Other Important Considerations
Families with Limited English Proficiency
CONFRONTING LANGUAGE BARRIERS
This section focuses on discharge planning with families who have limited English proficiency.
While in the NICU, families with limited English proficiency may experience more isolation. As much as possible, eliminate language as a barrier.
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IMPORTANT:
Keep in mind that computer automated translation services often follow algorithms and lack the nuance and cultural context that may be provided by a certified medical interpreter.
These types of computer software and services are discouraged for any important medical discussion because they may not be linguistically or culturally accurate.
The use of computer automated translation services should be limited to urgent situations when all other options have been exhausted or for very basic uncomplicated inconsequential information.
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Interpreter Use
Certified medical interpreters should be used for all discharge education and the in discharge planning meetings, with the order of preference being:
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in-person (best)
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video (helpful)
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phone (less than ideal)
Discharge materials should be delivered in the family’s preferred language and communication mode.
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Provide a medical interpreter when any primary caregiver has limited English proficiency. Family members may not be able to accurately interpret for each other, especially about medically complex concepts.
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Plan ahead when using an interpreter. Additional time is needed to coordinate interpreter availability, family needs, and time needed for the team to process information, reflect, and consider additional questions.
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Family comprehension of the discharge education and awareness of scheduled medical follow-up appointments should be confirmed by return demonstrations of their knowledge with interpreters.
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Family Members a Interpreters
Family members should only be used to help interpret if a certified medical interpreter is not available or in an emergent situation.
IMPORTANT: A minor should not be used as a family interpreter.
After a family member has been used as an emergency interpreter, a certified medical interpreter should be brought in as soon as feasible to verify the family’s understanding of the information.
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Patient-Related Information
Provide families with discharge materials in their preferred language.
These materials should be written in a manner that is simple, clear, concise, and devoid of medical jargon to aid understanding and decrease confusion.
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Translate patient-related information and medical records into the family’s preferred language or mode of communication by medically certified translators.
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Computer Translation
Items that are translated via a computer translation service should be verified by a certified medical interpreter for clarity and accuracy.
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Hospital Navigation
Develop a plan, note, id, or card for families to use to identify themselves as having a baby currently in the NICU.
Some families may have difficulty accessing and navigating the hospital because they are unable to communicate with security staff or front desk staff or read signs.
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Social Support
Families with limited English proficiency benefit from additional support from social workers, case managers, or peer-to-peer support programs as they prepare for discharge.
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Primary Care Involvement
A primary care provider should be chosen prior to discharge because culturally- and linguistically-appropriate options for a medical home may be more limited.
If the family has not chosen a primary care provider - and if you have taken time to build relationships with reliable, responsive providers in your community - the NICU team can help them make this selection.
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Parental Mental Health
Recognize that mental health issues can be more difficult to identify, monitor, and address when we don't share a family's culture and language.
Any screenings for perinatal mood and anxiety disorders (PMADs) or mental health screenings should be adapted and translated so that they are culturally accurate and appropriate.
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ESSENTIAL RESOURCE: The Edinburgh Postnatal Depression Scale (EPDS) is recommended for screening for depression in the antenatal and postnatal periods. It is free and has been translated into at least 20 languages. We especially like the newly adapted EPDS-US (available in English and Spanish) that uses a patient-centered, trauma-informed approach to screening and referral.
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