Caring for Children and Families With Limited English Proficiency: Current Challenges and an Agenda for the Future

Abstract

This month' s issue of Hospital Pediatrics features 2 articles addressing quality of care for children and families with limited English proficiency (LEP), 1,2 highlighting an important area of growing concern for clinicians and researchers. Children from LEP families make up a large and expanding proportion of the US population, 3 but as these 2 articles show, we continue to face substantial challenges both in providing these children with high-quality, equitable care and in studying them, which is an important prerequisite to developing effective interventions to improve care.A primary challenge in both caring for and studying LEP patients and families lies in correctly identifying them. Many institutions do not consistently collect language data, and those that do often record the primary language spoken at home, which does not adequately identify the presence of a language barrier or the need for interpretation. 4,5 This situation leads to clinicians being unable to rely on the language information captured in the medical record to determine interpreter need, which then encourages many to assess the family' s English ability with each communication and "get by" without an interpreter if they can.6,7 The collection of less helpful or inconsistent language information also makes it very difficult to study language barriers within large databases such as the Pediatric Health Information System, given the variability in the institution-level data.In pediatrics, we face the additional challenge of trying to determine whose English proficiency or interpreter need to document, because different caregivers' needs may differ and not all caregivers are always present. For the purposes of clinical care, it would be ideal to assess and document the English proficiency or interpreter need for each caregiver individually, although the question of how to handle multiproficiency families for research purposes would remain. These challenges are all evident in the definition of the LEP group in the article by Ju et al, 1 in which the authors used a combination of non-English primary language, documentation of interpreter use, and/or having a language barrier documented during the initial nursing assessment. This approach reflects the current limitations of the data collected at most institutions, but resulted in a somewhat counterintuitive LEP group that was larger than the population recorded as speaking a non-English primary language (26.3% LEP but only 18.5% recorded as a non-English primary language). This result may reflect failure to assess and record language for many families, incorrectly assigning families to English, or differences in the proficiency of caregivers present at different times (eg, the English-proficient mom was present at the initial assessment, but the grandmother with LEP

Association of limited English proficiency and increased pediatric emergency department revisits

“…59 Despite these challenges, it is important to study language to ensure provision of safe, equitable care to patients with LEP. 3,60 In our secondary analysis we sought to examine modifiable communication-related factors to potentially inform QI efforts 61 ; however, incomplete data limited these analyses. Previous literature has demonstrated patients with LEP receive inadequate discharge instructions, caregivers cite deficient discharge communication as a reason for revisits, and professional interpreter use (while underutilized in the pediatric ED) is associated with improved clinical care and discharge communication.…”

“…Patients with limited English proficiency (LEP) are more likely to experience disparities in care quality and adverse medical events compared to patients with English proficiency (EP). [1][2][3][4][5][6][7][8] LEP refers to individuals 5 years and older who report speaking English less than "very well" as classified by the U.S. Census Bureau. EP refers to individuals speaking English only or "very well."…”

“…24,[29][30][31][32] Pediatric ED return visits are widely studied, 26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] but few studies examining revisit predictors include language as a factor. 13,14,39 A better understanding of the impact of language on pediatric care quality and outcomes 3 and improved solutions to address these disparities are needed. [45][46][47] The objectives of this study are to: (1) examine the association of LEP and 72 h ED revisits resulting in discharge and hospitalization in a tertiary pediatric ED and (2) identify potentially modifiable risk factors for revisits among LEP patients.…”

Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents?

“…Another possible reason for delayed care in patients with a PLOE may be related to health literacy, which is instrumental in surgical care, because families are often required to make difficult decisions and follow complex medical instructions [7,35]. Multilingual clinicians, reliable interpreter services, and translated references and resources may help with this [5,24]. It may also be improved by special attention from the clinical care team to verify that families understand the proposed clinical recommendations and are actively involved in decision-making.…”

Language Barriers in Care for Low-Risk Febrile Neonates

“…ing language barriers in pediatric care 8 and particularly in the pediatric ED. 9 One unique challenge to the use of professional interpretation in the pediatric ED is that encounters are not planned and, particularly for newborn patients, sociodemographic patient information is rarely collected in the electronic medical record until after ED arrival.…”