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The concept of limited English proficiency (LEP) presents significant challenges when applied to the healthcare needs of the diverse and growing multilingual population in the U.S. We expound on the following ways in which the concept of LEP is problematic: the ethnocentric notion of a “primary language,” the ambiguous idea of “limited ability,” and the deficit-oriented construct of “language assistance.” We provide examples that illustrate the negative healthcare impact of LEP terminology, including the unaccounted-for complexities of health communication within the concept of “primary language,” the “limited abilities” of health professionals whose language skills are often unassessed, and the ignored role of “language assistance” resources such as interpreters as essential collaborators. Finally, we propose rethinking LEP by (a) reframing patient language using the term non-English language preference and (b) assessing health professional non-English language skills. These actionable strategies have the potential to improve language-appropriate healthcare for diverse populations.

Learning and developing as a reader are more complicated in a language the reader is simultaneously learning to speak and understand. This challenge is faced by millions of English learners (ELs) who are in all-English programs and must therefore learn to read, write, and develop as readers and writers while learning and becoming proficient in English. The author summarizes what is known about teaching ELs beginning and more advanced reading skills, all in English, as they progress through school. Drawing on classroom studies, interventions, and neurolinguistic research, the author focuses on how learning to read in a second language is similar to learning to read in a first language and what differences might exist. These differences, not surprisingly, have to do with ELs’limited English proficiency. The author’s intent is to begin with the knowledge base of the science of reading, build onto it research on effective literacy instruction for ELs, and then begin articulating what could become a science of reading instruction for students who are learning and progressing as readers in English while learning to speak and understand it. Promoting higher levels of literacy for ELs will require teachers to use what is currently known about effective practices in literacy instruction for students in general and, in addition, help ELs achieve higher levels of English language proficiency. Both English literacy and English oral language proficiency must be priorities if these students are to have adequate and equitable opportunities for success in school and beyond.

Individuals with limited English proficiency (LEP) face barriers to safe and high-quality health care. ‘Patient-experience’ is increasingly viewed as an important component of health care quality. However, the impact of language proficiency on ‘patient-experience’ is not well-described. This scoping review mapped the literature on the patient experience of individuals with LEP. We reviewed sixty qualitative and mixed-methods studies from EMBASE and MEDLINE published between 2007 and 2017. We identified four major themes: (1) Communication, language barriers, and health literacy, (2) Relationships with health care professionals, (3) Discrimination and intersection with other dimensions of identity, and (4) Cultural safety. We also identified factors that may improve LEP patient experience, including: mitigating language barriers through interpretation or language-concordant providers, offering translated patient resources, and educating health care professionals about cultural safety.

ObjectivesThe NHS is committed to providing high quality, equitable, effective healthcare services that are responsive to all patients’ needs.1 Audit aim: Assess adherence to offering interpretation services to non-English-speaking patients and carers during hospital admission.Focus: Investigate if patients on paediatric wards at St George's Hospital without English as their first language receive interpretation services and their frequency.Additionally, explore alternative communication methods if interpretation services are not used.MethodsA comprehensive audit was conducted to assess language support for non-English-speaking patients and carers during hospital admissions.Random audit days were selected between June and August 2023, surveyed patients/carers, and reviewed medical notes.Patients/carers were asked to rate their confidence in using English.Interpretation service effectiveness were evaluated and improvement areas were identified as part of the method.ResultsOut of the 142 inpatients surveyed, 32 patients were identified as having English as their non-primary language (see figure 1)Among the 32 patients for whom English was not their primary language, 12 individuals reported a confidence rating in using English of 3 or lower out of 5.40% used family member or a family friend or the child himself (see figure 3)17% used a medical staff who speaks the same language (see figure 3)The remaining participant were satisfied with understanding the general gist of the conversation (see figure 3)Abstract 6111 Figure 1Abstract 6111 Figure 2ConclusionThe audit reveals a gap in the utilization of interpretation services during hospital admissions in paediatric ward in SGH for patients and carers with limited English proficiency (see figure 2)Using a family member, a friend, or a staff member for interpretation was not the most suitable approach. This is because, in the first two scenarios, patient confidentiality was at risk, and relying on non-professional interpreters posed challenges, as their understanding and interpretation skills could not be reliably assessed. Relying on a staff member is not a sustainable solution as it does not offer consistency or continuity.1–3 ReferencesGuidance for commissioners: Interpreting and Translation Services in Primary Care, NHS England/Primary Care Commissioning, September.Language interpreting and translation: migrant health guide, Office for Health Improvement and Disparities, 23 June 2017.Interpreting, communication support and translation national policy, Public Health Scotland, 22 October 2020.

The present study examined the extent to which limited English proficiency (LEP) poses a risk to health service use in Asian Americans. With data drawn from the 2015 Asian American Quality of Life Survey (N = 2594), logistic regression was used to model the odds for four outcomes (no usual place for care, no regular check-up, unmet needs for medical care, and communication problems in healthcare settings). More than 62% of the sample had LEP. In the group with LEP, the odds of not having usual place for care increased by 2.09 times, of not having regular check-up by 1.69 times, of having unmet needs for medical care by 1.89 times, and of having communication problems in healthcare settings by 4.95 times. The findings highlight the vulnerabilities of Asian Americans with LEP in health service use and provide implications for health planning and interventions.

This study used a video prompting intervention to overcome language barriers between English-speaking trainers and Spanish-speaking immigrant parents of children with autism. Parents were taught instructional skills targeting independent dressing. A multiple baseline design across three families and a replication using an alternating treatments design with a fourth family were used to evaluate the effects of the intervention. All mothers reached mastery criterion and generalization of instructional skills was observed for three mothers, with treatment gains maintaining during follow-up. Improvement in independent dressing skills was observed for four children. Findings suggest that video prompting can be used to teach immigrant parents of children with autism who have limited English proficiency when there is a language mismatch between parents and trainers.

In this study, we aimed to investigate healthcare access and utilization among patients with limited English proficiency (LEP). We analyzed aggregated data from the 2018 California Health Interview Survey, a large population-based survey. Survey weighted univariate and multivariable logistic regression analyses were conducted. A total of 21,177 participants were included with 8.2% having LEP. Compared to participants with proficient English, LEP participants were less likely to have a usual place to go to when sick other than the ER or have a preventive care visit in the past year after adjusting for sociodemographic characteristics. However, LEP participants were also less likely to need to see a medical specialist and less likely to delay necessary medical care compared to English proficient participants. While patients with LEP were less likely to have access to preventative care, they were also less likely to delay necessary care.

ObjectivesFor families with limited English proficiency (LEP), language barriers impact on patient care.1 2 One US study found children whose families had LEP and with no access to an interpreter had a 2.1 higher odds of adverse events than children of parents who expressed comfort with English.3 Birmingham is a superdiverse city, with 51% of the population from minority ethnic backgrounds.4 We describe the provision of interpreting services in our children’s emergency department (ED).MethodsAnonymised, aggregate data on number of voice and video calls by language through the DORA interpreting system (delivered via a tablet device, introduced January 2021). Description of our ED Runner service. This study was deemed a service evaluation.ResultsFrom January 2021 to July 2023, staff made 2,631 calls – 22% via video and 78% via audio link. The service translated 49 different languages – top three were Arabic, Romanian and Urdu (see table 1), with 2.7% of patients needing the DORA service. This figure is likely higher with staff using own language skills and software such as Google translate.Abstract 6312 Table 1Top 10 languages accessed using online DORA interpreting service, January 2021-July 2023 (total calls = 2,631)Average call was 15.3 minutes (£0.63/minute for audio and £0.99/minute for audio – average cost for audio call, £9.64). Monthly usage slipped at our busiest time (Nov- Dec 2022, see figure 1), possibly due to availability (we have one tablet) and clinician headspace to use this (anomaly in the data for March 2023).Abstract 6312 Figure 1Monthly calls made using the DORA interpreter service from Emergency Department against attendances (in ‘ODs) Birmingham Children s HospitalED Runners, who started in October 2021, work twilight shifts in the ED seven days a week and aid with interpreting, explain waiting times, provide drinks/activities and signpost/escort families across the hospital. Feedback has been overwhelmingly positive (see figure 2).Abstract 6312 Figure 2Family feedback for the ED runner teamConclusionAddressing language barriers in the ED is vital to ensure good outcomes for families with LEP. We plan to implement screening for LEP to improve their ED journey.ReferencesFlores G. Language barriers and hospitalized children: are we overlooking the most important risk factor for adverse events? JAMA Pediatr. 2020 Dec 1;174(12):e203238. doi: 10.1001/jamapediatrics.2020.3238.Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS. Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review. Acad Pediatr. 2014 Mar-Apr;14(2):128–36. doi: 10.1016/j.acap.2013.10.003.Khan A, Yin HS, Brach C, et al. Association between parent comfort with English and adverse events among hospitalized children. JAMA Pediatr. 2020;174(12):e203215. doi:10.1001/jamapediatrics.2020.3215.Vinter R. ‘Diversity is a beautiful thing’: the view from Leicester and Birmingham. The Guardian, 29th November 2022.

Background and ObjectivesThe Neurodevelopmental Assessment Clinic (NAC) at Great Ormond Street Hospital (GOSH) recommends websites regarding Autism Spectrum Disorder (ASD) to caregivers of autistic children and young people. Since most information is only available in English, it is inaccessible to ethnic minority caregivers with limited English proficiency (LEP). This barrier makes it difficult for these families to make well-informed decisions about ASD management, contributing to health inequalities. This novel quality improvement project conducted with the NAC aims to reduce inequities in ASD information access. Bengali caregivers with LEP were targeted first.MethodsThe NAC’s recommended websites were audited to assess their accessibility for LEP individuals. A Plan-Do-Study-Act (PDSA) cycle was then conducted. A provisional written Bengali resource about ASD was developed by translating pre-existing information from GOSH and hyperlinking external sources. To evaluate the resource, a quasi-experimental study design was used where Bengali-proficient individuals without LEP completed a questionnaire.ResultsNAC’s recommendations consistently underperformed the standard for LEP users. The GOSH website had the worst performance (score=0). The provisional resource was evaluated by 30 participants. Non-parametric analysis confirmed that post-test scores, which reflected ASD understanding after reading the resource, were significantly higher than pre-test scores (p<0.001). These were not significantly affected by an individual’s existing ASD understanding, Bengali reading ability or Bengali education level. 17 participants provided qualitative feedback. Thematic analysis revealed limitations in language (35.3%) and positive feedback (29.4% ) were most commonly reported.ConclusionInitially NAC’s recommendations were inaccessible for LEP users. While this Bengali resource is useful, it remains inaccessible for some Bengali caregivers with LEP. Therefore, where possible, NAC must determine whether the informational needs of users can be met before recommending this resource. Further PDSA cycles should be used to improve the resource. Further research regarding resources for LEP users with end-user involvement is recommended.

The COVID-19 pandemic has been an unprecedented disruption in students’ academic development. Using reading test scores from 5 million U.S. students in grades 3–8, we tracked changes in achievement across the first two years of the pandemic. Average fall 2021 reading test scores in grades 3–8 were .09 to .17 standard deviations lower relative to same-grade peers in fall 2019, with the largest impacts in grades 3–5. Students of color attending high-poverty elementary schools saw the largest test score declines in reading. Our results suggest that many upper elementary students are at-risk for reading difficulties and will need targeted supports to build and strengthen foundational reading skills.