Title
Consider a preliminary analysis report in response to Board Referral No. 2025.06, seeking to design a pilot program at the Alisal Health Center in East Salinas to better meet the healthcare language needs of our Indigenous-language-speaking patients.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a preliminary analysis report in response to Board Referral No. 2025.06; and
b. Provide direction on a preferred referral processing option:
i. Proceed with completion of referral as outlined in preliminary report;
ii. Proceed with completion of referral based on modifications by Board;
iii. Return to Board with a more comprehensive analysis of referral and anticipated effort for completion; or
iv. Rescind referral.
c. Provide further direction, as appropriate.
PRELIMINARY ANALYSIS:
Background:
Board Referral No. 2025.06 was assigned on June 10, 2025 to the Health Department, to design a pilot program for the Alisal Health Clinic in East Salinas to better meet the healthcare and language needs of our Indigenous-language-speaking patients. The referral aims to create a pilot program for Alisal Health Center to include the following strategies: increase access to interpretation services by hiring Indigenous medical interpreters for appointments, while also recognizing the need for deeper system navigation and social support by employing community health workers to assist patients with completing forms, accessing resources, and addressing other barriers to care,, update the appointment system to flag whether a patient will need an indigenous interpreter for their appointment, provide cultural humility training for clinic staff on our Indigenous communities, and make available key patient information in Indigenous languages by mediums such as video or other digital outreach efforts, when possible, on matters, such as billing and coverage for medical expenses.
Project Description:
The Health Department is committed to health equity, linguistic justice, and culturally responsive care. The Department staff strive to serve the needs of all our clients, patients, and the general public, and that access to care is provided in a safe, respectful, and culturally affirming environment. Staff recognize the urgent need to improve language access and delivery of culturally appropriate services for our Indigenous communitiesCentro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO) and Natividad’s Interpretation Services Unit to identify strategies to implement and opportunities for collaboration.
Department staff recognize the unique challenges faced by the vast majority of CSB’s patients, especially those who speak Indigenous languages such as Mixteco, Triqui, Chatino or Zapotec, and who may have limited literacy in both English and Spanish. Staff are pleased to report the following commitments and actions taken so far:
• Data Analysis: A first look into our patient demographic data (primary language reporting) identifies a need to review our patient intake processes and staff training due to low number of patients self-reporting primary language as an Indigenous one. In 2024, the Alisal Health Center served a total of 11,062 patients, with the following language breakdown:
• 8,616 Spanish speakers (78%)
• 2,372 English speakers (21%)
• 25 Mixteco speakers
• 4 Chatino speakers
• Others (not specified)
• Assessment and Planning: A feasibility assessment for launching a pilot program to hire qualified Indigenous language interpreters and Indigenous community health workers is underway. The CSB Quality Improvement team developed a survey questionnaire which was distributed via text message to patients and families of Alisal Health Center. The text went out to 3,020 unique patient cell phone numbers. Below are the key findings from the119 survey responses:
o Primary Language Spoken at Home
§ 67% speak Spanish
§ 13% speak English
§ 17% speak Indigenous languages (High Mixtec, Low Mixtec, Zapotec, Triqui, Mam, Chatino)
o Communication Barriers
§ 16% report difficulty understanding medical staff due to their Indigenous language
§ 4% report difficulty due to other non-Indigenous languages
o Difficulty with Completing Forms
§ 39% find it somewhat or extremely difficult to complete clinic forms or surveys
o Interest in Interpreter Services
§ 44% said Indigenous language interpreters would be helpful
§ 20% said maybe
o Preferred Mode of Interpretation
§ 50% prefer in-person interpretation
§ 15% prefer phone
§ 8% prefer video
• Interpreter Flagging System: CSB staff are working with Health Information Technology and Electronic Health Records (EHR) team members to explore technical modifications that will allow us to flag Indigenous language interpretation needs during appointment scheduling and patient intake in the CSB’s EHR. Electronic health record patient entries will be updated to include preferred language and interpreter needs.
• Staff Training: Staff will be trained on strategies to employ to better identify Indigenous language needs and assure interpretation services are offered timely. Existing staff training curriculum will be modified to integrate cultural humility and Indigenous-focused modules i in collaboration with local Indigenous leaders and interpreters. Additionally, CSB will offer Qualified Interpreter Training, a 40-hour course, to Medical Assistants, who are the primary staff used by providers to interpret English to Spanish. Training to be provided by Natividad staff through a Memorandum of Understanding.
• Hire and Train Qualified Interpreters: Explore feasibility and sustainability to hire and train dedicated qualified interpreter/s, preferably Trilingual speakers (English, Spanish and an Indigenous language) to serve as in-house Indigenous Interpreters at Alisal Health Center. Staff are also exploring contracting for additional access to Qualified Medical Interpreters for Indigenous languages.
• Multi-lingual Patient Education: Provide oral assistance and pictorial/simplified versions of documents. Include language preference in After Visit Summaries (AVS). We recognize the importance of providing information in Indigenous languages, especially regarding essential topics like billing, medical coverage, and access to services. We will investigate the feasibility of creating video or other digital (digital flyers, audio messages, social media reels, etc.) materials in key Indigenous languages to ensure that all members of our community can understand and navigate the County’s healthcare system.
Next Steps
• CSB staff will present preliminary findings and proposed pilot program to CSB’s Community Health Center Board for input and direction. Staff will also identify funding sources and/or partnerships to support full implementation of pilot program.
Estimated Project Cost:
Staffing Level Estimate:
Additional information needs to be gathered to better understand the direct and indirect additional staffing required for this pilot program. The Health Department anticipates having an estimate of additional staffing needs by the end of August 2025.
Departmental Challenges:
Due to current budgetary constraints, staff anticipate there may be some challenges in timely implementing the Indigenous Language Interpretation Pilot Project. However, the CSB recently implemented an additional revenue-generating strategy aimed at increasing the Medi-Cal reimbursement rate from the Department of Health Care Services (DHCS). Upon approval and realization of these enhanced reimbursements, the Health Department will evaluate the feasibility of adding additional staffing and resources to support the successful implementation of the proposed pilot program.
Proposed Response Date:
County staff will provide an updated response to this referral in September of 2025.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
This recommendation advances the Board of Supervisors’ Health and Human Services Strategic Initiative and supports these key objectives: Reduce regional, socio-economic inequities in health outcomes; and improve health outcomes through health and wellness promotion and access to top-quality healthcare.
Mark a check to the related Board of Supervisors Strategic Initiatives:
__ Economic Development
__ Administration
X Health & Human Services
__ Infrastructure
__ Public Safety
Prepared by: Prashant Shinde, MHA, Bureau Chief, Clinic Services Bureau, 755-4526
Approved by: Debbie Paolinelli, Assistant County Administrative Officer, 755-5309
Attachments:
Preliminary Analysis Report
Board Referral No. # 2025.06