Health care services provided by Dell Children’s Health Plan (DCHP) are tailored to meet the needs of the CHIP AND STAR population. DCHP understands the linguistic and cultural competency requirements of its Members and is committed to ensuring that staff and subcontractors are educated about, remain aware of, and are sensitive to the cultural differences and linguistic needs of its Members. To accomplish this goal, DCHP has established a Cultural Competency Plan that builds on DCHP’s experience and relationship with its Members, DCHP staff, subcontractors, and the health care providers. The Cultural Competency Plan is supported by DCHP’s organizational structure.
This Plan is sustained through management and staff who are qualified to meet the needs of the population served. DCHP is committed to employing staff that are bilingual, and will supplement internal bilingual staff with contracts to provide communication, translation, and interpreter services. DCHP’s network includes providers of all specialties who maintain bilingual language capabilities to facilitate communication with patients.
Dell Children’s Health Plan remains committed to promoting the delivery of services, from staff, subcontractors, providers, and all enrollees in a culturally competent manner, including those with limited English proficiency and diverse cultural and ethnic backgrounds, religions, disabilities, and regardless of gendor, sexual orientation, or gender identity, in accordance with Title VI of the Civil Rights Act guidelines and the provision of auxiliary aids and services, in compliance with the Americans with Disabilities Act, Title III, Department of Justice Regulation 28 C.F.R. § 36.303, 42 C.F.R. § 438.206(c)(2), and 1 Tex. Admin. Code § 353.411. These provide in part that no persons in the United States must, on the ground of race, color, national origin, sex, age, disability, political beliefs, or religion be excluded from participation in, or denied any aid, care, services or other benefit provided by Federal or State funding, or otherwise be subjected to discrimination.
It is the policy of Dell Children’s Health Plan to be sensitive to and respect the diverse cultures, races, genders, gender identities and sexual orientation, ethnic backgrounds, religions, and disabilities of its Members, and provide linguistic access and disability related access to all CHIP AND STAR members. The Director of Government Operations and the Director of Member Services will coordinate to present a training program for all Dell Children’s Health Plan staff and subcontractors addressing cultural competencies. This program will be presented annually, and all staff will be required to attend.
All revisions and changes to the Cultural Competency Plan must be submitted to HHSC no later than 30 days prior to implementation of the changes.
- To recognize that there are many diverse cultures, races, ethnic backgrounds, religions, gender, sexual orientation, or gender identity and disabilities in Travis and surrounding counties.
- To develop a staff that recognizes, values, affirms, and respects, the worth of the individuals.
- To recognize how CHIP AND STAR Members should be treated in order to protect and preserve the dignity of each Member.
- Work toward equal access to service and recourses for racial and ethnic populations regardless of language, culture, and disability.
- Respect all Texans and exhibit sensitivity for their cultural practices.
- Incorporate cultural knowledge and strengths into policy and practice, recognizing the interaction of culture and health.
- Recognize the diversity within various racial and ethnic communities and distinguish between cultural identification and the culture of poverty.
- Develop and support a work force at all levels, which reflects the race and ethnicity of the population served.
- Strive to be cognizant and sensitive to differences in genders, gender identities and sexual orientation while providing compassionate care to all populations.
- Support programs that strengthen the capacity of multicultural communities to promote health.
- Establish policies and procedures to promote racial and ethnic community participation in the allocation of resources and the design and implementation of interventions developed to address their needs.
- Evaluate the effectiveness of programs in improving the health status of racial and ethnic populations.
- Promote unity through the celebration of diversity.
- Create an ongoing process to monitor level of culture competence, including the recognition of achievement and the identification of unmet needs.
The Cultural Competency Plan will involve the Dell Children’s Health Plan and subcontractors. To address members’ needs, Dell Children’s Health Plan and subcontractors hire linguistically and culturally competent staff. Dell Children’s Health Plan has a system of checks and balances to ensure subcontractor compliance with the civil rights/anti-discrimination laws. This commitment includes ongoing training and periodic reviews of the effectiveness and appropriateness of plan from Dell Children’s Health Plan and delivery of linguistic and cultural competency services to our members.
Addressing the Needs of the Members
- The first component of the Plan directly addresses the needs of the Members through instituting the following services:
- Employing staff whose cultural backgrounds are analogous to the Members
- Employing staff with bilingual or multilingual capabilities and who reflect the linguistic preferences of the Members
- Providing TDD access and interpreters for Members who are hearing impaired
- Providing DCHP Member Service and Health Education materials in Spanish and English. When requested, providing materials in audio, larger print, or Braille.
Education and Training
The Cultural Competency Plan is geared towards education and training to ensure that DCHP’s staff and subcontractors are sensitive and responsive to Members’ needs and are aware of the characteristics of its Members. To meet this goal, DCHP provides the following services:
- A cultural sensitivity training program for DCHP staff and subcontractors will be provided on an annual basis
- The cultural sensitivity training program will be mandated, regularly scheduled and updated on an ongoing basis to meet the Members’ needs
- “Train the Trainer” classes will be conducted on a regular basis to facilitate DCHP staff cultural competency training
The cultural sensitivity training program will address the following topics:
- Importance of the family
- Role of the family versus the individual
- Rules for interpersonal relations (showing respect vs. deference)
- Communication styles guided by respect and individuality
- Understanding that negative feelings may not be freely expressed by the Members
- Appreciating different communication styles (including nonverbal expressiveness) by individuals of various ethnic backgrounds
- Importance of interpreter services provided by trained personnel (e.g., lack of proper training could compromise communications)
- Assessing patient’s language of choice at intake
- Conveying a warm welcome and sincerity
- Teaching the value of prevention
- Appropriate salutation to different ethnic populations and age
- Values, attitudes and beliefs about different ethnic groups and social classes
DCHP is committed to ensuring that its staff and subcontractors are educated about the linguistic needs and cultural differences of its Members, have an understanding of the population that they serve, are willing to be responsive and sensitive to their needs, and have the ability to communicate effectively with Members.
The Cultural Competency Plan ensures that DCHP addresses the needs of its Members system-wide consistently and effectively. Therefore, every person in the organization has some level of responsibility and will be held accountable for implementing the program that provides services to individuals of all cultures, races, ethnic backgrounds, religions, and disability. The major methods for accountability consist of the following:
DCHP will utilize staff, providers, and interpretive services to assist Members with language needs. To ensure that Members receive appropriate and timely language interpretation, DCHP will have staff that are bilingual in English and Spanish and provide for interpreter services for language assistance other than English or Spanish. This includes interpreters for the hearing impaired.
Members of DCHP CHIP and STAR have multiple ways to access information regarding interpreter services that are provided at no cost. They can reference the member handbook or the website. Members can also reference the provider directory which includes languages other than English that are spoken in provider’s offices. The top 5 languages that are referenced in the provider directory are:
But all languages are available for interpretation during appointments with providers. The provider directory is available in a hard copy format and also on the website.
DCHP Members have access to many types of interpreter services. These services include:
- The Language Services team which provides interpretation and translation to Limited English Proficient (LEP) patients and ensures that all information given by the medical staff is conveyed in a language the patient understands. Trained Spanish staff interpreters/translators are available throughout the hospital 24 hours a day. Other languages (ASL, Farsi, Etc.) are also available on a per encounter basis through an on-call interpreter or the telephone language line
- Telephone Language Access will connect the caller to a Dell Children’s operator that can connect to an interpreter in over 170 languages
- Sign Language Access is a communication service for the hearing impaired which will provide Members qualified American Sign Language (ASL) interpreters at no cost to the Member
- DCHP will coordinate with interpreter vendors to ensure that Members receive face-to-face services during scheduled appointments with providers, if requested.
Member Services Line
In addition to the language interpretation services described above DCHP has a Member Services Line that is toll-free, available from 8 a.m. to 5 p.m., Monday through Friday. Member Services Representatives will be available to answer Member questions and will be bilingual in Spanish and English.
The Member Services Department will play a critical role in the implementation of the Cultural Competency Plan. One of the objectives of this Department is to ensure that all services and member interface functions are carried out in a sensitive, culturally competent manner.
Member Services Supervisor
The Member Services Supervisor will:
- Ensures adequate assignment of bilingual and ethnically diverse staff to meet performance objectives and service standards
- Supervises and monitors Member Services Representatives in handling urgent and complex cases for cultural sensitivity and linguistic appropriateness
Member Services Representatives
The Member Services Representatives will:
- At the request of a Member, assist in identifying providers with certain language capabilities, or ethnic background
- Respond to requests for Member language specific materials such as the Member Handbook or culturally sensitive education materials
- Identify and refer Members with special health education needs to the Case Management Department
This is a crucial issue with the CHIP AND STAR population, as they very often rely on mass transit for transportation. Thus, appointment times must be coordinated with bus routes and schedules. Member Services staff should keep the transportation issue in mind when helping a CHIP AND STAR member select a PCP or other provider. Information regarding transportation programs is included in the Member Handbook. It describes how the transportation program can be accessed by the member, or by DCHP staff or subcontractors on behalf of the member.
Emergency Department Usage
In the past, CHIP AND STAR recipients have used the emergency room as a physician’s office when faced with cultural barriers with access to health care. When the recipient or their child was ill, they went to the ER, where they were assured they would be treated, regardless of diagnosis, acuity, or time of the day. One of the greatest challenges DCHP will face is educating its CHIP AND STAR members to think of their Primary Care Physician first, and to call him or her instead of going to the ER for what is less than a true emergency. DCHP addresses the issue of appropriate use of services in the Member Handbook, and the DCHP case managers and utilization review nurses will conduct one-on-one counseling with members who have been identified as misusing the Emergency Room.