Remember, your patients are your teachers: Kartini Clinic's Approach to Multicultural Pediatric Care

so um thank you for joining us today for our Spotlight on providers my name is Daniel Hallberg I'm a Certified Healthcare interpreter for Spanish as well as the senior training manager at linguava interpreters and we are lucky enough to be joined today by Dr M knme mhel from the cartini clinic thank you so much for taking the time to join us and have a conversation with us today Dr mhel um we're going to be talking about a wide range of topics related to um Healthcare and how it interacts with medical interpretation and interpretation in the healthcare setting as well as translation services but before we get into all of those details I'd love to learn a little bit about you and the cartini clinic where you are the medical director would you mind telling us about the cartini clinic and the work that you provide for our community sure um the cartini clinic is located in North Portland not too far away from actually the Randle children hospital and the Legacy Emanual campus um the clinic was created by my senior partner Dr Julie tul uh in April of 1998 um and it was really formed out of necessity because here in the Portland metropolitan area Dr to found out at that time that there were no uh medical Home for Children and Families who were diagnosed with pediatric Eating Disorders so at that time if a child was diagnosed with an eating disorder automatically ad meant that they were um going to be admitted to a psychiatric unit so beginning in 1998 we've had you know different iterations of what exactly we do but really the focus is offering comprehensive services to children and their families uh who suffer from um pediatric Eating Disorders um we're first located a little bit closer to the hospital but we've been at our current location since 2015 well thank you so much for that and in terms of the distinction that you make there when you're talking about admission and folks that are uh basically working completely in an inpatient capacity how does that differ from the partial hospitalization program that cartini offers yeah so um so when you know when I mean I don't treat adults so I can't tell you what adults do sure but when we see a pediatric when we see a children you know below the age of 18 Who present to us about concerns about um you know nutritional worries and concern depletion and we worry are do they suffer from an e disorder we have to determine well first do they have a need disorder second using the American Academy of Pediatrics criteria uh do they go to inpatient facilities such as for example Randle children's hospital where I admit our patients or dor Becker where I trained um and then um and if that's not the casee the lower level of care is inre include what we call partial level of hospitalization where you know and or intensive Alpa program or outpatient program here at partini Clinic we can admit the kids at Randalls and I can take care of them but primarily the bulk of our patients are either in partial level of hospitalization which means 5 days a week the kids are here with us from 8:30 to 3:30 um and it's a multi-week Endeavor it's not a 1 to two day Pro you know it's not a 1 to two day treatment withal right or when they're steep down to a lower level of care when now they're finally back at school regular life and um so uh that means that's from 3 3:30 until 5:30 every day for another you know two to four weeks and then finally out patient care that makes a lot of sense and so when you're talking about a Fed day a week for multi-week um program for that lower level of care which is still obviously for folks that are are dealing with um an extreme need uh they're coming in and they have that requirement how do you go about providing all the things that a child is having interrupted in terms of schooling or other activities how does the cartini clinic play a role in making sure that children still have that degree of consistency within their experience at at the actual Clinic itself well so I think one of the biggest things that you know we have learned in the field of you know um pediatric eating disorder is that family based treatments has been shown as you know by evidence-based medicine to be superior to really focusing on the child alone so without the involvement of the parents without the knowledge that the parents bring I may know disease but I do not know um the understanding of what the family goes through what they have been through what their child has been through so we really I mean we not only want but we actually request finally demand that the parents are involved in this process so and it's a lot right so we ask parents involvement not only in participation in feeding their children participation in the medical you know delivery of the Care the parents also participate in Family Therapy uh but they have to also tell us gosh as this child's life is interrupted disrupted um how do we do this so collaborating with schools you know um h how the kid would be even transported to us right so we um our en catchment here for cartini clinic is not only Portland proper we serve the tri count area Southwest Washington we have sometimes families who are also coming from outside of Portland that we have to serve so yes without the families we cannot do this and no doubt treatment causes disruption and there is no good day for treatment doesn't matter what day the week you look at it so it's just hard yeah so with all of those challenges and the logistical planning required for a family that is going to uh engage in this level of treatment uh are there additional challenges that you've found when working with multilingual and Multicultural patients in families yes so I think that uh you know um I'm originally from Iran and I grew up in Africa so I you know clearly I can relate a little bit to the challenge of English not being my first language and the conundrum of um it's a blessing to have access to healthcare but it's a complete different story of like well how would this Health Care fit my family and am I able to Advocate to get the best care for my child while I continue to have a job and still have a roof on top of my head so often um I think people make assumptions about our families uh who are um multilingual or for whom you know English is not their primary language so um first we have to deal with our own um you know prejudicial understanding of what do we do for a family who may have some different way of approaching you know medicine based on their past experience in their home country and their current experience number one number two it may be also how we present information that could be very um eurocentric versus um really more embracing of other cultures let's give you an example um food is medicine let's food is medicine for our kids so without food I cannot heal the kids so just last week one of the parents had looked for example at our meal plan and said Dr Melle this meal plan that you want my child to to be on U for lack of better words um it's very white plan and I just had this conversation about well let's talk about this I mean uh what do you mean how can I help you and then if it's written on a piece of paper that you need to have X amount of starch x amount of fat x amount of protein the majority of us who come from different side of the world uh we think about food with love and then you somebody tells me that I have to measure the food that I gift to my child right never mind the fact that it needs to be in a form of a sandwich you got to be kidding me Dr M so the explanation of first treatment the destruction that it causes then the tools that we're using and really understanding how do these tools apply and or don't apply right um and really talking about even though I say that you have to do a sandwich no no no you don't have to do a sandwich so if you serve a hot lunch it's okay and gez I would love to come and join you for your hot lunch so I could have some of that food so the families have usually good laugh when I say that to so hearing well I'm sorry what was the problem to presenting the information and really realizing yes it is true that when you read the material it can it can sound like it's one size but it is not and then finally Danny you've been with us long enough that while some of the material can be also translated I I don't think translation alone does does the trick alone I mean yes we have some material that is in Spanish so for example our family questionnaires have been translated in in Spanish um our family parent manual has been translated in Spanish but that's langu one language right and I think all of you have also educated me that never mind Spanish alone just in Central America and Latin America there many dialects so I have had families who have come and shared with me well you gave me this in Spanish but that's not even my first language right yep so and if I didn't have the wherewithal of asking the parents I'm sorry what was your first language again why did we even bother interpreting you know or giving them a Spanish manual so it's complicated but we're willing to work um and then last but not least this has nothing to do even with language we've also found that um even in this country some of our families may not be literate which is even more complicated because it's um it's often associated with um shame and guilt so we find that usually a lack of literacy um we kind of bump against it so um so once that the staff figures out we have also done pictoral food journals for example I love that yeah absolutely like oh it's okay you don't have to write if you can send me pictures of how you fed your child I can make it work yep yep just taking a step back there was so much information that you just provided there and even within a medical context in a healthcare context to be talking about food as medic and recognizing that though this is a tool and it's part of the treatment plan that it's done with love and having to reframe the conversation so that again families are participating and active in this treatment plan but also uh tying it in to their cultural and specific needs I I really commend again the actions that you've taken and it sounds like it's through iterations you you bump into these particular challenges and come up with new Solutions so that it isn't a stagnant process it isn't like we're done you're continuously building off of the experience that you uh encounter with each patient and each opportunity would you say that's fair to say it is I think that one of the things that you know when I came to this Clinic 19 years ago my senior part taught me and if you walk around particularly in the back rooms not the front you will see that we have something that is framed and it says hey remember your patients are your teachers and you know yesterday I went to the Oregon Health Science University School of Medicine um commencement or graduation of their school of medicine School of 20 I mean class of 2024 and really the message that I think most of the speakers were having you know there was pretty much the same thing that I've heard for the last 20 some odd years which is it's one thing to be booksmart is a different story to really realize that our patients and our families uh teach us every single day so that being said it's that every child every family will bring something that we didn't know and if we're so stuck in our way of saying well this this is the way that I do it um and I don't even know how to really measure the word success so I think what we've tried to do in the past is um you know if I go as long as I go so it was for example well how do use interpretation please how do you work with um for example insurance companies to make sure that that is applicable understanding depending what flavor of insurance to the people have which one is covered which one is not covered uh I think during covid we understood that while we used to insist that it it used to be always on person well it's not going to be always in person I think for our families who are not primarily speaking perhaps that really helped a lot because now that we have more virtual opportunities that helps but that's not again one size fits all right because I have also seen that accessing virtual platforms is not virtually easy for everybody yeah so me learning to say okay it's okay I'm just gonna I'm just going to call I may have to just call instead of having to rely on it um the other part is material that could be translated ahead material that could be you know that we give to parents um you have also seen us looking at for example um samples of our meal plan and perhaps even recipes um I've observed for example um some family members who have an easier time with treatment and some who um truly it's just not even a disruption it's not only the severity of the kids's disease it just feels like everything is hard everything is just hard um I've worried about culture and the cross of mental health um so we've asked some of our fam families if they're willing to serve as peer support we've said um are you willing in time of duress if someone really really struggles to pick up the phone and call a parent and say Say Hey I was here 5 years ago 10 years ago and this is what my child did because again the stigma around mental health is very different from culture to culture and how it's understood can also be distinct correct and you know and we've had families who have told their kids well a child like you or this young cannot have anxiety cannot have depression uh God bless some of our families they have also brought um uh faith-based humans in their home to cleanse the house cleanse the child because you know Dr morelle is wrong in her assessment that the kid has anxiety and depression I don't blame them hey if you want to pray that's all good for me but to tell the kid that they do not suffer from anxiety and depression it makes them feel doubly bad you know that they're failing everybody they're failing their family and they're failing themselves so peers would help we have also parent group meeting but the parent group meeting has been super challenging because typically it's in English so if you want to have it with someone who doesn't speak a language participation has not been easy I would love to have it in different language but I've not been successful um we have another family who's lovingly for example created um recipes specific to I mean again granted it's a specific country you can't just say like well it applies to everybody but right at least it's not it's not american-based you know it's a little bit it has a little bit of flavor to it so it's really understanding how it changes um but our current uh to-do list includes having a Spanish speaking parent group meeting which we're working on and then again this recipe book which we think if we can have it at least in at least in Spanish helps but we'll figure out if we need in another language and Spanish is not the only language right we've had families who are from um Eastern Europe uh as well as also um southeast Asia as well too right definitely So within the actual program itself um what sorts of encounters are facilitated or assisted by uh interpretation um obviously there are occasional meetings with you directly um in the medical setting there are also as you mentioned family therapy sorts of encounters how and where do families engage with an interpreter and a cartini uh service provider so when the families meet so our Clinic is perhaps one of the you know we're called the zebra for a reason so where a family has a crossover of medical and mental health Under One Roof so they have medical and nurses appointment which again require uh you know participation not only of ourselves but also medical inter you know medical interpretation service they have family therapy which again requires parent parental involvement uh patient involvement Again Medical interpretation too um and then they typically the parents get weekly updates which again requires medical inter I mean it requires interpretation too because if the provider does not speak that language I mean how would you leave even a voicemail hey I'm such and such I want to tell you how your baby did but if I don't speak the language the parent would say oh my God what happened why you calling me you know I I want you know you'll Panic right I would Panic if I don't know what you're calling me for absolutely so really every level requires interpretation from making appointments doctor's appointments nurses visits family therapy to even updates so and the staff knows that it please do not leave messages in a language that they don't know it just doesn't help when you say the staff knows that how have you as an organization uh worked with staff to bring that level of understanding to bear so so I think it has been really work in progress right so I think I would have said 19 years ago if we started we started from a place where it depends on the population you serve and what your you know your insurance contracts are in plain English so Dr tul and I chose um gosh how long has it been that we've been having the current contracts we have I would say for the last solid 10 to 12 years we've had at least 40% of our population um having some form of uh Medicaid based population which has brought a lot more diversity to the kids we serve um that also meant that automatically uh serving children of all backgrounds uh we had to look at all of our practice for the last 10 to 12 years including the offering of our interpretation services so it's not kind of sort of maybe I would do is that you must deliver Equitable Services to all otherwise we have no business doing it right that's the first thing the next part is well how do you do it systematically well it's not without problems I mean I don't know how many times I look at a list a a a daily schedule I'm standing here and I'm like well okay what happened to my interpreter they're like whoops so it still happens right it's just that we are trained and I think we also asked for example linguava to come and help us and say how do you use an interpreter Services um over 20 years ago 15 20 years ago I served on the state Committee in um the certification of medical interpreters um that was fun and that was great but it's one thing to ask you to be a certified medical interpreters yes but how does the medical team utilizes services from scheduling how do we look at the patient and not you um what pronouns do we use when things don't go well what do you do to please never use family members all this stuff so we ask uh we were really happy that you came and trained the staff they loved it they found that that would to be um great and it offers some uniform training to people so rather than only well andm knows how to do it or the nurse knows how to do it it's everybody who gets it absolutely and yeah I I don't know that we shared that context for the audience who may be listening or watching this later on but I've actually had the opportunity over probably close to a decade at this point to serve as a healthcare interpreter for the cartini clinic and then come in and provide training like you mentioned for staff as well and one of the things that I love so much uh is not just the opportunity to serve as an interpreter but as an interpreter you're not allowed to interject your opinions or provide feedback in those settings you have to remain a neutral party and so to have an opportunity with your invitation to come in and work with staff under different pretexts where they can ask those questions that you shouldn't be asking during an encounter with a parent or a patient is a very unique uh conversation that we were thrilled to be a part of and um I think it's incredibly beneficial for both Healthcare interpreters to share that information back to Providers and for providers to have an un um filtered opportunity to uh talk about best practices one of the things we talked about in that program with uh staff at cartini Clinic was just the fact that interpreters can't review a chart ahead of an actual encounter and so providing a short briefing is such a beautiful and beneficial thing to be able to incorporate your interpreter into the care team to give them a better understanding of what they're getting involved in um thank you for that opportunity we appreciated it yeah and I think that for any other clinic or any other providers who are thinking about this what we did for our staff we generated a list of questions that we provide you ahead of time because we understood that each provider each staff will have a different perspective of what did they want to ask like for example uh where do you want me to sit what do you want me to tell you ahead what pronouns do you want me to to use um if I understand you did not interpret correctly what would you like me to do yeah you want to interrupt you or do you want me not to interrupt you so having um a qu having a list of some thoughts and questions and having a training like this it doesn't have to happen even yearly but I would say depending on staff turnover you know every two to three years it would be a good idea to have a refresher uh so really for any Clinic that is serving populations um that are diverse and or Medicaid in Medicare which by the way you're really obligated to make sure that you have um Equitable Services that includes interpretation services for all absolutely it's it's actually the law correct yeah I really appreciate all of the advice that you've shared uh the experience the hard-earned experience that you've been able to provide to our listeners and also to me um are there any parting words that you would like to share with anyone who's listening in about if you've never worked with an interpreter what things you should know how you can Implement a program uh if you are looking to work with Medicaid or Medicare in the ways that you're describing and abide by that compliance piece be in accordance with the law what would you recommend yeah so I I think it's a little bit more complicated than having a little check box and going okay I just checked that so I think well first of all it's understanding that um serving uh populations that are diverse uh brings a lot of love and you know I mean uh at least for those of us who are in medicine and remember why we got into medicine it's not supposed to be a job it's supposed to be a calling you know if you're doing it as a job it's just never going to work number one number two is that there are going to be days when things are difficult M and by difficult I mean that um well if I'm speaking the language of the family of course it's going to go faster so and if I'm using interpretation Services of course it's going to go slower so working with the staff and understanding more than implementation of contracts which company am I going to use am I properly set up do they know how to get to the place Etc it's also time allotment if the time is not properly sequenced everybody gets frustrated it's like the provid is frustrated because you have X number of minutes to finish The Interpreter doesn't do their job um and then the family feels like they got like 50% of what they were meant to be meant to get and what have they done you know it's not their fault and then finally my experience has been it's unfortunately quite a dichotomy when it works it works really well when it doesn't work it works miserably poorly yeah but it's not anyone's fault so it's just look at what went wrong go back and look and say well what can I do to tweak it so again as I said there are some families I have tried to offer the virtual platform man it's not working so I just make a note of it edia as The Interpreter walks in I'm like well here's a phone we're not going to wait for another 10 minutes to see if you know and Alisa's mama is going to get on the on on the virtual platform and I'm going to get frustrated we're g to just immediately call and I'm going to swallow my pride and not wait for it or not come up with darn excuses right um and then I have to tell you for some of her families we followed longitudinally I they still feel that cartini clinic is their medical home and that's because um they understand we we really care about their kid and that's why they trust us so I would say if proper context is provided um that's what that's what all parents that's what I want from my child and that's what I would like to see happen for all people regardless of language and culture um and then the final piece I would say and I don't think I mentioned this uh many culture is not parents only sometimes it takes an entire Village so the last child who I reviewed their case they showed up with an aunt an uncle and a cousin that may be a foreign language for those of us who for those who grown and graced here they're like well what do you mean why do you have three or four other people in this room that's that's how folks live so we don't have a problem with that we actually appreciate that we're like come on over that's not a problem the more people I can train the better it is for it is for the child so it's great when it's done well I I gotta say I I got chills a second ago when you were talking about it's almost a tagline just to leave the conversation but regardless of language being able to provide that level of care the vocation behind it um and making sure that again patients feel supported and are able to participate in their own care and those cultural considerations which you're calling out and have called out throughout this conversation are so critical to recognize that there are distinctions both in terms of perspective food C culture family Dynamics and all of these play into providing uh meaningful and effective communication and care to Multicultural families that extend beyond uh the framework that we may have in a western or Europe European Centric mindset um this has been incredibly fruitful thank you so much for your time Dr mosdale welcome we appreciate you and the work that you do and the work that cartini clinic provides to our families and uh looking forward to seeing you again soon thank you you take care thank you bye bye bye

Channel: Linguava

Views: 103

Keywords: language services, languages, interpretation, interpreter, medical interpreter, medical experts, linguava, linguavanation, hospitals, patients, translate, linguist, language specialist, language access, equity, language service provider, translation, language agency, over the phone interpretation, video remote interpretation, scheduled video interpretation, OPI, SVI, VRI, Remote Services, Remote Interpretation, Remote Interpreters, Remote Interpreter Solutions, Video Interpreter

Id: dtIAV1-b3_U

Length: 30min 6sec (1806 seconds)

Published: Mon Jun 24 2024