title vi of the civil rights act of 1964

NCDHHS Office of the NCDHHS Office of the SecretarySecretary

Title VI of the Civil Rights Act Title VI of the Civil Rights Act of 1964of 1964

Limited English Proficiency (LEP)Limited English Proficiency (LEP)


What is Title VIWhat is Title VI Title VI is part of the Civil Rights Act of 1964, as Title VI is part of the Civil Rights Act of 1964, as

amended, and its implementing regulations amended, and its implementing regulations provide that no person shall be subject to provide that no person shall be subject to discrimination on the basis of race, color or discrimination on the basis of race, color or national origin under any program or activity that national origin under any program or activity that receives Federal financial assistance.receives Federal financial assistance.

For our purposes, “national origin” equates to For our purposes, “national origin” equates to individuals who have a limited proficiency with the individuals who have a limited proficiency with the English language and their primary language is English language and their primary language is not English, hence the term “limited English not English, hence the term “limited English proficiency” or LEP.proficiency” or LEP.


To whom does Title VI apply?To whom does Title VI apply? This applies to on any organization (North Carolina This applies to on any organization (North Carolina

Department of Health and Human Services (DHHS) all Department of Health and Human Services (DHHS) all county social services, health departments, and area county social services, health departments, and area mental health agencies, etc.) or individual that receives mental health agencies, etc.) or individual that receives Federal financial assistance, either directly or indirectly Federal financial assistance, either directly or indirectly through a grant, contract or subcontract; is covered by Title through a grant, contract or subcontract; is covered by Title VI.VI.

Examples of other coverage include hospitals, nursing Examples of other coverage include hospitals, nursing homes, home health agencies, HMO’s, health service homes, home health agencies, HMO’s, health service providers and human services agencies.providers and human services agencies.

All organizations or individuals that are recipients of these All organizations or individuals that are recipients of these funds from HHS (federal agency) have an obligation to funds from HHS (federal agency) have an obligation to ensure that LEP individuals have a meaningful and equal ensure that LEP individuals have a meaningful and equal access to benefits and services.access to benefits and services.


Compliance with language access Compliance with language access requirementrequirement

The key to ensuring meaningful access for LEP The key to ensuring meaningful access for LEP persons is effective persons is effective communicationcommunication. An . An agency or provider can ensure effective agency or provider can ensure effective communication by developing and implementing a communication by developing and implementing a comprehensive comprehensive written language assistancewritten language assistance program that includes policies and procedures for program that includes policies and procedures for identifying and assessing the language needs of identifying and assessing the language needs of it’s LEP applicants/clients and that provides for a it’s LEP applicants/clients and that provides for a range of range of oral language assistanceoral language assistance, periodic , periodic training of staff, monitoring of the program and in training of staff, monitoring of the program and in certain circumstances, the translation of written certain circumstances, the translation of written materials.materials.


Options for providing oral language Options for providing oral language assistanceassistance

Hiring bilingual staff with expertise in the specific Hiring bilingual staff with expertise in the specific area for patients and client is the most desired area for patients and client is the most desired option.option.

Using bilingual staff from within the agency.Using bilingual staff from within the agency. Contracting for interpreter services.Contracting for interpreter services. Engaging community volunteers who are Engaging community volunteers who are

competent.competent. Contracting with a telephone interpreter service is Contracting with a telephone interpreter service is

the least desired option and most expensive.the least desired option and most expensive.


Translation of written documentsTranslation of written documents The necessity to translate written documentation The necessity to translate written documentation

will vary depending on several factors including will vary depending on several factors including the size of the population(s) being served and the the size of the population(s) being served and the size of the agency or provider.size of the agency or provider.

All state-generated documents are being All state-generated documents are being translated by DHHS.translated by DHHS.

Even when the population does dictate translation Even when the population does dictate translation of written documents, the provider must still of written documents, the provider must still provide oral interpretation of the written provide oral interpretation of the written document(s).document(s).


Where does the money come from Where does the money come from to satisfy the obligation?to satisfy the obligation?

Local agency budgets for interpreters and some Local agency budgets for interpreters and some written documents that are not state generated.written documents that are not state generated.

Title VI has been referred to on several occasions Title VI has been referred to on several occasions as an as an “unfunded mandate”.“unfunded mandate”. This is incorrect. This is incorrect. It is a civil right and therefore needs no funding. It is a civil right and therefore needs no funding.

This is an obligation placed upon an agency in This is an obligation placed upon an agency in exchange for federal funding (see all compliance exchange for federal funding (see all compliance agreements between the federal/state and local agreements between the federal/state and local agencies. agencies.


How do you determine the extent of your How do you determine the extent of your Title VI obligations Title VI obligations

(Four Factor Analysis)(Four Factor Analysis) The number or proportion of LEP individuals The number or proportion of LEP individuals

served or encountered in the eligible service served or encountered in the eligible service population.population.

The frequency with which LEP individuals The frequency with which LEP individuals come in contact with your program, activity come in contact with your program, activity or service.or service.

The nature and importance of the program, The nature and importance of the program, activity, or service.activity, or service.

Available resources and cost.Available resources and cost.


Factor OneFactor One

The number of proportion of LEP individuals The number of proportion of LEP individuals served or encountered in the eligible service served or encountered in the eligible service population.population.

Potential sources of data may include:Potential sources of data may include: - encounter data- encounter data - Data from Census, school systems, - Data from Census, school systems,

community agencies and data from client community agencies and data from client files.files.


Factor One continued…Factor One continued…

Also consider:Also consider:- Does the program serve minors whose - Does the program serve minors whose

parents/guardians are LEP?parents/guardians are LEP?- Are there populations who may be - Are there populations who may be

underserved because of language barriers?underserved because of language barriers?


Factor TwoFactor Two

The frequency with which LEP individuals The frequency with which LEP individuals come in contact with your program, activity come in contact with your program, activity or service.or service.

-How often is a particular language -How often is a particular language encountered?encountered?


Factor ThreeFactor Three

The nature and importance of the The nature and importance of the program, activity, or serviceprogram, activity, or service..

- How important is the recipient’s activity, - How important is the recipient’s activity, information, service or program?information, service or program?

- What are the possible consequences if effective - What are the possible consequences if effective communication is not achieved?communication is not achieved?

- Could denial or delay of access to services or - Could denial or delay of access to services or information have serious life threatening information have serious life threatening implications? implications?


Factor FourFactor Four

Available resources and costsAvailable resources and costs - What are the reasonable costs of providing - What are the reasonable costs of providing

language assistance services?language assistance services? - What resources are available?- What resources are available?


Applying the Four FactorsApplying the Four Factors

- Will be based on what is both necessary - Will be based on what is both necessary and reasonable in light of the four-factor and reasonable in light of the four-factor analysis.analysis.


DHHS AssistanceDHHS Assistance Formerly a Formerly a work groupwork group comprised of representatives from all divisions within comprised of representatives from all divisions within

the Department determined how best to use department resources to benefit the Department determined how best to use department resources to benefit the department and county agencies was established by departmental directive the department and county agencies was established by departmental directive in 2007 which will be revised in 2009. The future group will consist of in 2007 which will be revised in 2009. The future group will consist of advocates, state employees and non-profit representatives.advocates, state employees and non-profit representatives.

Title VI enforcement is through the Office of the Secretary. Currently under Title VI enforcement is through the Office of the Secretary. Currently under development is a standard monitoring and reporting system for state-wide use. development is a standard monitoring and reporting system for state-wide use. A standard complaint form for Spanish/English has been developed.A standard complaint form for Spanish/English has been developed.

A “glossary of terms” has been developed to ensure accuracy in translations. A “glossary of terms” has been developed to ensure accuracy in translations. This is accessible through the DHHS and Citizen Services websites.This is accessible through the DHHS and Citizen Services websites.

A translation contract has been developed, which will provide a list of A translation contract has been developed, which will provide a list of contractors that are approved by the department.contractors that are approved by the department.

A A model local planmodel local plan has been developed to assist the local agencies in has been developed to assist the local agencies in developing plan in full compliance with Title VI.developing plan in full compliance with Title VI.

A Title VI section is on the DHHS Citizen’s Services web page, as well as the A Title VI section is on the DHHS Citizen’s Services web page, as well as the Division of Social Services web page. In the near future, a Civil Rights web Division of Social Services web page. In the near future, a Civil Rights web page will have a link from the Departments main web page.page will have a link from the Departments main web page.


Continued…Continued… All the Divisions are in the process of translating written documents (vital All the Divisions are in the process of translating written documents (vital

documents, critical forms, etc.) at present only into Spanish, which is the documents, critical forms, etc.) at present only into Spanish, which is the largest LEP population. largest LEP population.

Language preference has been added to the reporting system for all DHHS Language preference has been added to the reporting system for all DHHS generated documents. A total of 25 language preferences have been listed in generated documents. A total of 25 language preferences have been listed in the race, ethnicity and language R/E/L project administered by the DHHS the race, ethnicity and language R/E/L project administered by the DHHS Division of Information Resource Management (DIRM).Division of Information Resource Management (DIRM).

A “certification” process for interpreters is currently being explored by the A “certification” process for interpreters is currently being explored by the Department in conjunction with the Center on New North Carolinians at UNC-Department in conjunction with the Center on New North Carolinians at UNC-Greensboro.Greensboro.

The department has contracted with Telelanguage, Inc. of Portland, Ore. to The department has contracted with Telelanguage, Inc. of Portland, Ore. to provide a department-wide language line at a low rate that is also available to provide a department-wide language line at a low rate that is also available to the local agencies at the same low rate of $ .95/per minute.the local agencies at the same low rate of $ .95/per minute.

Also the department is also considering a sole source contract for translation of Also the department is also considering a sole source contract for translation of all vital documents for the department’s divisions/institutions/schools.all vital documents for the department’s divisions/institutions/schools.

Assistance in the training of management teams in Title VI requirements.Assistance in the training of management teams in Title VI requirements. Assistance in developing partnerships with local advocates and legal services Assistance in developing partnerships with local advocates and legal services

organizations.organizations. Assistance in developing standard contract language for independent Assistance in developing standard contract language for independent

contractors.contractors.


Discrimination? Discrimination? Differences in services from the general or Differences in services from the general or

traditional population.traditional population. Differences in program benefits from the general Differences in program benefits from the general

or traditional population.or traditional population. Differences in treatment in obtaining services than Differences in treatment in obtaining services than

the general or traditional population.the general or traditional population. Intentional lack of information/communicationIntentional lack of information/communication Barriers or delays in participation which differ from Barriers or delays in participation which differ from

the general or traditional population.the general or traditional population. Lack of accommodations.Lack of accommodations.


Is it necessary to have Is it necessary to have interpreters present at times?interpreters present at times?

When interpretation is needed and is reasonable, When interpretation is needed and is reasonable, it should be provided in a timely manner. To be it should be provided in a timely manner. To be meaningfully effective, language assistance meaningfully effective, language assistance should be timely. While there is no single definition should be timely. While there is no single definition for "timely" applicable to all types of interactions at for "timely" applicable to all types of interactions at all times by all types of recipients, one clear guide all times by all types of recipients, one clear guide is that the language assistance should be provided is that the language assistance should be provided at a time and place that avoids the effective denial at a time and place that avoids the effective denial of the service, benefit, or right at issue or the of the service, benefit, or right at issue or the imposition of an undue burden on or delay of imposition of an undue burden on or delay of important rights, benefits, or services to the LEP important rights, benefits, or services to the LEP person.person.


What happens when LEP individuals insist What happens when LEP individuals insist upon using their own interpreter and upon using their own interpreter and refuses the services of the “free of refuses the services of the “free of

charge” interpreter?charge” interpreter?

Explain to the LEP individual (through your Explain to the LEP individual (through your interpreter) that they have a right to a “free of interpreter) that they have a right to a “free of charge” interpreter. Explain the complications of charge” interpreter. Explain the complications of interpreting and if they refuse, they have a right to interpreting and if they refuse, they have a right to use their own (minus children). Be sure to use their own (minus children). Be sure to document this action for liability and compliance document this action for liability and compliance purposes.purposes.


What is a vital document?What is a vital document? Whether or not a document (or the information it contains or solicits) is Whether or not a document (or the information it contains or solicits) is

"vital" may depend upon the importance of the program, information, "vital" may depend upon the importance of the program, information, encounter, or service involved, and the consequence to the LEP encounter, or service involved, and the consequence to the LEP person if the information in question is not provided accurately or in a person if the information in question is not provided accurately or in a timely manner. Where appropriate, recipients are encouraged to create timely manner. Where appropriate, recipients are encouraged to create a plan for consistently determining, over time and across their various a plan for consistently determining, over time and across their various activities, what documents are "vital" to the meaningful access of the activities, what documents are "vital" to the meaningful access of the LEP populations they serve. Thus, vital documents could include, for LEP populations they serve. Thus, vital documents could include, for instance, consent and complaint forms, intake forms with potential for instance, consent and complaint forms, intake forms with potential for important health consequences, written notices of eligibility criteria, important health consequences, written notices of eligibility criteria, rights, denial, loss, or decreases in benefits or services, actions rights, denial, loss, or decreases in benefits or services, actions affecting parental custody or child support, and other hearings, notices affecting parental custody or child support, and other hearings, notices advising LEP persons of free language assistance, written tests that do advising LEP persons of free language assistance, written tests that do not assess English language competency, but test competency for a not assess English language competency, but test competency for a particular license, job or skill for which knowing English is not required, particular license, job or skill for which knowing English is not required, or applications to participate in a recipient's program or activity or to or applications to participate in a recipient's program or activity or to receive recipient benefits or services. receive recipient benefits or services.


Does this apply to the private Does this apply to the private sector?sector?

All recipients of USDHHS and Federal financial assistance All recipients of USDHHS and Federal financial assistance channeled by the NCDHHS either directly or indirectly, channeled by the NCDHHS either directly or indirectly, through a grant, contract or subcontract are covered.through a grant, contract or subcontract are covered.

Common types of Federal assistance can be defined as Common types of Federal assistance can be defined as loans, grants, grants and loans of federal property, use of loans, grants, grants and loans of federal property, use of equipment and donation of surplus property, training and equipment and donation of surplus property, training and any other agreement or contract to provide assistance.any other agreement or contract to provide assistance.

Examples of common recipients may be hospitals, home Examples of common recipients may be hospitals, home health care agencies, managed care organizations, health care agencies, managed care organizations, universities and other health or social service research universities and other health or social service research programs.programs.

Physicians and other providers (especially, clinics) who Physicians and other providers (especially, clinics) who receive federal financial assistance (Medicaid and receive federal financial assistance (Medicaid and Medicare).Medicare).


What is the “real” penalty for non-What is the “real” penalty for non-compliance with Title VI?compliance with Title VI?

Loss of federal fundsLoss of federal funds Loss of future federal and state fundingLoss of future federal and state funding Subject to legal actions from the NCDHHS, legal Subject to legal actions from the NCDHHS, legal

services organizations and private individuals.services organizations and private individuals. Possible “Informed Consent” issues which could Possible “Informed Consent” issues which could

lead to medical malpractice charges for both the lead to medical malpractice charges for both the public and private sector.public and private sector.

The U.S. Dept. of Justice or the Office for Civil The U.S. Dept. of Justice or the Office for Civil Rights still have the authority to investigate claims Rights still have the authority to investigate claims of discrimination.of discrimination.


NCDHHS Title VI contact informationNCDHHS Title VI contact information

M. Terry HodgesM. Terry HodgesCompliance AttorneyCompliance AttorneyNCDHHS Office of the SecretaryNCDHHS Office of the Secretary2001 Mail Service Center2001 Mail Service CenterRaleigh, North Carolina 27699-2001Raleigh, North Carolina 27699-2001(919) 715-7449 Fax (919) 715-4645(919) 715-7449 Fax (919) 715-4645E-mail: [email protected]: [email protected]

title vi of the civil rights act of 1964

Documents

english language

language needs

written documentation

primary language

interpreter services

lep individuals

human services agencies

hhs federal agency