Language_Services_Guide_2014

services
better practice in victorian health services
and local government
language
A guide for service providers and organisations

acknowledgements
acknowledgements
reference group
Abbey Howe, Policy Coordination and Projects, Department of Health
Chris Hazelman, Manager, Ethnic Council of Shepparton and District
Dean Wickham, Executive Officer, Sunraysia Mallee Ethnic Communities Council
Jessie Lees, Manager, Access and Engagement, Western Region Health Centre (now cohealth)
Karella De Jongh, Chief Interpreter, St Vincent’s Health
Leah Bramhill, Senior Policy Officer, Office of Multicultural Affairs and Citizenship
Fortunata Maria Callipari, Multicultural Officer, City of Whittlesea
Michal Morris, General Manager, Centre for Culture, Ethnicity and Health
CEH thanks Reference Group members for their contribution to this publication and for their
commitment to improving the provision of language services in Victoria.
CEH project workers
Libby Matheson, Project Officer (until April 2013)
Seona Powell, Manager, Health Sector Development (until May 2013)
Spase Veljanovski, Project Officer
centre for culture, ethnicity and health
23 Lennox Street
Richmond VIC 3121
03 9418 9929
enquiries@ceh.org.au
www.ceh.org.au
Copyright © 2014 Centre for Culture Ethnicity & Health. All rights reserved.
North Richmond Community Health Limited. ABN: 21 820 901 634
CEH acknowledges the support of the victorian government

contents
contents
4 introduction
purpose of the guide
language services
methodology
6 considerations for better practice
in language services provision
9 case studies of better practice
10 partnering with refugee communities
12 a new survey tool delivers positive changes
14 an interpreter for every patient who needs one
16 making better use of bilingual staff
18 building organisational cultural competence
20 ‘talking book’ explains immunisation in 13 languages
22 a better start for children from migrant and refugee families
24 three steps to better translations
26 embedding an interpreter with local aged and disability services
28 a strong consumer focus improves translations
30 further information and resources

4
centre for culture, ethnicity & health
2011 Census reveals that 1.23 million
Victorians spoke 260 languages other
than English at home.
1.23
260
million victorians
languages
introduction
In 2005, the Centre for Culture Ethnicity and Health (CEH) published,
Language Services: Good Practice in the Victorian Health and Community
Sector to encourage and support organisations to improve their provision
of language services.
Almost a decade has passed since CEH released this
publication and an update with new examples of
language service initiatives is timely and necessary.
With Victoria becoming a more linguistically diverse
State, the need for such a guide is greater than ever.
The 2011 Census reveals that 1.23 million Victorians
speak 260 languages other than English at home.
This represents 23.1% of all Victorians, compared
with 20.4% in the last census in 2006.
Moreover, 212,651 Victorians who speak another language
report difficulty with speaking English. This represents
4% of all Victorians, but that is likely to be a conservative
figure as more than 240,000 Victorians did not respond
to the census question: ‘How well does the person speak
English?’ For these Victorians with limited English
proficiency, some form of language service is required
to support them in engaging successfully with service
providers, particularly in situations that demand more
complex communications or an understanding of
technical or specialised terms and concepts.
purpose of this guide
The Guide aims to inspire and encourage all agencies,
no matter how established or confident they are in their
practices, to aim for continuous improvement in their
provision of language services. It includes considerations
for good practice and examples from service providers
across Victoria. These examples, in the form of case
studies, also function as ‘how to’ guides - enabling
agencies to consider how they could implement these
or similar practices in their organisations.
The purpose of this Guide is to assist individual service
providers and organisations to reflect on their own
delivery of language services and to consider new ideas,
different approaches and better ways of providing
these services.
The Guide is aimed at service providers working in the
health, local government and community services sectors
in Victoria in rural, regional and metropolitan settings.
The emphasis on ‘better’ practice acknowledges that
service providers in these sectors vary in the progress
they have made in providing language services to their
communities. Ultimately, the Guide aims to support the
improved provision of language services to enable better
communication between service providers and people
with limited English proficiency.

5
introduction
language services
For the purposes of this Guide, language services include:
■■ Qualified interpreters - interpreters with an accreditation
or recognition credential from NAATI (National
Accreditation Authority for Translators and Interpreters)
■■ Translations undertaken by qualified translators
■■ Bilingual staff – employees who agree to communicate
with clients in a language other than English and are
not employed as qualified interpreters.
methodology
CEH prepared an invitation to submit examples of better
practice in language services, accompanied by a cover
letter and a template for completion. The invitation
was sent by email to 200 individuals and organisations
identified as likely to provide feedback or referral. The
same information was disseminated through the CEH
e-newsletter. Flyers were distributed at events in which
CEH participated. The invitation was also circulated
through CEH’s networks and by the project’s Reference
Group members.
Only basic information was requested in initial submissions,
with examples that met the criteria followed up by CEH. The
criteria were drawn from a literature review and decided
in consultation with the Reference Group. Submitters
were asked if their language initiative demonstrated
one or more of the following elements:
■■ A whole of organisation approach
■■ Client or community participation in service planning
and evaluation
■■ Evidence of the effectiveness of the service
■■ Evidence and mechanisms for continuous improvement
■■ Evidence of ongoing staff development and support.
Once examples were submitted, the project officer made
further enquiries with the nominated contact person.
If approved by the Reference Group, the project officer –
in consultation with the contact person – developed the
case studies as they appear in this Guide.

6
considerations for
better practice
in language
services provision
Since the first Guide was released in 2005, the landscape in which language
services are delivered has changed. There has been a move towards client and
community participation in service planning and evaluation, and new thinking
has emerged on cultural competence and health literacy when delivering a
quality service to clients, particularly those with limited English proficiency.

7
considerations for better practice in language services provision
In 2006, the Department of Health released Doing it with
us not for us: Participation policy 2006-09. Reflecting the
Victorian Government’s commitment to involving people
in decision making about their health care services, the
policy promotes participation by consumers, carers and
communities in the public health system. Demonstration
of client and community participation in the planning
and evaluation of language services is an important
element of the policy: who better to tell you if translated
information is relevant and understandable than the
intended audience?
By 2006, the term ‘cultural competence’ was gaining
currency in Australia, spurred by the need for service
providers across a range of disciplines to better address
the requirements of a growing multicultural population.
The Diversity Health Institute had released a position
paper on cultural competence in health care and the
National Health and Medical Research Council published
a guide on cultural competency in health.
There is no universally accepted definition of cultural
competence; however, the following definition is one
of the most frequently cited and is used by CEH:
Cultural competence is a set of congruent
behaviours, attitudes and policies that come
together in a system, agency or among
professionals; enabling that system, agency
or those professionals to work effectively in
cross-cultural situations.
Cross TL, Bazron BJ, Dennis KW and Isaacs MR (1989)
Towards a Culturally Competent System of Care, Vol. 1.
Georgetown University Child Development Centre, Washington DC
CEH has adopted a framework for cultural competence
through which every aspect of an organisation can
be measured, assessed and improved to ensure
that all clients receive high quality and culturally
59
australians
appropriate services. One of the framework’s domains,
Communication, focuses on language services. The reality
is that each of the other six domains in the framework –
organisational values; governance; planning, monitoring
and evaluation; staff development; organisational
infrastructure; and services and interventions – impact
on language services. Indeed, all five elements sought
in the language service initiatives submitted for this
Guide overlap with the broader framework for cultural
competence.
In Victoria’s culturally diverse society, literacy generally
- and health literacy in particular - continues to grow
as a significant issue for the health sector. In 2006, the
Australian Bureau of Statistics Adult Literacy and Life Skills
Survey found that 59% of Australians are functionally
health illiterate.
There are contested definitions of health literacy;
however, from a service provider’s perspective,
a health literate organisation is:
…an organisation that makes it easier for people
to navigate, understand, and use information and
services to take care of their health.
Brach et al (2012) Ten Attributes of Health Literate Health
Care Organisations
Washington, DC: Institute of Medicine, The National Academies
Press Health Literacy
For this reason, language service initiatives submitted
by organisations were considered for efforts to make their
messages better understood by the client or community
and not simply translated into another language.
%
59% of Australians are
functionally health illiterate.

8
This Guide aims to improve the
provision of language services
to enable better communication
between service providers and
people with limited English
proficiency.

9
case studies of better practice
case studies of
better practice
The case studies included in this Guide show a range of language
service initiatives from a variety of services providers. In some
cases, similar initiatives exist elsewhere and the case studies
included here should not be seen as the only, or best, examples.
To guide the reader, key words are highlighted for each
case study, reflecting the importance and relevance of
the language initiative to better practice in a particular
area. At the end of each case study, a comment is
provided to deepen the reader’s understanding of the
initiative’s merit.
The language initiatives that appear must be read in
context: what works in one place may not be suitable
in another. Furthermore, some initiatives are more
recent than others and achievements must be viewed
in this context.
These case studies function as ‘how to’
guides enabling agencies to see how they
may implement each example of better
practice in their organisation.

10
The Goulburn Valley has a well-established history as
a region for migrant and refugee settlement. Based in
Shepparton, Goulburn Valley Health (GVH) is a 280 bed
acute and extended care facility that provides surgical,
medical, paediatric, obstetrics and gynaecology,
intensive care and psychiatry services as well as
extended care and regional services. GVH provides
community services that complement its inpatient role.
A 2010 survey of members of the recently arrived Iraqi,
Afghan, Sudanese and Congolese communities by the
Ethnic Council of Shepparton and District Inc. identified
concerns about how to access hospital services and the
role of local health agencies. The survey also revealed
dissatisfaction about long Emergency Department
waiting times. This survey was followed by a series of
GVH medical and nursing staff consultations that further
defined specific health gaps and barriers faced by newly
arrived refugees in the Shepparton region. The need
for a new approach to communication was highlighted
as a means of engaging more effectively with refugee
communities as partners in health.
what Interpreter-assisted hospital tours for refugees
who Goulburn Valley Health
organisation/agency type Regional hospital
language service type Interpreters
initiative commenced 2010
key words Sustainable, health literacy, community engagement,
hospital system
major change(s) Increased participants’ confidence in accessing Goulburn
Valley Health services. Significant improvement in participants’
knowledge of the health system.
In 2010, a pilot program of hospital tours commenced,
supported by GVH’s Diversity Committee. The tours aim
to familiarise small groups of refugee English language
students with the hospital layout and to introduce health
literacy based ‘take-home messages’ about the hospital
system at selected departments such as pharmacy,
pathology, medical imaging and emergency. The tours
are also intended to provide an opportunity for refugees
to speak with GVH staff.
The core tour program is conducted over three one-hour
sessions. The sessions are held one week apart to enable
time between visits for participants to consider what they
have learned and identify issues and questions.
The program incorporates approaches designed to foster
effective engagement with consumers, staff and key
community agencies, including creating opportunities
for GVH staff to meet with and work alongside interpreters
and refugee community leaders.
A key contributor to the success of the tours is the
participation of qualified interpreters to encourage
dialogue between staff and community participants.
The cost for interpreters and translations associated
with the tour are met by GVH.
partnering
with refugee
communities

11
Goulburn Valley Health is a
280 bed acute and extended
care facility.
280beds
comment
GVH considers the cost of conducting the tours as a
good financial investment in addressing the needs of
an ‘at risk’ population whose lack of knowledge about
hospitals and hospital procedures might otherwise
result in over-reliance on and high use of the hospital’s
Emergency Department.
Several factors have enabled the long-term sustainability
of the project, including high level in-kind support from
the participating departments in GVH, high status and
priority attached to the hospital tours by senior staff and
departmental heads, strong partnership with external
organisations and minimal start-up costs for piloting
the hospital tours.
Ongoing evaluation of the program has informed changes
to the service model and led to the establishment of an
inter-agency Working Party to guide further development.
further information
Website www.gvhealth.org.au
Position Executive Director, Community
and Integrated Care, GV Health
Telephone (03) 5832 2700

12
what Innovative interpreters: making a hospital survey more
meaningful for CALD inpatients with limited English proficiency
who St Vincent’s Hospital Melbourne
organisation/agency type Metropolitan hospital
key words Health literacy, cultural competence, flexibility, improved
overall patient satisfaction, sustainable
major change(s) St Vincent’s CALD inpatients post-discharge will now be asked
for their feedback on a regular basis using a telephone survey.
The methodology will be used for all future surveys. All patients
have benefited from improvements to the hospital food menu.
St Vincent’s Hospital Melbourne (SVHM) is part of St
Vincent’s Health Australia and a leading teaching, research
and tertiary health service active across 18 sites throughout
Melbourne. The main hospital is located in Fitzroy.
The project developed from a need to find an effective
satisfaction survey tool for discharged inpatients from
culturally and linguistically diverse (CALD) backgrounds.
The Victorian Patient Satisfaction Monitor (VPSM)
previously used by the Department of Health was a
written survey that measured patient satisfaction with
the care and services provided by public hospitals and
helped hospitals to improve their services. However, it
is particularly difficult to engage patients from CALD
backgrounds with limited English proficiency (LEP) in
written surveys even if translated, resulting in a low
response rate. The new CALD survey tool has proved
to be more appropriate and effective in engaging
patients and meeting Department of Health consumer
participation requirements. For example, the tool can
be used to meet Standards 4 and 5 of the Cultural
responsiveness framework: guidelines for Victorian health
services, which require CALD patients’ feedback on
whether they received culturally appropriate care.
a new survey tool
delivers positive
changes
The survey tool required an understanding of the health
literacy issues affecting particular CALD patient target
groups. The Interpreter Services and Cultural Diversity
team at St Vincent’s had the requisite background
knowledge and experience about the barriers and
enablers to good communication between clinicians
and CALD patients, supported by research and
literature on health literacy.
The resulting survey reflected the cultural and
communication styles of CALD patients with LEP.
It was written in plain English and then translated for
colloquial, verbal delivery by interpreters who recorded
the patients’ answers verbatim. Many of the questions
were open-ended to allow for narrative responses from
which it was possible to deduce answers and identify
barriers to care. Accredited interpreters administered
the survey by phone in six languages (Arabic,
Cantonese, Mandarin, Greek, Italian and Vietnamese).
One hundred people were contacted and the response
rate for the survey was 90%. Patients were delighted
to provide feedback.

13
One hundred people were contacted by
accredited interpreters by phone in six
languages (Arabic, Cantonese, Mandarin,
Greek, Italian and Vietnamese) and the
response rate for the survey was 90%.
90patients
The pilot survey was conducted initially with agency
interpreters to avoid a potential problem arising from
hospital staff interpreters seeking feedback from patients
who may be concerned about how the information they
provide might affect their future hospital care. However,
this appeared not to be a concern for the majority of
patients, demonstrated by the quantity and quality of
positive and negative feedback.
One finding of the survey was low patient satisfaction
with hospital meals. A further smaller survey (35 CALD
patients) was undertaken in collaboration with the
Nutrition and Food Services departments to learn more
about patients’ food preferences. This led to a new
culturally appropriate menu with more diverse options
for all patients. The successful survey methodology used
for both surveys has been embedded into regular CALD
survey planning to be conducted by staff interpreters
(or bilingual staff).
comment
Surveys are often written and translated with little thought
to health literacy, literacy in the community language and
preferred cultural communication styles. At St Vincent’s,
the Interpreter Services and Cultural Diversity team used
their cultural and language knowledge and experience
to contribute to a new survey tool that addresses these
issues and has brought about positive changes to
hospital services.
The cultural responsiveness and menu surveys and the
methodology are sustainable and adaptable as they take
10-15 minutes to conduct. This means interpreters can
fit them in when convenient, such as between booked
interpreter appointments. The initial long survey required
a budget for external interpreters; future ones will not.
%
further information
Website www.svhm.org.au
Position Chief Interpreter,
Interpreter Services
Telephone (03) 9288 3482

14
what Integrated interpreter booking system
who Mercy Health
key words Integrated booking systems, opportunistic block booking
major change(s) Accurate data collection on interpreter usage for analysis
and planning.
More patients that require an interpreter now have access to one.
an interpreter
for every patient
who needs one

15
an interpreter for every patient who needs one
Mercy Hospital for Women (MHW) is a tertiary hospital
that provides maternity, neonatal, gynaecological and
oncology services to women and families in Victoria.
A centralised interpreting service is provided to the
hospital in Heidelberg and satellite clinics in Preston
and East Melbourne. In 2012/13, 9,432 services were
provided in 42 languages.
An increased demand for interpreters combined with
a growth in the number of requested languages prompted
a review of interpreter provision at MHW and led to
quality improvements in service delivery. Data analysis
initially showed that interpreters for outpatients were
provided based only on phone or email requests.
This indicated that it was possible that a proportion
of patients did not receive an interpreter, although the
exact figure was difficult to determine.
MHW developed and implemented an interpreter booking
report to link with the statewide HealthSMART integrated
patient and client management system (iPM) to reduce
reliance on individual requests for interpreters and
minimise the number of booking errors.
The Interpreter Bookings Coordinator generates
a report that identifies all outpatients who require an
interpreter and their appointment details. The system
is complemented by other strategies such as a clear
process to identify the need for an interpreter and a
centralised interpreter booking system that operates
across the hospital and its satellite clinics.
The point of difference with this system compared
to most other health services where booking of an
interpreter relies on an individual request from a clinic/
ward is that it eliminates the reliance on receiving
individual requests for an interpreter and the chance
of missing some bookings (through not being notified
of changes due to cancelled or rescheduled appointments).
Instead, the system allows the Interpreter Bookings
Coordinator to identify and book interpreters as
required - ensuring, for example, that an interpreter
is available for every patient who requires one for
an outpatient appointment.
The rate of outpatients who require an interpreter and
received one increased from 82% in 2009/10 to 96%
in 2012/13. The rate of inpatients who require an
interpreter and received one increased from 77%
in 2010/11 to 81% in 2012/13.
The system also facilitates opportunistic cluster bookings
of the same language patients. A daily list of all patients
who require an interpreter enables the Interpreter
Bookings Coordinator to identify same language patients
and, where possible, book them into a cluster. This
strategy reduces the cost of interpreting services.
comment
The streamlining of the interpreter booking system
reduces the occasions on which a patient who requires
an interpreter misses out on one. An important change
has been the initial identification that the patient requires
an interpreter and the language required. The MHW’s
staff training program includes information on how to
elicit this information.
further information
Website www.mercy.com.au
Position Manager, Multicultural Services
Telephone (03) 8458 4255
96% of Outpatients that require
an interpreter received one and
81% of Inpatients that require an
interpreter received one in 2012/13.
81inpatients
%
96outpatients
%

16
making
better use of
bilingual staff
Western Region Health Centre (WRHC) offers medical,
dental, counselling and allied health services across
the local government areas of Maribyrnong, Hobsons
Bay, Wyndham, Melton, Brimbank and Hume. WRHC’s
catchment has enormous ethnic and linguistic diversity
and the centre has a long history of employing staff
whose language skills reflect the local demographic
profile. In 2013, 34% of staff spoke one or more
languages other than English (LOTE) at home. Some
of these staff are employed because of their bilingual
and cultural backgrounds, while others are employed
primarily for their professional backgrounds. Their ability
to speak another language makes them particularly
valuable to the organisation.
In 2010, an organisational cultural competence review
found that staff were unclear about when and how to
use their own or their colleagues’ bilingual skills. One
of the report’s recommendations was to develop formal
policies and procedures, including clear definitions and
guidelines, alongside staff education.
what Organisational recognition and support for bilingual staff
who Western Region Health Centre (now cohealth)
organisation/agency type Community health service
language service type Bilingual staff
key words Cultural competence, bilingual staff
major change(s) Developed systems to guide and support bilingual staff
to use their language skills in the workplace.
To inform the development of effective policy and
procedure in this area, in 2011 WRHC surveyed all
staff to identify existing LOTE skills and staff attitudes
to bilingual staff using their LOTE in service delivery.
The findings from this survey, and consultation with
the WRHC Bilingual Staff Network, have informed the
development of a suite of organisational responses.
These include:
■■ Bilingual Staff Policy and Procedure
■■ Language Services Policy that references and draws
on the Bilingual Staff Policy and Procedure
■■ A Register that identifies staff with proficiency in a
LOTE who are willing to communicate in that language
with clients if needed
■■ Training for staff who manage and support
bilingual staff
■■ Documentation of language skills and use
in Individual Development Reviews, including
a mechanism for self-assessment of skills.

17
making better use of bilingual staff
comment
WRHC recognised that bilingual staff are a valuable asset
to the organisation and developed formal mechanisms
to support their communication with clients in their
preferred language. In a survey of bilingual staff, options
for how their contribution might be recognised were
explored and financial recognition was not rated as highly
important to the majority of respondents. WRHC has
taken steps to clarify the roles and responsibilities of
bilingual staff, with clear boundaries communicated to
all staff around the distinction between bilingual staff
and accredited interpreters.
The development of multiple strategies to support
bilingual staff has achieved a range of benefits for
bilingual staff, the organisation and clients.
These include:
■■ Addressing concerns from bilingual staff about
competency, accountability and quality in relation
to the use of their language skills
■■ Improving recruitment and retention of staff from
communities the organisation services
■■ Minimising risks to client safety and improving service
quality through clear guidelines, policies
and boundaries.
further information
Website www.cohealth.org.au
Position Manager Access and Engagement
Telephone (03) 9680 1116
34% of staff spoke one or more
languages other than English at
home in 2013.
34staff
%

18
what Transcultural and Language Services: an engine room
for organisational change
who Northern Health
language service type Interpreting, translation
key words Research, organisational cultural competence, consolidation
of language services and expertise
major change(s) The length of bed stay for patients with limited English
proficiency dropped more than for all patients overall.
Patients with limited English proficiency must now be
included in all patient research conducted at Northern Health.
building
organisational
cultural competence

19
building organisational cultural competence
Situated in Melbourne’s northern suburbs, Northern
Health comprises five major healthcare campuses:
Broadmeadows Health Service, Bundoora Extended Care
Centre, Craigieburn Health Service, Northern Health and
PANCH Health Service.
In 2007, the Transcultural and Language Service
(TALS) department was created to consolidate separate
language services into one centralised service. Internal
research found that contracting external interpreters in
large numbers was very expensive and also restricted
the quality control of interpreting services.
A business case for employing in-house interpreters
was successfully presented to management. As a result
of this and other strategies, TALS now contributes
significantly to staff training, clinical research and
education at Northern Health.
TALS currently:
■■ Employs 17 in-house interpreters (15.1 effective full
time), up from four in 2007
■■ Provides 46,000 occasions of service per year in more
than 100 languages
■■ Delivers 85+ transcultural training sessions per year
■■ Participates in internal and external research projects.
TALS’ many strategies have contributed to a greater
decrease in average length of stay for patients with
limited English proficiency compared to English-speaking
patients. From 2007/08 to 2012/13 the reduction was
2.5 days compared to 1.5 days.
TALS also plays an important part in building Northern
Health’s organisational cultural competence by offering
high quality language services (comprising interpreting
and translation of medical material), providing
transcultural training to clinical staff and contributing
to research and education. For example, Northern
Health’s Ethics Committee guidelines for research
involving patients require the inclusion of 25% of people
with limited English proficiency in the research group.
Clinicians are expected to consult TALS to ensure that
their research is culturally sensitive. Researchers access
in-house interpreters and educate these interpreters for
their role in the research. This process develops mutual
expertise between clinicians and interpreters within
Northern Health and is more effective than contracting
external interpreters specifically for occasions of contact
with research patients.
TALS’ strength is built on four pillars:
1. A strong in-house interpreter model of the
highest standard
2. In-house translation of medical literature
3. Training to clinicians and other hospital
staff on communicating effectively through
a qualified interpreter
4. Advice and collaboration in internal and external
research projects and student education
comment
To get to this position of strength, TALS implemented
incremental changes. The starting point was to ensure
reliable data was collected regarding the use and cost
of interpreters. It took almost two years to arrive at
a meaningful unit cost. After a Finance department
enquiry about how interpreters used their ‘down time’,
interpreters were encouraged to undertake translations
with a view to acquiring translation qualifications. This
change not only increased language services productivity,
but also the breadth and depth of expertise among the
staff interpreters.
Professional development has been another growth area
for Northern Health staff. The program started with a
one-hour transcultural training session offered 30 times
a year. Currently, 90 sessions are offered. Training is now
targeted to specific professions such as nurses, allied
health clinicians and doctors and is embedded in the
hospital’s education calendar. The training program has
been adapted to make some content accessible online
to staff on the Northern Health intranet.
further information
Website www.nh.org.au
Position Coordinator, Transcultural
and Language Services
Telephone (03) 8405 2881
TALS currently provides 46,000
occasions of service per year in
more than 100 languages.
46000services

20
In 2011, the Australian Government established new
local organisations, Medicare Locals, to work with general
practitioners and other primary health care providers to
improve access to frontline health services. Networking
Health Victoria (NHV) is a state level organisation working
with Medicare Locals to better integrate general practice,
other primary health care providers and the broader
state health system to meet the healthcare needs of the
Victorian community. The NHV Immunisation Program is
the state-based operation of the National
Immunisation Program.
The main focus of the immunisation program is to assist
Victorian Medicare Locals to support and encourage
general practice in all aspects of immunisation. NHV,
with support from Victoria’s Department of Health, also
undertakes some targeted activities with local government
immunisation teams and Aboriginal services.
Working in areas in Victoria that had been identified
as having low immunisation coverage, NHV and local
immunisation providers became concerned that proper
informed consent procedures regarding immunisation
were not being followed with families with limited English
proficiency and low literacy in languages other
than English.
An audio recording was made of the pre-immunisation
checklist used to prompt people to disclose health
information to their doctor or nurse before immunisation.
This ‘talking book’ is offered to people presenting for
immunisation or to a parent/carer of a child being
immunised. The A5 book comes with plastic sleeves in
which information is inserted in English and a selection
of community languages. There is one language per
page. At the bottom of each page is a button that when
pressed starts and stops the language audio recording
of the text on that page.
‘talking book’
explains
immunisation
in 13 languages
what Immunisation Talking Book
who Networking Health Victoria (formerly General Practice Victoria)
organisation/agency type State based organisation
language service type Translation
key words Technology, audio, low literacy in language other than English,
shared costs
major change(s) Adults with low English proficiency and low literacy in their
community language are better informed about immunisation
for their child.
The initiative has been taken up by other general practices
across Victoria.

21The book was first trialled in 2012 in Goulburn Valley
and in 2013 in Greater Dandenong and Hume. Several
other councils and Medicare Locals will be adopting
the ‘talking book’ in 2014. They will contribute funding
to purchase the book and NHV will meet the cost of
translations into other languages. The translations
are undertaken by qualified translators, independently
checked by a second translator and then recorded.
The audio translated recordings are then offered by NHV
at no cost to other organisations who wish to use the
‘talking book’ technology to produce their own versions.
The number of translations into different languages will
increase from four to 13 in 2014.
To date, the evaluation of the ‘talking book’ has been
anecdotal. Feedback has indicated the ‘talking book’
is more effective when there is a protocol ensuring that
all people presenting for immunisation are offered the
book, are shown how to use it and allowed sufficient time
to listen to the information. Community feedback that
some parts of the translation are not well understood
has resulted in changes to the English source document
to address health literacy issues.
comment
The ‘talking book’ is used as a supplement to, and not
a replacement for, communicating via an interpreter.
It aims to improve communication between the health
professional and client.
Costs are shared by other organisations adopting the
NHV talking book, which increases the likelihood that
this initiative is sustainable over the longer term.
further information
Website www.nhv.org.au
Position Immunisation Program Consultant
Telephone (03) 9341 5265The number of audio translated
recordings into different languages
will increase to 13 in 2014.
13translations

22
what Shopping Centre Based Multicultural Playgroups
with bicultural workers
who Brimbank City Council, Families and Early Years Unit
organisation/agency type Council
language service type Bilingual staff
key words Early intervention
major change(s) An increase in uptake of early childhood services by migrants
and refugees from non-English speaking countries.
a better start for
children from
migrant and
refugee families

23
46.1% of the residents of
Brimbank born overseas and
56.2% speaks a language other
than English at home.
56residents
%
Brimbank is the second largest municipality in Melbourne
and the largest in the Western Region. Ethnic and
linguistic diversity is high, with 46.1% of residents born
overseas and 56.2% speaking a language other than
English at home.
Brimbank has a low uptake of early childhood services.
Playgroup is considered a good entry point into the
system but, for many parents in the municipality
(especially those from migrant and refugee backgrounds),
playgroup is a new concept.
Brimbank manages two multicultural playgroups with
Bicultural Early Years Support Officers, which operate
from shopping centre shopfronts in Deer Park and
Sunshine. Families are more likely to approach the
playgroups when they see workers who are from their
ethnic group and the high visibility venues support this.
The workers speak English, Arabic, Dinka, Burmese,
Chin, Vietnamese and several Indian languages. The
playgroups operate 1.5 hours per week. Each session
has additional time allocated for set-up, pack-up and
group reflection. Staff are employed on a casual basis.
The bicultural workers have also helped to build capacity
for other early childhood staff. Childhood development
concepts in the Australian context are difficult to grasp
and understand for culturally and linguistically diverse
families. The bicultural staff are learning about these
concepts and educating the communities about early
childhood services through the playgroups. They are
also educating council staff about how these
communities respond to concepts of early childhood
services, such as ‘intervention’.
Brimbank has employed Bicultural Early Years Support
Officers specifically to take advantage of the short
window of opportunity to foster social connectedness
in early childhood (0-6 years) and strengthen
community links. Families are developing an interest
in and knowledge of their child’s development through
the playgroups and are also receiving more general
information about council services for their families. 46residents
comment
Despite the critical importance of language, the choice
of the term ‘bicultural’ over ‘bilingual’ reflects the
important cross cultural work these workers are doing
with families and other council service providers.
Brimbank acknowledges that workers have not undergone
formal language testing as they are not required to
interpret but instead engage directly with families in their
languages other than English.
This initiative is identified in general terms in the Municipal
Early Years Plan. The shopping centre based playgroup
model was developed by another council, but Brimbank
added emphasis on communicating with migrant and
refugee residents in their community languages.
further information
Website www.brimbank.vic.gov.au/
SERVICES/Child_Care_Kindergartens_
Playgroups/Playgroups
Position Best Start Facilitator
Telephone (03) 9249 4038
%
a better start for children from migrant and refugee families

24
MonashLink Community Health Service provides
an extensive range of primary care, oral health and
counselling services, as well as health promotion and
service coordination. These services are located across
four sites in the City of Monash.
After feedback on translations commissioned by
MonashLink indicated that these were not effective with
the target communities, the health service added a new
first step. Material for translation now goes through a
three-stage documented process:
1. A Marketing and Publications Reference Group
(MPRG) manages the process. The MPRG includes
consumers and clinicians and reports to the
organisational quality committee. The group develops
content and format for translated material based on
health literacy and consumer engagement principles.
The group engages clinicians in ongoing education
about consumer health literacy.
2. The text is translated by accredited translators into
selected local community languages.
what Three-stage translation process
who MonashLink Community Health Service
organisation/agency type Community Health Service
key words Health literacy, translation standards, consumer input,
quality processes, organisational cultural competence.
major change(s) All consumer publications go through a three-stage evaluation
process guided by local consumers using health literacy
principles. Translation standards are applied to publications
for translation and include checking for contextual accuracy
and relevance.
three steps
to better
translations
3. The completed translation is tested with consumers
to ensure it reads well and is relevant for local needs.
Bilingual staff are also a source for checking the
translated material. Translations are checked by
individuals as well as by a group, allowing issues
to be resolved with group input and discussion.
The Royal District Nursing Service (RDNS) Translation
Standards guide the overall translation process.
This process is useful for the development and
publication of any consumer-focused material. At the
MPRG, consumers give feedback on the content and how
it can be edited for clear communication in plain English,
not just for audiences with limited English proficiency.
All translations are text-based. No audio-visual materials
are developed as the organisation has a limited budget.
However, in 2013 the marketing and translation budgets
were consolidated to contribute to cost savings, which
may provide more scope for presenting material in other
formats in the future.
The MPRG conducts a self-review, including a baseline
audit and subsequent periodic audits of its work.

25
three steps to better translations
comment
The three-stage process is consumer-centred and
observes good practice principles for health literacy
and translations. Documentation supports the process,
including the organisation’s strategic plan and policy
and procedure manual. The MPRG has terms of
reference and a position description for consumers.
This work around translated material also appears in the
position descriptions and work plans of the Community
Engagement Coordinator and the Quality and Policy
Coordinator, ensuring a strong consumer focus and
quality perspective on the work.
further information
Website www.monashlink.org.au
Position Community Engagement Coordinator
or Quality and Policy Coordinator
Telephone 1300 552 509

26
what Value adding staff interpreter
who City of Greater Dandenong, Aged and Disability Services
organisation/agency type Council
language service type Interpreter
key words Cultural competence, sustainable, cost efficient,
improved quality
major change(s) Positive experiences working with a staff interpreter increased
the overall use of interpreters for clients speaking Vietnamese,
Cantonese and Mandarin.
embedding an
interpreter with
local aged and
disability services

27
embedding an interpreter with local aged and disability services
The City of Greater Dandenong is the most culturally
diverse municipality in Victoria and the second most
diverse in Australia, with 60% of its residents born
overseas and 55% from nations where English is not
the main language spoken. Of residents aged 70 or over,
54% speak languages other than English at home. The
most common languages are Italian, Greek, Vietnamese,
Cantonese and Mandarin.
Due to the high proportion of aged clients with limited
English proficiency, the council’s Aged and Disability
Services (ADS) quickly reached the credit line cap for
language services provided by the Department of
Human Services.
ADS noticed an increased gap in language service
provision when a bilingual case manager went on
extended leave. Initially, it was decided to cover the
bilingual case manager’s position with an agency
interpreter and a case manager. This worked for a short
time but was expensive. ADS then piloted a 12-month,
full time in-house interpreter position, funded through
the council’s general budget. At the time, no qualified
staff interpreters were employed in local government
in Victoria. The council advertised for a Vietnamese
accredited (or willing to become accredited) interpreter
who also spoke Cantonese and Mandarin.
During the 12-month pilot period, each phone call,
answered and unanswered, was logged; every home visit
and Planned Activity Group session was documented;
and any other interpreting work was noted. An external
evaluation was conducted using this data and interviews
with ADS staff, the interpreter, clients and families. The
evaluation concluded that it was extremely valuable to
have a qualified interpreter in the ADS team and that
the staff interpreter position compared favourably to
accessing agency interpreters in terms of costs
and quality.
Some staff referred to the staff interpreter being ‘more
than an interpreter’, indicating that the role is more
versatile and helpful than that of an agency interpreter
who has no background knowledge of ADS. Staff
reported that communicating to their clients via a
staff interpreter was quicker and easier than through
an agency interpreter, which generally took more time
and was more complicated.
comment
The position description has been reviewed annually
for the last five years, with an increased focus on
opportunities for professional development. The position
has evolved from a narrow interpreter role to something
more flexible that is now embedded productively within
ADS. The expanded role has allowed the interpreter to
bring different skills, knowledge and information into
the ADS team and led to changes in staff induction
training about how to work with interpreters. The role
now extends to working with other areas of council and
assisting in community consultations, particularly in the
areas of health, wellbeing and community building. The
position is a sustainable and a long-term investment
for the City of Greater Dandenong, with demographic
projections indicating that there will be a high need for
an interpreter in these three languages for the next
ten to 15 years.
further information
Website www.greaterdandenong.com
Position Access and Quality Coordinator
Telephone (03) 8571 5229
60% of residents of the Greater
Dandenong born overseas and 55%
are from nations where English is
not the main language spoken.
55residents
%
60residents
%

28
what Multilingual resources
who Centre for Culture, Ethnicity and Health
organisation/agency type Statewide program
key words Community participation, tailored content, format
and dissemination.
major change(s) Community participation in development and dissemination
of translated information aimed at their own community.
a strong consumer
focus improves
translations
The Centre for Culture, Ethnicity and Health (part of
North Richmond Community Health) works closely with
communities affected by problem gambling to produce
culturally appropriate information resources.
Existing Gambler’s Help information translated into
community languages was found not to resonate
with targeted culturally and linguistically diverse
communities. Furthermore, the existing resource format
and dissemination methodology did not incorporate
community specific information channels.
To produce each resource, the CEH uses the
following process:
1. Target communities are identified through
demographic data, prevalence of problem gambling
and community interest.
2. Key stakeholders, including service providers
and community leaders, are approached for
advice and feedback.
3. Focus groups are held to understand community
attitudes to gambling and to determine culturally
appropriate messages and images for the resource.
Consideration is also given to the format of the
resource and the method for dissemination.
4. Drafts and design mock-ups are tested with
key stakeholders.
5. Translated versions of the resource are verified
by key stakeholders.

29
a strong consumer focus improves translations
Examples of the format, dissemination method, key message and image for different communities are outlined below.
targeted community
and language
format and
dissemination
key message
and image
Chinese international students
in simplified Chinese characters
Poster disseminated through
international student associations
and universities
‘Five things to know before you put
your cards down’. Each key message
was printed on the image of a
playing card.
Tigray-Tigrinya in Tigrigna Posters distributed at a community
launch and through community
leaders, organisations and
businesses
‘Don’t let gambling problems tear
our families apart’. In foreground
mother crying holding an infant
accompanied by young child - all
are walking away from father
standing in front of poker machines.
Khmer in Khmer Pocket fold out and poster
distributed by community and
religious organisations at major
community festivals
‘Don’t hide your problems. Let’s help
our families stop problem gambling.’
Man holding his head over bills
spread on kitchen table.
Sudanese in Sudanese Arabic
and Dinka
Three panel brochure disseminated
through a community organisation
and Gambler’s Help Services
‘Is gambling taking too much of your
money and your time?’ Main image
of head of anguished man with
playing cards around him.
comment
While the starting point and the process are similar
for each community, the end result is unique regarding
content, images, format and dissemination method.
Consulting key stakeholders through all stages of
development strengthens the likelihood that the final
product will be culturally appropriate to the target
audience. Involving community members in the
consultation process educates them about gambling
issues. These people potentially become another means
of spreading the message within their communities.
further information
Website www.ceh.org.au/resources/
publications
Position Communications Officer, Centre
for Culture, Ethnicity and Health
Telephone (03) 9418 9929
In all examples, the information is repeated in English with the same accompanying images. This bilingual format
helps to reach community members, such as teenagers, who are stronger in written English than their community
languages. It also allows Gambler’s Help counsellors and community workers to see what information
they are distributing.

30
further
information
and resources
consumer participation
The Victorian Department of Health has published Doing it with us not for us: Participation policy 2006-09:
http://docs.health.vic.gov.au/docs/doc/Doing-it-with-us-not-for-us:-Participation-policy-2006-09
cultural competence
CEH has developed tip sheets for each of seven domains that make up a framework for cultural competence:
http://www.ceh.org.au/culturalcompetence
Sarah Stewart (2006), Cultural Competence in Health Care: Diversity Health Institute Position Paper, Diversity Health
Institute: http://203.32.142.106/clearinghouse/ search with words ‘position paper’.
National Health and Medical Research Council (2006), Cultural competency in health: A guide for policy, partnerships
and participation: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/hp19.pdf
health literacy
CEH has been involved in several health literacy projects and has developed tip sheets that cover a range of aspects
of health literacy: http://ceh.org.au/health-literacy
The Australian Commission on Quality and Safety is a government agency that leads and coordinates national
improvements in safety and quality in health care across Australia: http://www.safetyandquality.gov.au/
The Ophelia project is a three-year Victorian initiative that will identify and test new interventions to address health
literacy needs in people attending a broad range of Victorian agencies: http://www.ophelia.net.au/
language services
CEH has developed tip sheets that cover interpreters, bilingual staff and translations:
http://www.ceh.org.au/resources/publications
Victorian Government Guidelines on Policy and Procedures for Interpreting and Translating can be accessed from
http://www.multicultural.vic.gov.au/projects-and-initiatives/improving-language-services/standards-and-guidelines
The Victorian Department of Health’s Language Services Policy can be accessed from
http://www.health.vic.gov.au/diversity/cald.htm
Michael, J., Aylen, T. and Ogrin, R. (2013), Development of a Translation Standard to support the improvement of
health literacy and provide consistent high-quality information’, Australian Health Review, vol. 37, issue 4, pp. 547-551

contact
Centre for Culture, Ethnicity & Health
23 Lennox Street, Richmond, 3121
P. (03) 9418 9929
www.ceh.org.au

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