DIREZIONE GENERALE STAFF RICERCA

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MIGRANT-FRIENDLY AND CULTURALLY COMPETENT
COMMUNICATION the development of an integrated
language and cultural mediation service for
hospital and primary care services Azienda USL
di Reggio Emilia Staff RICERCA E INNOVAZIONE Dr.
Antonio Chiarenza Dr.ssa Amelia Ceci Dr.ssa
Ilaria DallAsta
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The Azienda Unità Sanitaria Locale of Reggio
Emilia local health service
Reggio Emilia City Hospital
Guastalla Hospital
Correggio Hospital
Part of the Regional Health System 6 Districts
(primary care) 5 Hospitals 3,500 employees 470
medical doctors 349 GPs
Montecchio Hospital
Scandiano Hospital
Castelnovo Monti Hospital
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3 STAGES FOR THE DEVELOPMENT OF Linguistic
Cultural Mediation SERVICE

• STAGE 1. RESPONDING TO THE URGENT NEEDS OF
  UNDOCUMENTED MIGRANTS (UDM)
• STAGE 2. RESPONDING TO THE NEEDS OF SETTLED
  MIGRANTS
• STAGE 3. ENSURING EQUALITY OF ACCESS TO ALL
  CITIZENS (INTERCULTURAL CITY)

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STAGE 1 responding to the urgent needs of
undocumented migrants (UDM).
Main concern to face the impact of illegal
migration on healthcare

• To provide access for urgent treatment for UNMs
• To ensure mother and child care for UNMs
• To bridge the gap for UNMs to access primary care
• To control infectious diseases

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STAGE 1. Measures implemented
MULTILINGUAL INFORMATION AND APPOINTMENT OF
INTERCULTURAL MEDIATORS IN SPECIFIC AREAS OF
UNDOCUMENTED MIGRANT HEALTH CARE
FREE ACCESS TO HOSPITAL SERVICES (assignment of
temporary status) For urgent and essential
treatment SPECIFIC HEALTH CARE CENTRE FOR
MIGRANT FAMILIES For mother and child
care VOLUNTRY NETWORK OF GPs To foster access to
primary care PUBLIC HEALTH INTERVENTIONS To face
TB and hepatitis
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STAGE 2 responding to the needs of settled
migrants
Main concern to promote health and health
literacy for migrants and minority groups
To improve clinical communication betweenstaff
and migrant patients To increase migrant
patients health literacy
To improve staff inter-cultural competence
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STAGE 2. Measures implemented
DEVELOPMENT OF A MODEL OF GOOD PRACTICE FOR
INTERPRETING INTERCULTURAL MEDIATION WITHIN
THE EU PROJECT MIGRANT-FRIENDLY HOSPITALS
(2002-2005)
INTERPRETING SERVICES ARE MADE AVAILABLE WHENEVER
NECESSARY Optimizing existing services and
developing new ones PATIENTS ARE INFORMED ABOUT
LANGUAGE SERVICES AND HOW TO OBTAIN THESE
SERVICES. Empowering patients and minority
groups CLINICAL STAFF ARE TRAINED ON HOW TO WORK
COMPETENTLY WITH INTERPRETERS. Developing
specific training PATIENT EDUCATION MATERIALS
ARE AVAILABLE IN NON-LOCAL LANGUAGES Developing
culturally adequate written material

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Migrant-Friendly Hospitals (2002-2005) A
European Initiative to Promote Health and Health
Literacy Migrants and Ethnic Minorities
Kaiser-Franz-Josef-Spital, Vienna,
Austria Immanuel-Krankenhaus GmbH, Rheumaklinik
Berlin-Wannsee, Berlin, Germany Kolding
Hospital, Velje-Kolding, Denmark Hospital
Spiliopoulio Agia Eleni, Athens,
Greece Hospital Punta de Europa,
Algeciras-Cádiz, Spain Turku University
Hospital, Turku, Finland Hôptial Avicenne,
Paris, France James Connolly Memorial Hospital,
Dublin, Ireland Azienda Unità sanitaria Locale
di Reggio Emilia, Reggio Emilia, Italy Academic
Medical Centre, Amsterdam, The
Netherlands Uppsala University Hospital,
Psychiatric Centre, Uppsala, Sweden Bradford
Hospitals NHS Trust, Bradford, U.K.
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Implementation and evaluation of a new Linguistic
Cultural Mediation service at Guastalla
hospital within the MFH project
IMPLEMENTATION OF A NEW LCM service in 3 model
hospital wards (obstetrics gynaecology,
paediatrics and AE) In-house interpreting
intercultural mediation system Established
cooperation with the district (women
clinics) COORDINATION at hospital
level TRAINING and education for model department
staff on working with intercultural
mediators TRANSLATION OF WRITTEN MATERIALS
(hospital information, multilingual
questionnaires, discharge/follow-up)
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STAGE 3 ensuring equality of access to all
citizens
Main concern to develop of culturally competent
health services

• TO RESPOND TO THE NEEDS OF DIFFERENT COMMUNITIES
• TO ENSURE EQUAL ACCESS TO QUALITY CARE FOR ALL
• TO IMPROVE MINORITY GROUPS ABILITY TO USE ALL
  HEALTH SERVICES
• TO FOSTER PARTICIPATION AND INTEGRATION

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STAGE 3. Measures implemented

• SET UP OF A LCM service for the whole province of
  Reggio Emilia by
• Community-based interpreting intercultural
  mediation as a shared resource for all health
  care services.
• Using an external agency for intercultural
  mediators (Social cooperatives).
• Connecting the needs of hospitals, primary care
  and social services
• Developing partnerships in the community with
  local authorities.
• ESTABLISHED COORDINATION both at central and
  district level
• DEVELOPED TRAINING and education
• For hospital staff
• For intercultural mediators
• DEVELOPED GUIDELINES on cultural mediation and
  translation/interpreting
• SYSTEMATIC DOCUMENTATION continuous assessment

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A definition of intercultural-mediator
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Intercultural mediation services provided

• Languages Arabic, Chinese, Hindi, Urdu, Punjab,
  Albanian, Russian, Ukrainian, Turkish, Romanian..
• 19 intercultural mediators
• Type of interventions for clinical encounters
  and health promotion activities
• On site presence of the intercultural mediator
  (in hospital)
• Weekly scheduled intervention
• Urgent intervention (within 2/3 hours)
• Intervention over the phone
• Interpreting and translations
• Patient information and education
• Community information and education

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Number of hours of LCM service by health
structures
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19
7
37
29
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LCM service activities by languages
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LCM service activities by type of interventions
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Number of telephone interventions in one year
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LCM service interventions by type of encounters
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LCM service interventions by type of services
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Concluding remarks

• Tendency to continue to use informal
  interpreters, such as family members
  (particularly in AE departments)
• Risk that health staff delegate certain tasks to
  intercultural mediators
• Tendency to consider the use of intercultural
  mediators as a panacea for the management of
  intercultural encounters
• Need to create appropriate and recognised
  training programmes for intercultural mediators
• Need to define quality standards for
  intercultural mediation, interpreting and
  translation
• Need to develop a policy for culturally competent
  communication.

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Information and documents
Azienda Unità Sanitaria Locale di Reggio
Emilia Direzione Generale Ricerca e
Innovazione Via Amendola, 2 42100 Reggio Emilia
http//www.ausl.re.it
Antonio.chiarenza_at_ausl.re.it Amelia.ceci_at_ausl.re.i
t Ilaria.dallasta_at_ausl.re.it