The Anderson Memorial Hospital, located in a large urban center, has a service area in which the largest population group is African American (75%) followed by Whites (20%). The population in the service area is predominantly low-moderate income with a higher-than-average unemployment rate.

The staff reflect the racial mix of the population. Most staff are monolingual English speakers with the exception of 10 nurses and a receptionist who speak Tagalog, one pharmacist who speaks Japanese, and janitorial staff who are mostly Spanish speakers. However, the service area is undergoing rapid demographic changes: The African American population is declining and being replaced by two Latino groups—individuals and families from Guatemala and El Salvador.

La Clinica del Pueblo is located in a small Southwestern town. La Clinica serves a population of migrant farm workers and their families (55% of the patient population) from nearby rural areas, most of whom are Spanish-speaking Mexican immigrants who work the migrant stream; a stable population of Native Americans who live off-reservation (25% of the patient population); and the remaining 20% of the patient population is white.

Canning and flower-growing industries are enabling a sizeable group of Mexican immigrants to settle permanently in the area. Dr. Ramirez, the medical director, who is an internal medicine physician, has seen a large increase in the number of the clinic’s patients with chronic lifestyle diseases, most notably diabetes. He and one physician assistant speak Spanish fluently. The other four physicians and one Native American nurse practitioner do not speak Spanish.

The state has decided to send all of its Medicaid patients into health management organizations (HMO). The Medicaid population is highly diverse, both linguistically and culturally. Many of the health management organizations have had little experience in providing services to limited English speakers. The state Department of Public Health has a contract with the State University to provide technical assistance in developing a new language access plan that they will recommend to the HMO plans.

The contract requires an assessment of state demographics and languages used, creation of standardized criteria for providing language services at various points of service, and cost projections for the provision of these services. How would you approach these tasks?

A federally qualified community health center, which provides dental and mental health services, has several sites serving urban and rural areas. Low-income white populations primarily reside in the rural counties compared to more culturally and linguistically diverse populations in the urban areas. Many languages other than English are spoken by the patient population, but none of these languages are spoken by more than 5% of the patient population.

The most predominant languages are Urdu, Persian, Somali, Korean, Vietnamese, Cantonese, and Spanish. One site has culturally diverse Spanish-speaking physicians and nurses, and one site has a clinical psychologist who is Korean American