ABA center (private equity funded) denied family because they speak Spanish

[borne_before]

Just met with a family. I am currently doing an eval - the kid has textbook autism - and it's basically just going through the motions. But the parents speak Spanish. Dad and mom can get by in English (basically they have emerging BICS). I gave them a list of 5 places to get on the waiting list for. They met with one place - scheduled an intake - and when they showed up, they basically were like "oh, you're not a good fit for us." The family felt like it was pretty racist. They take the local medicaid insurance - which mandates things like interpreters, which insurance will provide.

My instinct is to call their director and chew them out. Any advice would be appreciated.

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[ClinicalABA]

Just met with a family. I am currently doing an eval - the kid has textbook autism - and it's basically just going through the motions. But the parents speak Spanish. Dad and mom can get by in English (basically they have emerging BICS). I gave them a list of 5 places to get on the waiting list for. They met with one place - scheduled an intake - and when they showed up, they basically were like "oh, you're not a good fit for us." The family felt like it was pretty racist. They take the local medicaid insurance - which mandates things like interpreters, which insurance will provide.

My instinct is to call their director and chew them out. Any advice would be appreciated.

Call the director and let them know that a family you are working with felt they were turned away because they speak Spanish. Kindly ask if this is a policy, as you'd want to properly direct future referrals. Firstly, though, you might want to confirm with the family exactly what they were told were the reasons.. It could in fact be a discriminatory practice in play, but you also may not be getting the entire picture. We've denied services aftercp intake for simple things like not being able to meet the child's scheduling needs (e.g. nap times) up to things like unsafe environment (weapons/drugs and paraphernalia in the open- necessitating a DCF call) or the father literally propositioning the staff during the intake. In the later cases, yiubcan bet the families didn't tell their other clinicians the real reasons.

 

[Sanman]

The only thing I could add to what @ClinicalABA said is a question of whether this was racism or there was a legitimate concern about being able to communicate with the family adequately enough to engage in care. While some places may make a good faith effort to engage in translation services and be struggling to accommodate the family, there are other facilities I have been to in my area of work that consider an ipad that no one can find the charger for adequate translation services. Either way, it does not make sense to burn a bridge if you may need to refer other clients to them in the future. However, this may be a good time to assess who has proper Spanish or foreign language services to guide those types of clients to better referrals in the future.

 

[borne_before]

I'm gonna be like "Not super stoked y'all begged for our referrals, knowing the type of population my clinic sees, to refer out spanish speaking families, when medicaid will pay for interpretation. The last family felt it was pretty racist TBH. That makes me look bad and I know you guys are under a ton of pressure from private equity to grow and make money. It's a bad look TBH and I'm going to consider sending referrals elsewhere. There is no shortage of ABA shops around town."

 

[bluecolourskies]

I would clarify the situation. Like you said, they have enough English to get by but not 100% comprehension. Are they new to the USA?

I had a very recent example of a newly arrived Ukranian family that had the government insurance (i forget if it was state or federal) they went to a clinic that did not accept their insurance. they offered to pay cash, the clinic said no we can’t accept cash pay from you. They told me that “obviously nobody needs ukranians here, we are not welcome” and I had to explain to them that it had nothing to do with their country of origin- there is a law/policy that government insurance carriers can’t pay cash for care, and clinics aren’t going to risk getting in trouble.

So before you chew anyone out, verify the facts!

 

[WisNeuro]

Definitely verify. I refer out all of my spanish speaking patients, now and when I was in the hospital. Can I do the evaluation with an interpreter? Sure. Will they be better served by one of the 2 spanish speaking board certified folks in town who can do the eval entirely in their native language? Almost definitely. The only ones I took were the Russian evals with an interpreter, as there is no native language option.

 

[PikminOC]

I used Google translate with a greek patient. It worked well.

 

[WisNeuro]

I used Google translate with a greek patient. It worked well.

I would consult with your liability insurer before doing this again.

 

[PikminOC]

I would consult with your liability insurer before doing this again.

Not concerned.

 

[WisNeuro]

Not concerned.

Obviously.

 

[futureapppsy2]

I would consult with your liability insurer before doing this again.

Yeah, this is a liability mess (unless you're a malpractice lawyer, than it's $$$$$$$) in medicine in general but especially in mental health.

 

[futureapppsy2]

Another consideration is if the family requested intervention services be provided to the child in Spanish. If they don't have Spanish-speaking therapists and techs and the family wanted Spanish language services, the clinic was probably right to turn them away, because the high-quality Spanish-language input won't be there. If the family is okay with intervention services in English, then there's a much stronger argument for accepting them, provided the other factors also align.

 

[borne_before]

Another consideration is if the family requested intervention services be provided to the child in Spanish. If they don't have Spanish-speaking therapists and techs and the family wanted Spanish language services, the clinic was probably right to turn them away, because the high-quality Spanish-language input won't be there. If the family is okay with intervention services in English, then there's a much stronger argument for accepting them, provided the other factors also align.

The main language at home is probably english - non of her sibs speak spanish.

 

[Mojito_15]

I do interpreter services frequently in several languages as I work in an area of the US where that's necessary. I do refer if appropriate for better services- mainly for the Spanish-speaking patients whom I can get to go elsewhere- but I agree it's problematic to refuse services to someone b/c of language. I also have observed that many people simply refuse to serve other languages because they don't like to have to call an interpreter. Happens at our practice, where we've got pretty easy access to phone interpreters. If this practice cannot provide adequate services in another language- they should- at a minimum- have somewhere else to refer. If they didn't even do that- then a call is appropriate.