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Capstone proposal: utilizing trained medical interpreters: a workshop for medical providers
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RUNNING HEAD: Capstone Proposal
1
Utilizing Trained Medical Interpreters: A Workshop for Medical Providers
by
Loreen Gulli, MSW, LCSW
SOWK 722
Doctoral Capstone Project
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work
University of Southern California
Dr. Ronald Mandserscheid, advisor
May 2020
RUNNING HEAD: Capstone Proposal
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Executive Summary
One problem related to the Grand Challenge of Close the Health Gap that can often be
overlooked is the issue of physician-patient communication. More specifically, how physicians
communicate with non-English speaking patients. This an important problem to consider for
many reasons, but three that are of central importance are the increase in the non-English
speaking population, how poor physician communication with non-English speaking patients
often results in adverse health outcomes, lower life expectancy and overall poorer quality of life
and the lack of consistent and appropriate use of trained medical interpreters even when this is an
available resource.
Included in this proposal are the current demographic statistics of non-English
speaking households in the United States, focusing specifically on the Latino/Hispanic
population; the past and current healthcare attitudes of this population that contribute to the
problem and physician behavior/attitudes or barriers that contribute to the inconsistent or
inappropriate use of trained medical interpreter services.
It is important to consider that 21% percent of households in the United States speak a
language other than English in the home and 17% of those households are Spanish-speaking.
This proposal will highlight the increased needs of that population in order to address long-term
healthcare outcomes. Additionally, this program will be piloted in Colorado which has the eighth
highest Latino population in the country.
An innovative program to improve physician comfort with, and use of, trained
interpreters is introduced considering stakeholder perspectives, namely hospital participants such
as attending physicians who do not like mandates in their care, and trained medical interpreters
who express frustration with lack of proper utilization.
RUNNING HEAD: Capstone Proposal
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Several groups and community organizations that are stakeholders, including physicians
and Spanish-speaking patients, would benefit from an innovation aimed at addressing this social
problem. The workshop proposed as an innovation to solve this problem will draw on the
foundations of Social Cognitive Theory, Normalization Process Theory and Diffusion of
Innovations to help influence behavior and effect change. The first-year timeline for this
workshop will be geared toward project planning and workshop curriculum, as well as hospital
agreement to offer this program, with the long-term goal aimed toward all physicians utilizing
interpreter services appropriately and consistently when treating Spanish-speaking patients.
Program outcomes will be measured through pre and post workshop surveys as well as
competency sign-off. Additionally, project reach will be considered and plans for an eventual
longitudinal study to measure long-term healthcare outcomes will be addressed.
Financially, this program will be funded through federal grants, foundation grants and
in-kind donations. The pilot program can be implemented at a relatively low initial cost of
$15,000. Once the pilot is completed and plans for expansion are explored, alternate funding
sources may need to be considered.
The next step after pilot implementation, is to communicate the results of the outcome
measures to stakeholders and funding sources to further the expansion of the program into
hospitals around the country. Additionally, developing a marketing campaign to advertise the
program to hospitals will be important, as well as educating Spanish-speaking individuals about
their right to a trained interpreter.
RUNNING HEAD: Capstone Proposal
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Conceptual Framework
When considering the twelve Grand Challenges of Social Work as defined by the
Academy of Social Work and Social Welfare, the challenge most applicable to the experience of
this writer is Close the Health Gap. As a social worker whom witnessed firsthand the inequities
in the hospital healthcare system, a passion was instilled to consider ways to improve the quality
of, access to and consistent use of available resources.
The book, Grand Challenges for Social Work and Society, points out that “Although the
United States is among the wealthiest nations in the world and spends far more per person on
health care than any other industrialized nation, the population’s health is rapidly deteriorating”
(Fong, et al 2018). Although health inequity plays a role, it appears in this country that even in
more affluent areas individuals are not as healthy as their counterparts in other industrialized
nations (Fong, et al, 2018). To consider what a crisis this is, then, in underserved communities
makes it clear why this issue was identified as a Grand Challenge. The ability to explore creative
ways to address a global issue such as healthcare from a Social Work lens can bring a new
perspective and continued focus on programs aimed at prevention and programs to champion for
disadvantaged communities.
In terms of healthcare inequality in the United States, it is important to explore social
determinants and the role they play in this problem. As previously mentioned, much of the Close
the Health Gap Grand Challenge focus centers on this very issue. A social determinant of health
is a social factor that can influence a person’s health. Some of these social determinants of
health, as suggested by the World Health Organization and accepted by many governmental and
non-governmental organizations, include income, stress, social support, education, addiction,
housing and transportation, among many others. In the United States, social determinants of
RUNNING HEAD: Capstone Proposal
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health are viewed as resources that enhance one’s life, such as access to food, education, health
care and other resources that could potentially add quality or longevity to a person’s lifespan.
The relation of these social determinants to the problem of Close the Health Gap is that not every
community or individual has equal access to these resources in a systematic and equitable way.
As an important component of social determinants of health, the resource being explored
for this innovation is access to, and proper use of, trained medical interpreter services for non-
English speaking patients. Research indicates language barriers between medical providers and
their patients can result in a lack of proper treatment and can even lead to potentially fatal
medical-related errors (Bramowicz, 2017). Furthermore, as previously mentioned, language
barriers can lead to poorer health outcomes and lower life expectancy in non-English speaking
patients (Silva, 2018, Falkenstein, et al., 2016). Interviews with medical personnel revealed that
there was little correlation between language barriers and poor health outcomes. It was clear that
providers were able to correlate poverty or lack of resources to this problem, but do not seem to
understand that language/interpreter services is a resource that, if unavailable, affects long-term
health in minority populations (Gulli, 2018).
In terms of how physicians communicate with non-English speaking patients, it is crucial to
explore the current state of our hospital healthcare system, as there is a plethora of inequities
regarding patient care in the healthcare system in the United States. This is specifically one of
the areas in the system that has opportunities for improvement in order for non-English speaking
patients to receive adequate care.
This focus on physician-patient communication with non-English speaking patients is
important to consider as the immigrant population is increasing throughout the United States.
Approximately 21% of households in the United States speak a language other than English and,
RUNNING HEAD: Capstone Proposal
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of those households, 42% report limited English proficiency (US Census Bureau, 2018). This
statistic comprises a variety of ethnicities and languages, but the focus of this intervention will be
on the Latino/Hispanic population because, of the 21% non-English speaking households
previously described, roughly 17% are Latino. In these Latino households, 10% do not speak any
functional English (Raynor, 2016). Therefore, because Latinos are the largest non-English
speaking minority population in the United States, they will be the focus of this proposal.
In Colorado, where this problem will initially be addressed, the Latino population is
currently at 21%, which is higher than the national average. In fact, Colorado has the eighth
largest Hispanic population in the country and that number is expected to increase exponentially
in the next decade (US Census Bureau, 2018).
Additionally, other statistics regarding Latinos in Colorado that potentially have an impact
on Close the Health Gap include: 34% of births in Colorado are to Hispanic women, 28% of
Latino children ages 17 and younger live in poverty in Colorado, the median age of Colorado
Latinos is 27 and 48% of foreign-born Colorado Latinos are medically uninsured (Pew Research
Center, 2014).
In terms of population demographic shifts, small rural Colorado towns that were once
historically Caucasian are seeing an increase in Hispanic immigration and are now reporting
upwards of a 30-40% Latino census (Simpson, 2017). This change to the population has altered
the demography and economy of small towns which can drastically affect a rural area that has
little infrastructure in place to meet the diverse needs of a minority community, especially the
need for adequate healthcare resources.
RUNNING HEAD: Capstone Proposal
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Lastly, when considering social determinants of health and access to adequate resources, it
is important to remember that 28% of Latino children in Colorado live in poverty and 53% of
Hispanic households in Colorado speak a language other than English. These numbers would
suggest that access to resources that positively influence health and quality of life would be
limited.
In addition to exploring Latino demographics and access to healthcare services, it is
also important to consider some of the behaviors Latinos exhibit that can be harmful to their
long-term health. It is also crucial to consider if these behaviors are a result of the inability to
understand their healthcare provider clearly. Whether this is due to lack of access to resources or
the inability communicate effectively with medical providers, research indicates that the Latino
population is less likely to utilize preventative care services although they suffer more from
chronic illnesses like diabetes and hypertension that could be well managed with these services.
For example, based upon recent statistics from the Centers for Disease Control, Hispanic
individuals are 50% more likely to die from diabetes and liver disease than non-Hispanic Whites.
Additionally, they have 24% more poorly controlled blood pressure and 23% more obesity
(2018). In addition to the fact that Latinos do not generally seek preventative care, there is also a
concern that patients whom experience language barriers do not participate as readily in follow-
up care or follow discharge instructions provided by their physician.
These are the most relevant examples of harmful healthcare behaviors that justifies
developing an innovation to address this problem. It is important to change these behaviors to
increase the long-term health outcomes in Spanish-speaking communities. In order to change
these behaviors, however, individuals in disadvantaged communities need to be assured they will
have access to a medical provider who can communicate in their language.
RUNNING HEAD: Capstone Proposal
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In this regard, it is crucial to consider minority attitudes about healthcare and how
these attitudes contribute to this problem. In terms of the Hispanic population, one of the
behaviors that contribute to the problem of physician communication with non-English speaking
patients is that minority cultures do not often question authority figures. In a more traditional
Western culture, trust in the physician as an authority figure is often based on educational and
professional credentials. For minority cultures, trust is generally established by referrals from
close friends or family. In these cultures, trust develops through relationship building instead of
credentials. It is challenging to develop a relationship with a medical provider, however, when
they speak a different language or refuse to utilize a service created for this very purpose. It is
also challenging for minority cultures to develop rapport with a traditional Western-based
practitioner because they often have limited understanding of chronic disease, preventative
medicine or self-care (Carteret, 2010).
Another aspect of minority attitudes toward healthcare is that despite the availability
of interpreter services in many healthcare facilities, there is also a component of non-English
speaking patients refusing to utilize this service (Carteret, 2014). Of the many reasons why non-
English speaking patients will not take advantage of a trained interpreter, shame ranks among the
highest. For many non-English speaking individuals migrating to the United States, admitting
they do not understand something can be embarrassing. This is an important factor for physicians
not only to consider, but to also learn how they will address a patient’s refusal for this service
when it is clearly needed.
Another challenge identified by the research is that, even when medical interpreters are
an available resource, they are not being consistently utilized. For example, despite the federal
policies mandating the use of trained staff, physicians are still often using ad hoc interpreters
RUNNING HEAD: Capstone Proposal
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(family, friends or non-medical clinic staff) or no interpreters at all. In a study by Flores, et al.,
out of 530 Hispanic patients in an Emergency Department, 43% were not examined with the use
of an interpreter. In those scenarios where an interpreter was utilized, 39% of them were
untrained (2012).
According to Smithsonian.com, “even in hospitals that have implemented language
interpretation programs, many doctors elect to use their own skills or an ad hoc interpreter to
save time. “Doctors often don’t call interpreters when they need to,” says Gany. “Given the time
constraints that providers are under, if it takes one extra iota of time to use an interpreter, they
will try and get by with their own rudimentary language skills.” (Hoffman, 2015).
These scenarios exist when trained interpreter staff is available, but despite the federal
laws requiring interpreter services, there is no Medicaid/Medicare funding to pay for this service
or reimburse providers for this service. Therefore, in many underserved communities with
limited resources, there is no payor source for a trained interpreter.
Lastly, another challenge regarding physician communication with non-English speaking
patients, besides the lack of consistent and adequate language resources, is that physicians are
not formally trained in the use of trained medical interpreters. Additionally, they do not receive
much education regarding the importance of using interpreters or the reality of poor health
outcomes due to language barriers. So, even when interpreter services are available, and
physicians want and choose to use them, they are often not utilizing them effectively.
As previously mentioned, through this writer’s interviews with medical providers in
several Colorado hospitals, there was little correlation between language barriers and poorer
health outcomes. There was also little to no education regarding social determinants of health,
RUNNING HEAD: Capstone Proposal
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and the role they play in healthcare outcomes, provided in medical school. Currently, medical
school students are receiving more education on social determinants than in prior years, but this
remains an opportunity for improvement. All of the providers interviewed were interested to hear
more about the connection, however, and all agreed on the importance of utilizing interpreters.
There is a growing body of research and literature devoted to the topic of the use of
trained interpreters in the healthcare arena. Not all of the literature focuses on healthcare
outcomes, but the majority of the research does indicate the importance of patients understanding
their medical providers for many reasons, including increasing their patient satisfaction.
In a recent online article in Patient Engagement Hit, the author explains the importance of
non-English speaking patients feeling a connection to their medical provider. In this qualitative
study, non-English speaking patients said that interpreters made the care encounter easier to
navigate. Spanish-speakers, in particular, reported that in-person interpreters were preferable.
“For the Spanish-speaking patients, speaking a language other than English added another layer
of complexity and difficulty regarding basic interaction with doctors and staff, as well as
interaction with residents specifically,” the team reported. “Patients described a general concern
as to whether doctors and patients fully understood each other when having to work through an
interpreter.” (Heath, 2018). Interestingly, some of the respondents added that interpreters were
not always ideal because utilizing an interpreter often felt impersonal and made the care
encounter take longer.
Despite the growing public awareness of the importance of trained interpreters in
healthcare, and the current federal laws mandating this procedure, there are groups and
individuals whom do not agree with this practice. For example, as recently as November 2018,
Yahoo posted an article and video that demonstrated a cardiologist in California mistreating a
RUNNING HEAD: Capstone Proposal
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Spanish-speaking patient very poorly because she brought her daughter as an interpreter. The
cardiologist refused to utilize the interpreter and continued to verbalize that using an interpreter
is not the same as speaking the same language as his patient. He also verbalized, quite harshly,
that the patient should just learn English. This may seem like an extreme example, but it begs
the question as to whether this treatment of non-English speaking patients occurs on a regular
basis throughout the country.
A recent article in Electronic Health Reporter outlines the importance of the use of
trained medical interpreters in hospitals. This article also discusses how language barriers have
been an issue for quite some time in the healthcare setting. The author reports, “Currently most
hospitals provide only limited interpreting services, or more often than not, no services at all. In
those circumstances, doctors must rely solely on the patient’s family members, friends or non-
fluent bilingual staff members to help communicate with the patient or the patient’s family.
These “ad hoc” interpreters are less likely to tell patients about medication side effects and more
likely to misinterpret or omit questions asked by health care providers. This is not their fault, of
course, as most individuals are not familiar with what information is pertinent, or even how to
translate certain medical-related jargon. Despite their best efforts at being thorough, they may be
unconsciously leaving out important details” (Bramowicz, 2017).
Lastly, there is a common perception throughout the country that Hispanic immigrants
utilize the emergency department more frequently for their medical care, thereby increasing
medical costs and causing long wait times for care. This belief focuses on recent Latino
immigrants, or an undocumented Hispanic population, and contributes to contentious feelings
about immigration in general. A recent study out of Med Care concluded however that “contrary
to popular perception, the least acculturated Hispanic individuals are the least likely to use the
RUNNING HEAD: Capstone Proposal
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emergency department. As acculturation level rises, so does one’s likelihood of using the
emergency department, particularly for non-urgent visits” (Allan and Cummings, 2016). The
actual numbers indicate that, “compared to U.S.-born non-Hispanic white individuals, the least
acculturated Hispanic individuals are 14.4 percentage points less likely to use the emergency
department for any reason, 9.8 percentage points less likely to use it for a non-urgent reason, and
5.3 percentage points less likely to use it for an urgent reason” (Allan and Cummings, 2016).
Studies like these are important from an environmental perspective as they can help dispel myths
that contribute to the persecution an immigrant population, especially related to the topic of
healthcare that is a focus of our current political climate.
Understanding the environmental climate related to a problem is a crucial step in
determining not only the need for change, but also how to plan for and implement that change. A
logic model is a beneficial tool that allows the change agent to visualize and organize the goals
and possible outcomes of any project created to effect the desired change. In this particular
problem of physician communication with Spanish-speaking patients, the goal of the logic model
would be to outline what resources are needed to educate physicians regarding the proper use of
interpreters and consider how to change attitudes and behaviors that contribute to this problem.
The long-term goal would center on all physicians utilizing interpreter services appropriately and
consistently thereby increasing relationships with Latino patients and positively affecting
healthcare outcomes and quality of life.
In terms of the logic model attached as Appendix A, it is crucial to outline all of the
activities involved in implementing this workshop and how it will address the problem of
physicians not utilizing trained medical interpreters.
RUNNING HEAD: Capstone Proposal
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The most important input that relates to this problem, and that is needed to begin this
pilot, are staff to teach the class. Staff will preferably be social workers and medical interpreters
who have a clear understanding that Spanish-speaking patients are not getting the interpreter
services they need, which can ultimately affect long-term health. Medical interpreters also have
an understanding of Latino attitudes toward Western healthcare and their need to build trust with
their provider. This can be helpful in the input portion of implementation.
Additional inputs are residents to attend the class, a well-developed course curriculum
and the technology and space to facilitate this workshop. A well-developed curriculum addresses
this problem in the sense that it will include information about social determinants of health, how
language barriers impact health outcomes and quality of life and implicit bias of residents
working with non-English speaking patients. This is an important aspect to not only address the
problem, but will help to sustain the solution as resident physicians will have a deeper
understanding of their responsibility to utilize interpreters.
Activities related to the problem that are inherent in the logic model are training staff,
having staff meetings for professionals teaching the course, teaching the course at the beginning
of a resident’s tenure and checking them off on their skills after course implementation. From a
more macro perspective, it will be important at this stage to begin to develop policy related to
this workshop.
Outputs will revolve around implementing this workshop once per year during resident
orientation. After workshop implementation, residents will then be trained to use interpreters
appropriately and they will also understand why they need to use them consistently.
Additionally, at this stage in the logic model, outputs will need to include an organizational chart
along with expectations for instructors and the beginning of an organizational strategic plan.
RUNNING HEAD: Capstone Proposal
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In terms of the immediate outcomes of this workshop and the problem it is addressing,
the plan is to have a well-developed curriculum that can be standardized to any facility to teach
residents how to use interpreters. Also, the hope is that residents will begin to use interpreters
immediately and can explain to their attending physicians why they learned this is important.
This is one of the biggest challenges as, according to this writer’s research, there is currently no
documented training program to teach physicians why and how to use trained interpreters.
Regarding program metrics, there will be immediate data available to analyze as there
will be pre and post-surveys for attendees to complete. This data can be used as an immediate
outcome to determine workshop implementation success.
In the logic model, intermediate outcomes include evaluating the workshop to plan for
long-term outcomes, residents using consistent language around the use of interpreters and the
hope that attending physicians will see the benefit of this workshop and will want to attend
themselves. In the interim, there will also be process improvement opportunities for this
workshop based on data analysis.
Long-term outcomes for this problem will revolve around implementing this workshop in
teaching hospitals around the country as well as ensuring all physicians begin to use interpreters
consistently and appropriately. From a long-term perspective, this program will be implemented
in several healthcare facilities throughout the year and will begin to reduce healthcare disparities
in Spanish-speaking populations. Long-term funding will come from HRSA grants and Medicare
funds.
Additionally, there are federal mandates that are in place to ensure the use of trained
medical interpreters, but they are rarely enforced. One of the long-term outcomes of this program
RUNNING HEAD: Capstone Proposal
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is federal policy that is more stringent regarding interpreter use but that will take time to garner
legislative support.
In addition to utilizing a logic model to conceptualize a framework for addressing the
problem of physician-patient communication, it is important to have a theoretical foundation
when considering an innovative solution to a problem. Research indicates that solutions
developed with an underlying theoretical infrastructure are more successful than interventions
without. In addition to explaining behavior, a theory can also suggest how to influence and
change behavior in a more effective manner. In this particular innovation, several different
theories or models can be useful for understanding behavior and effecting change.
One theory to consider when focusing on changing the attitudes and behaviors of
physicians regarding the use of interpreters is Social Cognitive Theory. Social Cognitive Theory
“explains human behavior in terms of a three-way, dynamic, reciprocal model in which personal
factors, environmental influences, and behavior continually interact” (Glanz, 2019). Individuals
learn through their own experiences and learn through observing how others behave and seeing
the consequences of those behaviors. Having their behaviors reinforced positively or negatively
also plays a role into how individuals learn.
Another aspect to consider when attempting to alter behavior and effect positive
healthcare change is to normalize whatever process is implemented to effect change.
Alternatively, in other words, make the new process the norm rather than the deviant behavior.
Normalization Process Theory seeks to explain what people do (their actions) regarding an
innovation rather than their attitudes or beliefs. One of the propositions of this theory is that
“complex interventions become routinely embedded (implemented and integrated) in their
organizational and professional contexts as the result of people working, individually and
RUNNING HEAD: Capstone Proposal
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collectively, to implement them” (normalizationprocess.org, 2019). This can be helpful concept
in creating a workshop that increases a resident physician’s actions in using an interpreter, which
will then eventually become a behavior integrated into their normal practice.
Lastly, in terms of technology-related interpreter services, one of the reported barriers in
the utilization of language lines or video-conferencing is awkwardness or ease of use. In recent
interviews, medical staff disclosed that, due to the awkwardness of language technology, they
often rush through their conversation and leave out important details. This practice of not being
thorough in an attempt to ease one’s discomfort is dangerous and contributes significantly to this
problem. When considering how to change these behaviors and attitudes then, the theory of
Diffusion of Innovations could be useful. This theory was introduced in 1962 by a
communications professor named Everett Rogers and attempts to explain the rate at which new
ideas are adopted and utilized by various groups. According to this theory, not all individuals or
groups adopt an innovation at the same rate and there are certain characteristics that indicate an
individual’s openness to accepting an innovation (LaMorte, 2018).
Problems of Practice and Innovative Solutions
Due to concerns around physician communication with Spanish-speaking patients and
the role language barriers play in long-term health outcomes, the proposed intervention being
considered to address this problem is a one-day mandatory workshop aimed at teaching resident
physicians how to use interpreters appropriately. In addition, they will also learn about social
determinants of health, their own inherent biases and the importance of communication in
improving long-term health outcomes in Spanish-speaking patients. With this mandatory training
prior to resident physicians treating patients, the goal is to increase effective physician-patient
communication and improve patient outcomes with these patients.
RUNNING HEAD: Capstone Proposal
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At the end of their medical school training, the resident physician would attend this
workshop taught in collaboration by medical interpreters, social workers and health literacy staff.
This workshop would initially be piloted at Children’s Hospital Colorado, as they are a teaching
hospital, have a large Spanish-speaking patient population and have social work, medical
interpreter and health literacy departments.
The workshop participants will learn how to use every form of interpreter service (live
interpreter, language line, video conference) and would get to practice during the course of the
workshop. They would also learn, from the social work trainer, a brief overview of social
determinants of health and the importance of overcoming language barriers to improve health
outcomes (Gulli, 2018). In this way, they are both learning how to use an interpreter in an
appropriate manner, and leaving with an understanding of the importance of interpreter
utilization. This is crucial, as another challenge in this problem is physicians choosing not to
utilize an interpreter, even when available, which is a behavior that can be changed. An example
agenda is included in Appendix C, Program Manual.
Once a resident begins seeing patients after workshop completion, he would need to be
evaluated on this competency by one of the medical interpreters in the hospital. The focus will
initially be on Spanish-speaking patients as the opportunity to utilize these services will be
greater, but as the program develops, additional languages will be included.
One component of determining the need for an innovation is to consider the important
stakeholder groups impacted by the issue and their perspective on the problem.
There are several groups from both a healthcare and community perspective that likely feel
very connected to this problem whom could also be beneficial in implementing this program.
RUNNING HEAD: Capstone Proposal
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From the hospital healthcare standpoint, trained medical interpreters play an integral role in this
problem and, through interviews with this writer, share their frustration with physicians whom
do not use them consistently or appropriately. Trained medical interpreters are aware of the time
constraints placed on medical providers whom have to wait for their arrival, but it becomes more
difficult for staff to develop trust with Spanish speaking patients once the physician has begun
his assessment without formal language assistance (Gulli, 2018).
Trained medical interpreters also have a clearer understanding of minority attitudes
around healthcare than their Western medicine colleagues. They are more aware that if Spanish-
speaking patients are better able to build relationships with providers they understand (Carteret,
2014), the outcome one would expect to see is better participation in preventative care and fewer
medical complications from chronic conditions, which ultimately saves money in the healthcare
arena and benefits all.
In this regard, physicians have a vested interest in patient outcomes and are an important
stakeholder group to consider in this innovation. Although the focus of this proposal is on
teaching physicians not only how to use interpreters appropriately, but in changing their attitudes
surrounding the barriers that impede interpreter utilization, the main goal of providing medical
care is to improve a patient’s health. With education focused on the importance of the use of
interpreters, and how their patients will fare better long-term with good communication, this
writer has to believe that physicians are committed to providing this good care.
Although they are also clients that will eventually be involved with this innovation, a
clear stakeholder group in this problem is Spanish-speaking patients and their families. This is an
important solution as miscommunication from providers can adversely affect their long-term
health. As Latino patients need to feel trust in their providers through relationship building, they
RUNNING HEAD: Capstone Proposal
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will benefit from this innovation as their providers are learning how to communicate with them
more effectively.
In terms of organizations that can influence, and are impacted by this problem, one is
community health centers. These centers treat minority patients in underserved neighborhoods
but often lack the funding for the resources available in large healthcare institutions. Training
physicians to utilize interpreters in the hospital can be a benefit to community health centers as
they may see their patients coming in more often for preventative care or for follow-up as they
understand more clearly the discharge instructions provided in the hospital.
When considering community health centers as a stakeholder, it is also important to focus
on the Heath Resources and Services Administration (HRSA) as an organization with an interest
in this problem. The goal of HRSA is to fulfill their mission of improving health care to
vulnerable populations through funding grants for relevant healthcare programs (hrsa.gov). In
developing this mandatory workshop, it could be beneficial to seek financial assistance from
HRSA to support the eventual growth of this program with implementation into varied
healthcare facilities, especially community health clinics in underserved neighborhoods that have
little access to a payor source for interpreter services. In this writer’s recent interview with a
tenure-track University professor, whom works in programs funded solely by HRSA grants, it
was recommended to include them as a resource when considering program implementation and
long-term timelines (Gulli, 2019).
In addition to exploring how stakeholder groups view this problem and will benefit from
the innovation, it is also important to examine how this program relates to the theories of change
previously mentioned. In terms of Social Cognitive Theory, one component that is important to
consider in this innovation is the concept of self-efficacy. “Self -efficacy or a person’s
RUNNING HEAD: Capstone Proposal
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confidence in his or her ability to take action and to persist in that action despite obstacles or
challenges, is especially important for influencing health behavior change efforts” (Glanz, 2019).
Resident physicians who undergo this four hour workshop will need to display enough
confidence to use a trained interpreter and may need to stand up to an attending physician who
has a different practice. The goal is that resident physicians will develop different attitudes and
behaviors in regards to using interpreters and will begin to dispel that behavior from the bottom
up. This will be the only way long-term behavioral change can occur in this setting.
Additionally, as previously mentioned in regards to this theory, learning occurs when
behaviors are reinforced either positively or negatively. If a resident physician remembers his
workshop knowledge, uses an interpreter appropriately, is able to develop trust with a Spanish-
speaking patient and can witness this patient following provided instructions, the behavior of
using an interpreter appropriately is positively enforced and more likely to occur in the future.
Changing the social norm of not utilizing an interpreter consistently or appropriately is the
goal of using a Normalization Process Theory as a foundation for this project. Having the ability
to integrate the actions of using an interpreter, regardless of one’s beliefs about the practice, will
be important in this innovation as not all physicians will want to ideologically adopt this practice.
In this workshop, utilizing the ideas behind the Diffusion of Innovations theory will be
useful in increasing a provider’s comfort level with the current technology available for
interpreter services. As mentioned previously, discomfort with the use of language lines and
video-conferencing can lead to providers not being thorough during appointments. In this
workshop, resident physicians will learn how to use this technology and be encouraged to
practice in the classroom setting. According to this theory, there are characteristics that indicate
whether someone will adopt an idea or product early or late. The majority of individuals fall into
RUNNING HEAD: Capstone Proposal
21
the middle bell curve of accepting an innovation. In this workshop, however, it would be useful
to identify the extremes on either side and use the early adopters to role model to the late
adopters in terms of using interpreter technology.
Project Structure, Methodology and Action Components
In terms of project structure, a prototype has been created to operationalize this workshop
(Appendix C). The attached prototype is a program manual intended to guide the facilitators of
this class how to teach the objectives outlined in the workshop agenda. As this prototype is a pilot
workshop program aimed at teaching medical providers why, and how, to use trained interpreters,
a program manual is the most effective way to describe and demonstrate this innovation.
In a comparative market analysis, this program is innovative, as a review of the literature
did not provide information regarding hospital-wide programs in this regard. There are articles
posted online that provide recommendations for how to properly utilize an interpreter, but the
largest gap in the literature involves physician training in the utilization of these services. In a
search of the literature, this writer found no specific studies regarding patient outcomes when a
physician is trained to use an interpreter versus being trained spontaneously on this expectation
on the job. Additionally, the workshops this writer did find are geared toward training medical
interpreters, not providers. This is an area of research to consider and this proposed innovation
would address this gap.
Additionally, there is a plethora of literature indicating that one of the biggest factors
impeding the use of a trained interpreter is time constraints (Hseih, 2014) but none of the
suggestions for eradicating this concern focused on simply training physicians on how to use
interpreters more efficiently. Also, there is little research available regarding how to change
RUNNING HEAD: Capstone Proposal
22
physician attitudes and behaviors surrounding the use of interpreters, which will be an area of
focus for this innovation. The ultimate goal is to create a new accepted behavior of utilizing this
service to provide better patient care.
Furthermore, this program will aid physicians in communicating with patients in general,
for which they receive little training in medical school. For example, medical school students, on
average, receive approximately four hours of education on patient communication while
employees whom are trained to work at the Apple Genius Bar are required to take at least forty
hours of communication training. Additionally, included in this customer service training, is a
heavy emphasis on empathy and making people feel valued (Khan, 2016). This appears to be an
area that is sorely lacking in physician education.
As previously mentioned, utilizing a logic model (Appendix A) to visualize how a
program will work is important in planning and implementing this innovation. In this particular
project, planning the resources, or inputs, needed to effectively develop this workshop is crucial.
The first resource is a well-developed curriculum (Appendix C) that addresses some of the
identified barriers to interpreter use and utilizes class discussion to deliver the information
needed to alter behavior. The curriculum outlines how many instructors are needed to teach the
program. Based upon their investment in this program being successful, it would make sense to
utilize social workers, medical interpreters and a health literacy educator as workshop
instructors, if possible.
Additional inputs will include classroom space and resident physicians to attend the
workshop. New resident physician cohorts generally start each July in a teaching hospital, but
determining the size of each incoming class will be important to plan for classroom space and
adequate instructors and materials. On average, this writer is planning for 30 residents in a
RUNNING HEAD: Capstone Proposal
23
workshop with three trained instructors, as well as additional trained medical interpreters to
assist with in class role plays and competency sign off after the workshop.
The activities that have taken place in the development and implementation of this
program are writing curriculum and researching available instructors to train the workshop.
Upcoming activities will include securing the classroom and teaching the course once each July
when physicians begin their residency. Having regular staff meetings with the assigned
facilitators to discuss program outcomes will also be important as well as having medical
interpreters sign residents off on a this competency once they begin seeing patients.
The outputs that would be expected to occur after gathering resources and participating in
workshop planning activities, is that one workshop will be developed per year and resident
physicians will be trained to use interpreters appropriately.
The immediate outcomes that would be expected after program development and
implementation is that the workshop would be a well-developed standardized program to teach
residents how to use interpreters and that many of these residents would begin using this service
immediately after workshop completion. Data collection and analysis will also be important after
the initial workshop to help guide future workshop planning. Intermediate outcomes will include
the consideration of process improvement opportunities and evaluating the effectiveness of the
workshop once residents begin using interpreters consistently. The hope is that, as an intermediate
outcome, other physicians begin to express interest in attending the workshop. This would ensure
involving physicians as relevant stakeholders so they feel a level of involvement with this process.
Along those lines, long-term outcomes would include implementation of this workshop several
times throughout the year to include physicians at all levels with the goal that all providers would
RUNNING HEAD: Capstone Proposal
24
begin using interpreters appropriately. Furthermore, if physicians use interpreters consistently, the
ultimate goal is a reduction in adverse healthcare outcomes for Spanish-speaking patients.
Of course there are obstacles in any new innovation and it is important to consider those
barriers and how to address them. From the perspective that it is crucial to have hospital and
physician buy-in for program success, one of the strategies will include identifying early physician
adopters of the program so they can be utilized as champions in moving the pilot forward. It will
be imperative to identify additional hospital staff that buy into this program early and want it to
succeed, as well.
Providing continuing education regarding the need for this workshop and its
effectiveness in solving the problem of physicians not using interpreters is also an important
implementation strategy. Ongoing education is a valuable tool in the success of any program.
In terms of addressing the difficulty of assessing long-term health outcomes, which will
eventually require a longitudinal study, it will be important to implement the strategy of
developing partnerships with community clinics that treat Spanish speaking patients. This is also
an important way to include outpatient clinics as stakeholders. These clinics can provide
qualitative and quantitative data regarding how their patients are doing with follow up care once
they can more clearly understand hospital instructions. Prior to a full-blown longitudinal study,
data from clinics regarding whether their patients have better follow up could be an indicator that
the workshop has been effective in increasing interpreter use. Along these lines, it will also be
crucial to implement the strategy of ongoing data analysis to capture as much information about
program outcomes as possible. This will help guide the implementation of ongoing workshops
and programs in additional hospitals.
RUNNING HEAD: Capstone Proposal
25
In developing this pilot and determining implementation strategies, it is also to consider
what leadership strategies and characteristics are important to ensure successful implementation
and long-term success. In order to achieve the strategic goals in any organization, it is crucial for
leaders to display characteristics that enable them to be relational enough to maintain an engaged
workforce, but strategic enough to set future goals to encourage ongoing success. In this
prototype and pilot program, these are factors this writer must consider when gaining stakeholder
buy-in.
In the StrengthsFinder model (Clifton Strengths, 2019), leaders who are able to set
future goals and maintain an engaged workforce would likely excel in the executing and strategic
thinking domains. One of those skills might be responsibility since the leader is ultimately
accountable for the organization’s performance (in this sense, this pilot’s performance). Also, a
leader with a strength in context would also be important as hospitals want some type of
recognition for interpreter training they believe they have been providing. These types of leaders
look back to understand the history of an organization as well as look back to understand the
present and become more wise about an organization’s future.
While it is important to have relationship building skills, like empathy, when you are
committed to providing services to underserved communities, it is also important to have the
self-assurance of an influencer to make strategic goals a reality. Compassion for the members of
your community can only go so far when developing a business model.
In terms of the 7C approach as outlined by Tropman & Wooten (2010), a leader in this
program would fare well if she had characteristics that indicate a professional and articulate
temperament. It will be crucial to develop collaborations with internal and external stakeholders
to further the reputation of this prototype in the community.
RUNNING HEAD: Capstone Proposal
26
Another important factor to consider in the development of this pilot program is the
budget. As the program will initially take place in a teaching hospital, utilizing conference rooms
and technological equipment will not be a costly endeavor. This writer will develop a proposal for
a HRSA grant to cover the funding for use of classroom space and additional staffing costs. In
addition, this writer will seek in-kind donations from the hospital and a grant from the hospital
foundation. In total, this writer is estimating $11,200 from a HRSA grant, $2,800 from a Children’s
Hospital Foundation grant and $1,200 from an in-kind donation at Children’s Hospital. The total
costs anticipated are $5,000 to develop the program, $4,800 for three additional trainers, $1,400
for program materials, $800 for training space and technology, $2,000 for this writer’s training
fee, $600 for catering and $200 for incidentals. The total revenue equals $15,000 and the total
costs are estimated at $15,000 (Appendix A).
Program measurement will occur in several ways. Based on the agenda, there will be pre
and post surveys aimed at measuring a resident’s pre workshop knowledge of interpreter use,
social determinants of health and their own inherent bias in treating people of color. These pre
and post surveys will be important in understanding general audience knowledge and how to
plan future training. These pre and post surveys will utilize a Likert scale to score respondents
quantitative answers as well as an open ended section to gather qualitative responses. As these
surveys have recently been developed, they will need to be validated for reliability after pilot
implementation.
As these pre and post surveys will be utilized to assess knowledge transfer, it will be
important to also include a third party evaluation, which happens some time after completion of
the workshop, to determine if a behavioral change has occurred. This evaluation will consist of a
competency check-off which is conducted by trained medical interpreters once a resident begins
RUNNING HEAD: Capstone Proposal
27
to treat Spanish-speaking patients. Once residents treat their first two to three Spanish-speaking
patients, an interpreter can check off that they are demonstrating their new skill. This enlists the
assistance of trained medical interpreters as stakeholders and ensures they feel involved in this
process.
As mentioned previously, however, measuring overall program success from a long-term
healthcare outcome perspective will be different. As the goal of this innovation is to increase
physicians’ use of available interpreter services, it will be important to determine if this is
actually occurring. One way to gather this information is to collect hospital data of patients that
identified as Spanish-speaking and review their charts to see if an interpreter was used prior to
workshop implementation. After workshop implementation, it will be important to collect the
same data to determine if more patients whom identified as Spanish-speaking were assessed by a
provider with the assistance of interpreter services. This will be the most effective way to see if a
Spanish-speaking patient who needed an interpreter was provided with one. In other words, is
this program reaching all of the intended recipients? As this prototype is still in the pilot
development phase, this form of longitudinal study will need to be developed after the initial
workshop is conducted and pre and post surveys are evaluated.
From a communication perspective, if the pilot is successful based upon measurement
outcomes it will be crucial to advertise the workshop throughout the hospital to garner interest
and expand the program. Meeting with hospital administration to share metrics and demonstrate
pilot outcomes will be an important step in continuing hospital buy-in and possibly mandating
this workshop for all hospital employees.
RUNNING HEAD: Capstone Proposal
28
Additionally, since HRSA will be providing grants for the pilot, providing outcome
measures will be imperative to collaborating with them in the future to expand the program to
other areas.
Lastly, although federal policies are in place that mandate using trained medical
interpreters, this is not happening on a consistent basis and Spanish-speaking families are not
complaining. Developing a marketing ad campaign targeted in LatinX communities that explains
their rights to an interpreter and the complaint process might be an effective tool to move this
program forward.
Conclusions, Actions and Implications
The social problem of physician communication with Spanish-speaking patients is an
important aspect of the Grand Challenge of Close the Health Gap. Language barriers account for
poorer health outcomes, lower life expectancy, and poorer quality of life and can even result in
medical mismanagement and death. Currently, there are no standardized training programs in
place to teach resident physicians not only how to use interpreters appropriately, but also the
importance of understanding social determinants of health and their own inherent biases when
treating patients of color.
The attached prototype, which is a workshop geared toward teaching residents how to
use interpreters, falls under the context of education. It will function as mandatory training
residents receive when they arrive at the teaching hospital for orientation so it will not feel like
an extra course they need to take. It will also take the place of medical interpreters needing to
visit each department for an introduction to their services once the program is implemented
hospital-wide. This workshop can change the way hospital staff view the importance of utilizing
RUNNING HEAD: Capstone Proposal
29
medical interpreters as it addresses the important role language barriers play in healthcare
outcomes. It also addresses the problems that can occur if providers use ad hoc interpreters.
When considering the potential for this program, however, it is also important to explore
the barriers and limitations that could impede success. One of the barriers to physicians utilizing
trained interpreters is interpreter availability and this will likely continue to be a barrier in the
first year, or more, after implementation. An important consideration is that this resource could
become scarcer as physicians begin using interpreters consistently and their availability
decreases. If physicians begin to change their behavior and use interpreters consistently, and
then the resource becomes more difficult to access, this negative reinforcement could cause
physicians to revert to the pre-existing norm. Having the ability, through data, to indicate
increased interpreter use and decreased availability will be important strategically in order to
promote hiring additional interpreter staff. One implementation strategy to address this issue is
to access new funding that could potentially help hospitals install different interpreter methods
without increasing staff. Additionally, time studies can demonstrate increased interpreter use
along with improved patient-physician relationships, which might encourage the hospital to
increase their staffing levels.
At Children’s Hospital Colorado, where this project will initially be piloted, residents
attend an orientation and medical interpreters provide very basic in-person training to different
hospital departments. It might be beneficial to find a way to combine the two in a way that works
for this project. This could be an integral next step to ensure long-term success of the program.
In terms of next steps for advancing this program, if this becomes an organization, then
Mission, Vision and Values will need to be identified and core competencies developed. If this
RUNNING HEAD: Capstone Proposal
30
workshop becomes integrated as part of the resident orientation, then specific standard operating
policies and procedures can be written into pre-existing policies that are relevant.
Additionally, a next step in the continued development of this program is to create
additional measurement tools that not only gather the reach of the project but also the long-term
health outcomes that could eventually save a healthcare facility money. The best way to ensure
this pilot can become an established program offered throughout the country is to develop
outcome measures that demonstrate improved patient outcomes and reduced cost to insurance
companies and hospitals. In terms of next steps, that will be a longer term goal.
RUNNING HEAD: Capstone Proposal
31
References
Allen, L., Cummings, J., Emergency Department Use Among Hispanic Adults: The Role of
Acculturation. Med Care. 2016 May: 54(5): 449-456.
American Academy of Social Work and Social Welfare. http://www.aaswsw.org
Accessed January 20, 2019
Bramowicz, M. Why Hospitals are In Desperate Need of Interpreting Services. Electronic Health
Reporter. (2017).
Cardiologist is called ‘racist’ after slamming patient for not speaking English.
https://yahoo.com/lifestyle/cardiologist-called-racist-slamming-patient-not-
speaking-english-121038834.html?.tsc=fauxdal. (6 November 2018).
Carteret, M. (2014). Overcoming Language Barriers and Resistance to Interpreter Services.
https://www.dimenensionsofculture.com
Carteret, M. (2010). How Culture Affects Expectations of Physicians.
https://www.dimensionsofculture.com
Clifton Strengths. Retrieved from Gallup. Com website on September 12, 2019.
https://www.gallupstrengthsfinder.com
Falkenstein, A., Tran, B., Ludi, D., Molkara, A., Nguyen, H., Tabuenca, A., Sweeny, K.
Characteristics and Correlates of Word Use in Physician-Patient Communication.
Annals of Behavioral Medicine. 2016; 50: 664-677.
Glanz, K. Social and Behavioral Theories. e-source Social and Behavioral Sciences Research.
https://obssr.od.nih.gov/wp-content/uploads/2016/05/Social-and-Behavioral-Theories.pdf
Accessed 2/23/2019.
Gulli, L. Unpublished interviews (2018); University of Southern California; SOWK 706.
RUNNING HEAD: Capstone Proposal
32
Gulli, L. Unpublished interviews (2019); University of Southern California; SOWK 712.
Heath, S. How Cultural, Language Barriers Impact Positive Patient Experience. Patient
Engagement Hit. Accessed on January 24, 2018 via
https://patientengagementhit.com/news/how-cultural-language-barriers-impact-positive-
patient-experience.
Health Resources and Services Administration. Accessed 3/22/2019 at https://www.hrsa.gov
Hoffman, A., Millions of Americans are Getting Lost in Translation During Hospital Visits.
Smithsonian.com (September 2015). Accessed 4/12/18 via
https://www.smithsonianmag.com/innovation/millions-americans-are-getting-lost-
translation-during-hospital-visits-180956760/#DyidjtrSMgi1clfJ.03
Hornberger, J. C, Gibson, Jr, C. D., Wood, W., Dequeldre, C., Corso, I., Palla, B., Bloch, D. A.,
Eliminating Language Barriers for Non-English Speaking Patients. Medical Care 1996;
34 (8), 845-856.
Hsieh, E., Not Just “Getting by”: Factors Influencing Providers’ Choice of Interpreters. J Gen
Intern Med 2014; 30 (1): 75-82.
Juckett, G., Unger, K., Appropriate Use of Medical Interpreters. American Family
Physician. 2014 Oct 1; 90(7): 476-480.
Jacobs, B., Ryan, A., Henrichs, K., Weiss, B., Medical Interpreters in Outpatient Practice. Ann
Fam Med January/February 2018 vol. 16 no. 1 70-76.
Khan, H., The Apple Store Guide to Insanely Great Customer Service. Shopify (4/28/2016).
LaMorte, W., Behavioral Change Models. Boston University School of Public Health. (2018)
32-63.
Oshman, T., Do Language Barriers Contribute to Medical Errors? The Oshman Firm. (February
RUNNING HEAD: Capstone Proposal
33
2017).
Migration Policy Institute. Frequently requested statistics on immigrants and immigration in
The United States, 2018.
www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-
immigration-united-states.
Normalization Process Theory. https://www.normalizationprocess.org
Accessed 3/24/2019.
Pew Research Center, Hispanic Trends. Demographic Profiles of Hispanics in Colorado.
2014.
Ragavan, M., Cowden, J.D. The Complexities of Assessing Language and Interpreter
Preferences in Pediatrics. Health Equity, 2018, 2.1, 70-73.
Raynor, E.M., Factors Affecting Care in Non-English-Speaking Patients and Families. Clinical
Pediatrics, 2016, 55 (2) 145-149.
Silva, M., Genoff, M., Zaballa, A., Jewell, S., Stabler, S., Gany, F., Diamond, L.C., Interpreting
at the end of Life: A Systematic Review of the Impact of Interpreters on the Delivery of
Palliative Care Services to Cancer Patients With Limited English Proficiency. Journal of
Pain and Symptom Management. 2015, 51 (3), 569-580.
Simpson, K., Rural Colorado’s white population is declining, and minorities are transforming the
region’s culture and economy. The Denver Post, 2017
https://www.denverpost.com/2017/11/09/colorado-rural-demographic
Tropman, J. & Wooten, L. (2010). Executive Leadership: a 7C approach. Problems and
Perspectives in Management. 8(4), 47-57.
United States Census Bureau (2018). https://www.uscensusbureau.org
RUNNING HEAD: Capstone Proposal
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Appendix A: Logic Model and Program Implementation
Inputs Activities Outputs Immediate Outcome Intermediate Outcome
Long-term outcomes
All physicians use interpreter services appropriately and consistently.
The workshop is provided several times a year and offered to all healthcare professionals.
Reduction in healthcare outcome disparities for non-English speaking patients.
Implement as a standardized workshop in all healthcare facilities
HRSA or Medicaid/Medicare Funded
Medical
Interpreter/Social
Work staff to teach
class
Residents to attend
class
Course curriculum
Video equipment
Funding
Classroom space
Train staff
Teach course
at the
beginning of
residency
Staff meetings
Check off
residents on
compliance
after class
Policy
developmen
t
One
workshop
developed
per year
Residents
trained to
use
interpreters
A well-developed
standardized program
to teach residents how
to use interpreters.
Many of the residents
will begin using
interpreters correctly
immediately
Organizational
chart with
Mission Vision
and Values
Leadership
expectations
Strategic
planning
development
Evaluation of
workshop
Consistent
language and
engagement
Established
physicians
express interest
in the workshop.
Process
improvement
opportunities based
on data analysis.
New
organization
metrics for
outcomes,
compliance and
accountability.
Data collection
and analysis.
RUNNING HEAD: Capstone Proposal
35
Appendix B
July 1, 2020-June 30, 2021 Budget
Revenue:
HRSA Grant 11,200
Children’s Foundation Grant 2,800
CHCO In-kind donation 1,200
Total Revenue: 15,200
Expenses:
Personnel Expense
Developer 5,000 1 developer/lead
Lead Trainer 2,000 3 contract trainers
Trainers 4,800 4 medical interpreters
Interpreters 400
Total Personnel 12,200
Operating Expense
Training space 800 1 room w/projector
Program materials 1,400 handouts/surveys
Catering 600 meal/drinks/snacks
Supplies 200 pens, folders
Total Ops 3,000
Total Expenses: 15,200
Surplus/Deficit: 0
RUNNING HEAD: Capstone Proposal
36
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Asset Metadata
Creator
Gulli, Loreen
(author)
Core Title
Capstone proposal: utilizing trained medical interpreters: a workshop for medical providers
School
Suzanne Dworak-Peck School of Social Work
Degree
Doctor of Social Work
Degree Program
Social Work
Publication Date
05/11/2020
Defense Date
04/16/2020
Publisher
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close the health gap,OAI-PMH Harvest,physician communication with Spanish-speaking patients,workshop to train medical providers
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Ghosh, Subharati (
committee member
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committee member
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