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Culturally Competent LEP and Low-literacy Services

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Entities that receive federal funding must take reasonable steps to ensure access to services for people with limited English proficiency (LEP).

Section 601 of Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, provides that no person shall “on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” This statutory requirement is bolstered by Department of Health and Human Services (HHS) regulations and HHS Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons — 2006 (PDF | 928 KB).

Assessing Needs and Developing an LEP Plan

HHS guidance requires recipients of federal funding to take reasonable steps to ensure LEP individuals have meaningful access to their programs and activities. This standard is designed to be a flexible and fact-dependent.

The starting point is an individualized assessment that balances the following factors:

  • The number or proportion of LEP individuals eligible to be served or likely to be encountered by the CCBHC
  • The frequency with which LEP individuals come in contact with the program
  • The nature of the program, activity, or service provided by the program and its importance to people's lives
  • The resources available to the CCBHC and costs

The needs assessment will play a large role in making these determinations. The HHS guidance also provides details on how to prepare and maintain an LEP plan.

How to Provide LEP Services

HHS guidance suggests that the following factors are considered:

  • Oral language services (interpretation), which may be provided by:
    • Bilingual staff
    • Staff interpreters
    • Contract interpreters
    • Telephone interpreter lines
    • Community volunteers and family members or friends, although these are considered undesirable options in a behavioral health context
  • Written language services (translation):
    • Written translations of vital documents for each eligible LEP language group that constitutes 5% or 1,000 individuals, whichever is less, of the population of persons eligible to be served or likely to be encountered; or
    • If 5% is less than 50 people, provide written notice in the primary language of the group of their right to receive competent oral interpretation of the materials, free of cost
  • The competency and confidentiality of interpreters

Technological advances might offer additional options.

Requirements From the Criteria

The Department of Health and Human Services (HHS) has developed criteria for CCBHC certification. Access the complete CCBHC certification criteria – 2016 (PDF | 755 KB).

The criteria include the following requirements related to consumers with LEP or low literacy:

Program Requirement: Staffing

  • 1.d.1. If the CCBHC serves people with LEP or with language-based disabilities, the CCBHC takes reasonable steps to provide meaningful access to their services.
  • 1.d.2. Interpretation/translation services are provided that are appropriate and timely for the size/needs of the LEP CCBHC consumer population (bilingual providers, on-site interpreters, language telephone line). To the extent interpreters are used, such translation service providers are trained to function in a medical and, preferably, a behavioral health setting.

Program Requirement: Availability and Accessibility of Services

  • 2.c.3. People who are served by the CCBHC are educated about crisis management services and Psychiatric Advance Directives and how to access crisis services,... at the time of the initial evaluation. This includes people with LEP or disabilities (CCBHC provides instructions on how to access services in the appropriate methods, languages, and literacy levels in accordance with program requirement 1).
  • 2.d.2. The CCBHC has a published sliding fee discount schedule(s). The sliding fee discount schedule is communicated in languages/formats appropriate for people seeking services who have LEP or disabilities.

Program Requirement: Scope of Services

  • 4.d.5. As part of certification, states will establish the requirements for comprehensive diagnostic and treatment planning evaluation evaluations. Factors that states should consider requiring include, among others: assessment of need for other services required by the statute (including LEP or linguistic services).

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