267535 Does mandated threshold language assistance programming decrease the quality of care mental health agencies provide?

Tuesday, October 30, 2012

Sean McClellan, BA , Health Services and Policy Analysis program, UC Berkeley, Berkeley, CA
Lonnie Snowden, PhD , School of Public Health/Division of Health Policy and Management, University of California, Berkeley, Berkeley, CA
Background: Title VI of the 1964 Civil Rights Act prohibits federal funds recipients from providing care to limited English proficiency (LEP) persons more limited in scope or lower in quality than care provided to others. In 1999, the California Department of Mental Health implemented a “threshold language access policy” to meet its Title VI obligations. Under this policy, Medi-Cal agencies must provide language assistance programming in a non-English language where a county's Medical population contains either 3,000 residents or 5% speakers of that language. While language assistance programming improved the accessibility of care in some cases, the effect on the quality of that care is unknown.

Research Design: We examined the impact of threshold language policy-required language assistance programming on the quality of care provided to Spanish speakers having LEP, before and after county agencies implemented programming. We measured quality according to the number of new clients in each county receiving at least 3 follow-up visits within 90 days of their first contact with the system. Exploiting a time series with nonequivalent control group study design, we studied this using Poisson regression with fixed county effects to account for unobservables.

Results: Language assistance programming alone did not diminish the quality of care received by Spanish-speaking clients having LEP. However, the incidence of new clients receiving 3 follow-up visits within 90 days decreased significantly when private contractors implemented the programming (IRR=.739,p<.05).

Conclusions: Language assistance programs may have diminished the quality of care provided by county agencies when implemented by private contractors.

Learning Areas:
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe unexpected impacts of new policies.

Keywords: Mental Health, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD Student and health services researcher at the UC Berkeley School of Public Health, in my third year of the Health Services and Policy Analysis program. I am an author on two peer-reviewed publications, including one in press at the journal Medical Care, using the same data referred to in this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.