The Robert Wood Johnson Foundation established the National Program Office (NPO) for Hablamos Juntos, in late 2001. The goal of the program is to develop affordable models for health care providers to overcome language barriers and to develop the business case for language services. Using demonstration sites and a two-phase grant process (a planning phase and an implementation phase) 10 grantee organizations, in communities or catchment areas with new and fast-growing Latino populations, will develop and test systems of medical interpretation, signage, and print materials across multiple delivery points within the local healthcare systems.
During a press conference at the Washington Press Club, December 12, 2001, RWJF announced the formation of Hablamos Juntos along with survey results concluding that language barriers hinder access and delivery of quality health care to Latinos with limited English. Hablamos Juntos was created to invest ten million dollars in ten demonstration sites and to produce interventions that can be replicated by health organizations across the country.
The NPO sent out a call for Letters of Intent (LOI) in December 2001 for Hablamos Juntos, resulting in 178 responses by the February 1, 2002 deadline. Letters of Intent came from 40 states, the District of Columbia and the U.S. Virgin Islands. California providers responded enthusiastically to the program, with 24 providers submitting LOI’s, followed by New York (17), Texas (13), and Illinois (12). These LOI’s were carefully reviewed and evaluated by a panel of experts, the Hablamos Juntos National Advisory Committee (NAC).
On February 22, 2002, after much deliberation, 23 applicants were selected by the NAC and invited to submit full proposals for further consideration. Proposals were submitted by the April 26, 2002 deadline. NPO staff developed review criteria and a review tool and assigned the proposals to review committees comprised of National Advisory Committee (NAC) members, members of the Robert Wood Johnson Foundation, and NPO staff. Each proposal was assigned a primary and secondary NAC reader. Scores for the proposals were tallied and presented at the May meeting in Crystal City, VA. The goal of this meeting was to discuss the 23 proposal finalists and applicants for site visits. After two days of reviewing and discussing the proposals, NAC members were successful in recommending 15 applicants for site visits.
Site visits took place in the summer of 2002, with 8 site visits conducted in June and 7 conducted in July. Site visit review teams consisted of NPO and RWJF staff, and two NAC members. A member of the evaluation team from the RAND Corporation participated in 5 of the site visits. Applicants were oriented to the review process and prepared with review criteria prior to the visits to help them structure the site visit. A Site Visit Rating Sheet was developed to help the site review team evaluate the applicant during the site visit.
In August 2002, NAC members met in San Diego, CA to make recommendations on which applicants to fund as demonstration sites. Fifteen applicants were reviewed and discussed, with ten being recommended as Hablamos Juntos demonstration sites.
The planning year included several grantees meetings and three deliverables.
Getting Acquainted October 10-11, 2002
Grantees meet with NPO staff in Las Vegas, Nevada. This marks the first time that grantees meet each other, and the first time the NPO can officially congratulate grantees on their accomplishment.
Exploring the State of the Field January 8- 10, 2003
Meeting in Phoenix, AZ, grantees and the NPO explored the state of the field. The meeting focused on how health organizations are building language capacity (Testing & Training of interpreters) and developing written materials (Translation).
Developing Program Requirements March 5-7, 2003
In Miami, FL grantee explored a range of strategies and interventions to increase interpreter services and create replicable models that are affordable. Using small groups to share ideas and opportunities and brainstorming local implementation challenges, the meeting contributed to a set of program requirements that all demonstration sites would work to achieve. Special opportunities in the sites were also identified.
Draft Design Presentations April 24-24, 2003
Grantees and their executives, met in Chicago, IL to present draft proposals to a distinguished panel of experts to obtain feedback on their plans. A white paper on the potential of symbol usage in health care signage was also presented.
Resource and Needs Assessment
Grantees completed a Resource and Needs Assessment with four components: 1) develop a profile of the limited English proficiency (LEP) Latino population in the region, their health and language needs and determine how the demonstration program may best serve this population; 2) assess the language capacity of local healthcare providers and identify potential for improving and increasing this capacity; 3) identify synergistic opportunities that may exist with other community efforts to develop language services; and, 4) determine the future demand and trends for language services. The assessments in all demonstration sites informed planning activities and collectively helped the NPO better understand demonstration environments and offer grantee technical support.
Using a logic model, grantees developed demonstration model designs to: 1) clarify interventions that will be applied in the demonstrations; 2) ensure a manageable scope of work for implementation; and, 3) consider the long-term impact of the interventions in demonstration model catchment areas. The design documents articulated unique opportunities and challenges embedded in the demonstration environments. Draft plans were presented to a panel of stakeholders who offered suggestions and critiques.
Grantee sites were required to develop a Business Plan based on a 5-year planning horizon to demonstrate that interventions proposed were viable investments that will continue beyond the grant period. The goal of the Business Plan deliverable was to present an analysis of expected costs, cost savings and potential funding sources to sustain interventions selected.
Review of Implementation Proposals
Reverse Site Visit July 31, 2003 – August 1, 2003
The Reverse Site Visit was an opportunity for grantees to describe their proposed demonstration models and presented their rationale to the Hablamos Juntos National Advisory Committee. Through this process, the NAC then offered recommendations to the NPO and the Foundation. Proposed models were assessed on the potential for replication and financial sustainability, and whether presenters demonstrated strong commitment to systems change with implementation funding. Nine of ten sites were recommended for funding and in December 2003 the tenth site was approved.
The implementation phase has involved the following grantee meetings:
Language Services and Technology November 12-13, 2003
Grantees were asked to explore various ways of providing interpreter services and how technology could be applied to bridge the language gap through the many encounters that comprise a health care visit. Attendees heard panel presentations on developing local multilingual language banks and the potential of more cost effective models using technology such as 1) Telephone; 2) Video-Conferencing and 3) Hand Held Devices.
Language and Interpreter Skills Assessment, Scoring & Administration Workshop December 11-12, 2003
Two-day workshop helped to prepare grantees to administer and score the Language and Interpreting Skills Assessment tools in their demonstration sites. Participants received hands on practice and guidelines to score four assessment tools with language specific rating practice in Spanish from Claudia V. Angelelli, Ph.D., Assistant Professor, Department of Spanish & Portuguese, San Diego State University, the assessment tool designer and expert in Translation & Interpreting and Applied Linguistics. To learn more about the assessment tools see Language and Interpreter Skills Assessment.
Developing Useful Spanish Materials January 15, 2004
The meeting focused on the limitations of translations and criteria health organizations can use to make "make or buy" decisions related to the production of Spanish materials. Grantees heard presentations on the challenges presented by different types of text and the approaches needed to create useful Spanish materials. The results of the Gap Analysis were presented and ways for grantees to work collaboratively were discussed.
Health Care Interpreter Instructor Training April 12-16, 2004
Week long training held in Oakland, California offered to faculty in colleges and universities interested in partnering with Hablamos Juntos grantees to start college-level health care interpreter training program. The training exposed participants to the curriculum and design of the Health Care Interpreter Certificate Program offered by San Francisco City College. Gayle Tang, Director of Kaiser Permanente's National Linguistic and Cultural Programs developed the week long training specifically for Hablamos Juntos sites and Kaiser Permanente staff with the hope of replicating these program in Hablamos Juntos partnering educational institutions and Kaiser regions. Participants received Instructor's tools and templates to provide a solid foundation for course instruction. To learn more about the training programs being developed by the site see Educational Partners.