers adversely affect a patient’s ability to communicate with their health care team (Eckhardt, Andrew, & Mott, 2006). There have been very few national initiatives focusing on linguistic responsiveness in Canada. With the exception of medical interpretation services for deaf patients (Stradiotto, 1998), the rights of Canadian patients to trained health interpreters have not been established, nor have the responsibilities of health services to ensure provider/patient communication, national training, accreditation and service standards (Rochefort, 2001). Moreover, national consultation on language access in health care resulted in little follow-up (Rochefort, 2001). As a result, there is wide variation among regions in the availability of language access services, models of service provision, and program standards. Although some provinces have undertaken specific initiatives, they are not nationally coordinated. Issues of linguistic responsiveness have not received high-profile attention in recent health service review initiatives such as the Romanow Commission (Bowen Thesis, p. 10). The standard addresses the main points of the care continuum where effective communication is crucial to safe, high-quality health services. This includes admission, assessment, treatment, end-of-life, and discharge and/or transfer of care. The standard considers the organizational structures and processes required at the governance and leadership levels to support and ensure effective communication: service planning, data collection, development of policies and procedures, adequate resources, and staff 5

Communication in Minority Language Situations - HSO 11012:2018 (E) education and training. The standard integrates patient communication needs into organizational processes to address the quality of linguistically appropriate services in health service organizations.

1 Scope 1.1 Purpose This draft standard for public review specifies requirements for healthcare institutions to deliver quality health services to patients and families in linguistic minorities. The standard, once approved by the Technical Committee, will provide:  healthcare institutions with guidance on how to ensure quality and safety within their unique institutional and linguistic context;  policy makers a blueprint for the requirements to designate and recognize healthcare institutions offering quality healthcare of linguistic minorities in their jurisdictions; and  external assessment bodies with measurable requirements to include in assessment programs. This standard will not be intended to be used alone, but in conjunction with standards that apply to healthcare institutions providing health and social services within the context of minorities language situations. The draft standard for public review is intended to be used for review and consultation by the public only and not fit for the purpose specified above until approval by the Technical Committee. To obtain a final copy, please visit HSO e-store when published or one of our participating Assessment Bodies.

1.2 Applicability This standard is intended to apply to healthcare institutions providing health and social services within the context of minorities language situations.

2 Reference publications There are no normative reference publications in this draft standard for public review. Informative reference publications are found in Annex A.

3 Terms and Definitions Active offer An active offer of service is an open invitation to the public to use one of Canada’s two official languages (English or French) when communicating with or receiving a service from the federal government. Active offer includes a bilingual greeting and visual cues, such as signs, that support this invitation. Bilingual person An individual who has some degree of proficiency in the two languages assessed against the Canadian language benchmark (French and English). An elevated level of bilingualism is the minimum qualification for a competent interpreter but by itself does not ensure the ability to interpret. Communication Communication is the transfer of information, ideas, or feelings.

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Communication in Minority Language Situations - HSO 11012:2018 (E) Interpreting services Services that facilitate language communication between two or more parties who do not share a common language by delivering, as faithfully as possible, the original message from the source into the target language. Language awareness Explicit knowledge about language, and conscious perception and sensitivity in language learning, language teaching, and language use. Language awareness issues include exploring the benefits that can be derived from developing a good knowledge about language, a conscious understanding of how languages work and of how people learn and use them. Language awareness also includes learning more about the ideas about language that people normally operate with, and what effects these have on how they conduct their everyday affairs. Linguistic competence The ability of staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences, including those with limited English or French proficiency or limited literacy. Minority language A minority language is a language spoken by a minority of the population of a territory. Such people are termed linguistic minorities or language minorities. Qualified interpreter A qualified interpreter is a language professional who has been trained by a recognized training program and has also tested for proficiency in English and French, and has also knowledge and practice of professional ethics.

4 Requirements for Communication in Minority Language Situations COMMUNICATION AND LANGUAGE SERVICES 1. The organization actively offers and provides health services in both official languages according to the language preferences and needs of the patient. 1.1 The organization demonstrates significant efforts to actively provide services in the language of the patient, using trained bilingual staff or volunteers. Guidelines Efforts include the organization demonstrating that every effort has been made to recruit trained bilingual staff and volunteers. 1.2 The organization provides all patient-facing written and oral materials in French and English. Guidelines Patient-facing materials include patient education documents, consent forms, information pamphlets, audiovisual material, and website information, etc.

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Communication in Minority Language Situations - HSO 11012:2018 (E) 1.3 The organization ensures all patient-facing materials respect appropriate language formatting for the type of document. Guidelines For example, consent forms should be in consecutive format, with French immediately followed by English. 1.4 If services cannot be provided according to the language preferences and needs of the patient at the time of the encounter, patients are provided with access to a qualified interpeter as quickly as possible and at no cost to the patient. Guidelines Protocols should be in place to guide decision making with regards to the offer of qualified interpreters where language barriers arise in practice. 1.5 Where interpreting services are required, they are provided by someone who is adequately trained and tested. Guidelines When efforts are made to actively offer bilingual services and trained bilingual staff or volunteers are not available, a qualified interpreter may be offered. In this case, the provision of trained and tested interpreters ensures patient safety and quality of care. 1.6 Interpreting services comply with all relevant national, provincial, and local mandates governing language access.

2. Services and supports are accessible and delivered in the preferred or required official language of the population served. 2.1 The organization puts a protocol in place to ensure care does not vary in quality or accessibility regardless of a patient’s indicated official language of preference or need. 2.2 The organization ensures patients and their families are informed of their right to linguistically appropriate services. 2.3 The organization offers clear signage in French and English. Guidelines Bilingual signage should be available at the entrance of the building and for all directional indications in the building. 2.4 The organization communicates informed consent in the patient’s preferred or required language. Guidelines Informed consent documents and discussions must be provided in the patient’s preferred or required language by trained bilingual staff of volunteer. When access to trained bilingual 8

Communication in Minority Language Situations - HSO 11012:2018 (E) staff of volunteer would delay access to care, a qualified interpreter must be engaged to provide a translation of informed consent documents and discussions.

3. Bilingual services are available for clinical research participants. 3.1 The organization makes patient-reported outcome measures administered in clinical research available in French and English. Guidelines Where patients or service users are invited to participate in clinical research, language awareness is part of each stage of the research process. 3.2 The organization posts calls for expression of interest by suitable patients or service users in French and English. Guidelines Posting calls for expression of interest in French and English helps guarantee that all populations in a minority situation are aware of planned clinical research and have the choice to enroll.

GOVERNANCE, LEADERSHIP AND WORKFORCE 4. The organization has an evidence-informed language access plan that is tied to its mission, operating principles, and service focus. 4.1 The organization’s leaders make the commitment to linguistically appropriate service highly visible by disseminating the language access plan to staff, volunteers, patients, and the community. Guidelines The language access plan should be communicated internally and externally (e.g., through annual reports, websites, and other similar means). 4.2 The language access plan is developed with the participation of staff, volunteers, patients, and the community.

5. A consistent, validated, and shared definition of linguistic competence is developed and used. 5.1 The organization has common definitions related to linguistic services that are accessible to patients, staff, and volunteers. Guidelines The organization should access and use standardized terminology in French and English. This may be accomplished by way of an organization glossary, forum, or internal sharing system.

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Communication in Minority Language Situations - HSO 11012:2018 (E) 5.2 The organization has access to an established test of language competence. Guidelines Linguistic competence requires a non-biased evaluation. Various measuring tools (e.g., the Canadian language benchmark) are available.

6. Strategies are implemented to recruit, retain, and promote, at all levels of the organization, diverse staff, volunteers, and leaders who represent the minority language group(s) of the service area. 6.1 The organization uses proactive strategies to build a diverse workforce capacity. Guidelines The organization should ensure work equity for bilingual and monolingual staff and volunteers. Different proactive strategies should be sought for the additional services provided by trained bilingual staff, such as incentives, mentoring programs, and partnerships with local schools and employment programs. 6.2 The organization incorporates the goal of staff and volunteer diversity in its mission statement and strategic plan. Guidelines Linguistically diverse staff and volunteers should be represented in the leadership of the organization as well as its governing boards, clinicians, and administrative personnel. The organization should include a language capacity factor in developing its health care provider team. Using a team approach, there should be sufficient capacity to provide health care services in the patient’s preferred or required language.

7. The organization’s staff and volunteers explicitly inquire about the preferred or required language of each patient and record this information in all appropriate records. 7.1 The organization flags language preferences and needs identification for all staff and volunteers across the organization. Guidelines Language preferences and needs identification are required in the screening and data capture of medical and health care records. Preferred or required language should be flagged in the electronic medical record banner or other easily identified location (e.g., language identification card) for all staff and volunteers, as applicable, to see. The organization should ensure there are systems and processes to identify, record and disseminate language of preference or need. 7.2 The organization establishes a preferred or required language screening protocol. Guidelines

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Communication in Minority Language Situations - HSO 11012:2018 (E) The organization has established an evidence-based protocol for how and when to ask patients about their preferred or required language. 7.3 The organization has policy to respond to language preferences and needs. Guidelines The policy may provide guidance for staff and volunteers to refer to a colleague, adapt behaviour to the patient, or provide patients with the choice of preferred or required language. 7.4 The organization ensures all staff are appropriately trained in screening for language preferences or needs. Guidelines Training will ensure that data may be collected from patients at the first point of contact and verified and confirmed at various points during the patient's care. 7.5 The organization validates language preferences or needs throughout care delivery. Guidelines Language preferences or needs should be verified with the patient on entry into the system and reconfirmed at every stage of care. Patients have the option to opt-out of language identification at any point. 7.6 The organization identifies language proficiencies for its staff and volunteers. Guidelines Identification of proficiency is standardized, validated, and made visible through, for example, the use of badges or lanyards.

8. The organization ensures that staff skills in providing linguistically competent health care services are continuously improved by language skills and awareness training and that such skills are assessed. 8.1 Trained bilingual staff who communicate directly with patients in their preferred or required language demonstrate a command of French and English. Guidelines Staff should be assessed on their knowledge and facility with the terms and concepts relevant to the type of encounter, including general and professional vocabulary. 8.2 The organization has a variety of knowledge transfer initiatives to help monolingual staff become competent in the other official language. Guidelines The organization should encourage the participation of staff at all levels and disciplines in ongoing linguistic education or other training in linguistically competent service delivery. 11

Communication in Minority Language Situations - HSO 11012:2018 (E) Training should be based on validated adult learning principles, conducted by appropriately qualified individuals, and properly evaluated with a pre/post methodology. 8.3 The organization provides language sensitivity training to all staff and volunteers.

ENGAGEMENT, ACCOUNTABILITY AND ORGANIZATIONAL CULTURE 9. Patients are provided with and made aware of how to access information on their rights regarding linguistically appropriate services. 9.1 The organization notifies patients, in French and English, of their right to receive health care in their preferred or required language. Guidelines The French and English notices should provide patients with information regarding their right to access and receive services in their own official language. Notices may be provided verbally or in writing. 9.2 The organization’s staff and volunteers verify that the patient and family understand information provided about their care.

10. The organization develops, implements, and disseminates evidence-informed policies and procedures that recognize the role of linguistic competence in addressing language barriers in health care. 10.1 The organization assigns a specific staff member, volunteer, or department to promote linguistic competence and awareness initiatives. Guidelines Language access champions should be identified at all levels, from governance to leadership to service delivery. The organization assesses how well its systems, programs, services and resources, staff, volunteers, leaders, and administrators meet the language needs of the communities it serves. Linguistic initiatives promote linguistic competence of staff and volunteers (language ability and sensitivity to linguistic minorities), bilingual signage initiatives, access to free interpreting services, and related activities. 10.2 The organization provides patients with satisfaction and evaluation surveys in both official languages that are understandable. Guidelines Baseline and ongoing evaluation activities are performed and updated regularly to define service needs, identify opportunities for improvement, develop action plans, and design programs and activities. Patients are engaged in evaluating language access and other communication services through patient-reported outcome measures, to ensure quality and satisfaction. Patient satisfaction surveys should also include an evaluation of their satisfaction with the language skills of the health care provider. 12


10.3 The organization has resources to assist patients who face unresolved language barriers in health care. Guidelines Resources included in a complaint management process may direct the patient to French or English language services or offices, patient relations, a community official language minority advocacy group, or a language affairs secretariat. The organization should inform patients of the channels available to them to remedy language barriers in health care. 10.4 The organization adopts an approach of progressive improvement in its active offer of bilingual services. Guidelines In providing linguistically appropriate services, changes should be manageable, measurable, and sustainable relative to the organization’s capacity for change.

11. Multiple methods are used to obtain up-to-date information on the health needs of the official language minority populations served. 11.1 The organization establishes relationships with official language minority communities in its jurisdiction to better understand their health care needs. Guidelines Patients and community representatives of official language minorities (patients, clients, family representatives, etc.) should be actively consulted and involved in a broad range of planning and implementation activities. Feedback may be solicited through a variety of mechanisms including governing boards, community advisory committees, ad hoc advisory groups, and community meetings, as well as informal conversations, interviews, and focus groups. Such collaborations provide the organization with the opportunity to learn from the experience of official language minorities and have more impact on addressing shared challenges. 11.2 The organization analyzes data about service use patterns to determine where official language minority groups face access barriers. Guidelines Examples of service use patterns include initial access and main points of the care continuum. The organization maintains current information regarding official linguistic groups that are moving into the service area. 11.3 The organization participates in outreach activities at several levels to emphasize the importance of offering services in the patient’s preferred or required language. Guidelines Outreach activities include workshops, conferences, information sessions on topics such as linguistic and cultural competence and sensitivity, and active referral services. Organizations 13

Communication in Minority Language Situations - HSO 11012:2018 (E) where staff and volunteers are made aware of these issues are better able to implement linguistic capacity services and face less resistance. Outreach activities can also be used to increase public confidence in opting for linguistically appropriate services.

12. The organizational culture promotes awareness of official language minorities. 12.1

Leadership supports the active offer of bilingual health care services.

Guidelines Leadership ensures the provision of orientation, training, mentoring, and other support to all staff and volunteers to ensure they understand and accept the values, principles, and practices governing linguistic competence in quality of care. Staff and volunteers should be aware of communication issues, available training, personcentered care, who the patient can reach out to, patient support resources, and web-based support. The organization demonstrates its support of initiatives that promote linguistic diversity. 12.2 The organization promotes awareness and understanding among staff and volunteers on the importance of supporting a bilingual culture.

Annex A - Refrences Acquadro, C., Conway, K., Hareendran, A., & Aaronson, N. (2008). European Regulatory Issues and Quality of Life Assessment (ERIQA) Group Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health. 11(3):509–521. Agency for Healthcare Research and Quality. (2016). Plain Language at AHRQ. Rockville, MD. http://www.ahrq.gov/policy/electronic/plain-writing/index.html Agency for Healthcare Research and Quality. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD). Agency for Healthcare Research and Quality. (2012). Providing Oral Linguistic Services. Rockville, MD. Available online: http://www.ahrq.gov/professionals/systems/primary-care/cultural-competencemco/oralling.html Eckhardt, R., Andrew, S., & Mott, S. (2006). Culture and communication: identifying and overcoming the barriers in caring for non-English-speaking German patients. Diversity in Health and SOcial Care, 3:19-25. Aucoin, L. (2008). Compétences linguistiques et culturelles des organisations de santé, Analyse critique de la littérature, [Linguistic and cultural competence in health care organizations, Critical analysis of the literature] Submitted to Société Santé en français, p. 18. Basch, E., Spertus, J., Dudley, R. A., Wu, A., Chuahan, C., Cohen, P., … Goertz, C. (2015). Methods for Developing Patient-Reported Outcome-Based Peformance Measures (PRO-PMs). Value in Health. 18: 493-504.

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Communication in Minority Language Situations - HSO 11012:2018 (E) Basch, E., Torda, P., Adams, K. (2013). Standards for Patient-Reported Outcome-Based Performance Measures. Journal of the American Medical Association. 310(2): 139-140. Bernard, A., Whitaker, M., Ray, M., Rockich, A., Barton-Baxter, M., Barnes, S. L., … Kearney, P. (2006). Impact of language barrier on acute care medical professionals is dependent upon role. Journal of Professional Nursing. 22(6) 355-8. Betancourt, J. R. (2003). Cross-Cultural Medical Education: Conceptual Approaches and Framework for Evaluation. Academic Medicine.78:560-569. Boudreau, A. (2007). A Master Plan for the Deployment of Francophone Health Human Resources in Minority Francophone Communities, report commissioned by Health Canada. Bowen, S. (2015). The impact of language barriers on patient safety and quality of care. Societe Santé en Français. Cross, T.L., Bazron, B.J., Dennis, K.W., & Isaacs, M.R. (1989). Toward a Culturally Competent System of Care. Volume 1. National Institute of Mental Health, Child and Adolescent Service Program (CASSP) Technical Assistance Center, Georgetown University Child Development Center. Eckhardt, R., Andrew, S., & Mott, S. (2006). Culture and communication: identifying and overcoming the barriers in caring for non-English-speaking German patients. Diversity in Health and Social Care, 3:19-25. Flores, G. (2006). Language Barriers to Health Care in the United States. The New England Journal of Medicine. 355:229-231. Gauthier, H. (2011). Étude exploratoire sur les compétences linguistiques à l’embauche [Exploratory study on linguistic competence as a hiring criterion], Report submitted to Santé en français (formely known as Conseil communauté en santé du Manitoba), Prepared by Hubert Gauthier Conseil Gestion. Goode, T., & Jones, W. (2003). Definition of linguistic competence. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Guerrero, E. G. (2013). Organizational Characteristics that Foster Early Adoption of Cultural and Linguistic Competence in Outpatient Substance Abuse Treatment in the United States. Evalation and Program Planning. 35(1): 9-15. Harun, A., Harrison, J. D., & Young, J. M. (2013). Interventions to improve patient participation in treatment process for culturally and linguistically diverse people with cancer: a systematic review. Asia-Pacific Journal of Clinical Oncology. 9(2): 99-109 Healthcare Interpreting Network. (2010). National Standard Guid for Community Interpreting Services. Available online: https://static1.squarespace.com/static/52d566cbe4b0002632d34367/t/5578a5b0e4b0841713c656fc/1433970096792/National_Standard_Guide_for_Community_Interpreting _Services.v3_new_format_Sep_2011..pdf Henderson, S., Kendall, E., & See, L. (2011). The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health & Social Care in the Community. 19(3): 225-249. Hewlett, S., Nicklin, J., Bode, C., Carmona, L., Dures, E., Engelbrecht, M., … Gossec, L. (2016). Translating patient reported outcome measures: methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in six European languages. Rheumatology (Oxford). 55(6): 1006-16.

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Communication in Minority Language Situations - HSO 11012:2018 (E) Martinez, K., & Van Buren, E. (2008). Cultural and Linguistic Competence – Implementation Guide. Technical Assistance Partnership for Child and Family Mental Health. Available online: http://fredla.org/wpcontent/uploads/2016/01/clcImplementationGuide.pdf Meuter, R. F. I., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Services Research. 15: 371. National Center for Cultural Competence. (2007). A guide for Advancing Family-Centered and Culturally and Linguistically Competent Care. Available online: http://fredla.org/wpcontent/uploads/2016/01/fcclcguide.pdf National Health Care for The Homeless Council. (2011). Addressing Cultural and Linguistic Competence in the HCH Setting: A Brief Guide. Available online: https://www.nhchc.-org/wpcontent/uploads/2011/10/CulturalCompetence0406.pdf Northern Ontario School of Medicine, Health Sciences Unit. (2014). Working with Francophones: Health Sciences CC Implementation Tooklkit. Available online: http://www.nosm.ca/uploadedFiles/Education/NODIP/Francophone%20CC%20Implementation%20Toolki t_Appendix%20E_Q%20and%20A_Feb2014.pdf National Quality Forum. (2013). Patient Reported Outcomes (PROs) in Performance Measurement. Available online: https://www.qualityforum.org/Publications/2012/12/PatientReported_Outcomes_in_Performance_Measurement.aspx Plas, J. M., & Lewis, S. E. (2001). Person-Centered Leadership for Nonprofit Organizations. Sage Publications. Rochefort, L. (2001). Symposium on Interpreting in a Health Care Setting: Summary Report. Report of the November 2002 Symposium funded by Health Canada. Unpublished. Société Santé en Français et Réseau franco-santé du Sud de l'Ontario, Framework for Recruitment & Retention of Bilingual Human Resources in the Healthcare Sector, March 2015. http://francosantesud.ca/en/bestpractices/framework-for-recruitment-retention-of-bilingualhuman-resources-in-the-health-sector/ Schyve, P. (2007). Language Differences as Barriers to Quality and Safety in Health Care: The Joint Commission Perspective. Journal of General Internal Medicine. 22(Suppl 2) 360-361. Stradiotto, R. A. (1998). Supreme Court declares failure to provide sign language interpreting during medical care unconstitutional. Hospital Quarterly., 1, 74-76. The Commonwealth Fund. (2006). The Evidence Base for Cultural and Linguistic Competency in Health Care. Available online: http://www.commonwealthfund.org/publications/fund-reports/2006/oct/the-evidencebase-for-cultural-and-linguistic-competency-in-health-care Traisnel, C and E Forgues. (2009). La santé des minorités linguistiques: l’approche canadienne au regard de cas internationaux. Francophonies d’Amérique 28: 17-46. Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to Action. Winnipeg, MB. U.S. Department of Commerce Bureau of the Census. (n.d.). Language Identification Flashcard. Available online: http://www.justice.gov/crt/cor/Pubs/ISpeakCards.pdf.

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Communication in Minority Language Situations - HSO 11012:2018 (E) U.S. Department of Health and Human Services, Office of Minority Health (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report. Washington, DC: March 2001. P3-20 Whitman, M. V. & Davis, J. A. (2008). Cultural and linguistic competence in healthcare: the case of Alabama general hospitals. Journal of Healthcare Management. 53(1). 26-39; discussion 39-40. Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005). Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 8(2):94– 104. Wilson-Stronks, A., Lee, K. K., Cordero, C. L., Kopp, A. L., & Galvez, E. (2008). One Size Does Not Fit All: Meeting The Health Care Needs of Diverse Populations. Oakbrook Terrace, IL: The Joint Commission. Wilson-Stronks, A., & Galvez, E. (2007). Hospitals, Language and Culture: A Snapshot of the Nation: Exploring Cultural and Linguistic Services in the Nation's Hospitals. The Joint Commission and The California Endowment. Wolz, M. (2015). Language barriers: challenges to quality healthcare. International Journal of Dermatology. 54(2): 248-250.

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