Language Accessibility

With a population of more than 320 million people, the United States is a diverse landscape, representing members of different races and cultures, who speak a variety of languages. The 2015 U.S. Census estimates that more than 60 million people speak a language other than English at home, with more than 350 different languages spoken in the United States.1

When working with individuals who have limited English proficiency and/or prefer communicating in a different language, it’s important to have trained and qualified interpreters on hand to help you communicate. During the conversation, use the same verbal and non-verbal etiquette with the individual as you would if the interpreter were not present. For example, sit across from the individual, maintain eye contact, and monitor their verbal and non-verbal language for signs of understanding or distress.

Consider the following when selecting an interpreter: 

  • Trained and qualified interpreters should be available to any patient/client who has limited English proficiency or other communication needs. 

  • Decisions on interpretation vary on a case-by-case basis, depending on the availability of resources and the individual's needs. 

  • Look for in-person services through accredited agencies. Phone interpretation is not ideal but is better than someone who is not neutral (such as a relative or friend of the individual) or is unfamiliar with medical terminology.

  • Interpreters should be screened for conflicts of interest.

  • Individuals should be told they can refuse a particular interpreter if they are not comfortable speaking in front of them. 

Hold a pre-interview meeting with the interpreter to prepare for the case. In addition to confidentiality expectations, consider discussing the following during this meeting: 

  • Using a trauma-informed approach and common terminology to ensure the interpreter does not unintentionally use harmful language that could be perceived as victim blaming

  • Regularly monitoring for signs of stress in the individual and slowing down or pausing as needed to not overwhelm them 

  • Translating verbatim all questions and answers and avoiding substituting words, even if the individual uses slang or swear words

  • Preparing to hear the details of a person’s trafficking experiences, which can be difficult, and even triggering or traumatizing for the interpreter


United States Census Bureau. (2015). Census Bureau reports at least 350 languages spoken in U.S. homes.

Communication and Language Assistance

As we covered in the SOAR Online module, Culturally and Linguistically Appropriate Services, the second theme of the CLAS Standards is Communication and Language Assistance. This set of Standards provides recommendations on how organizations can address language and communication barriers to meet the needs of people with limited English proficiency, or LEP.

Approaches to overcoming language barriers could include hiring bilingual providers, bilingual/bicultural community health workers, and interpreters, both onsite and via telephone. The CLAS Standards provide a baseline for guiding organizations in identifying areas where they can improve their linguistic competence. Below is a brief summary of the CLAS Standards related to Communication and Language Assistance and some basic strategies for implementing them:

Standard 5: Offer language assistance to individuals with LEP and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

  • Ensure that staff is fully aware of, and trained in, the use of language assistance services, policies, and procedures. 
  • Develop processes for identifying the language(s) an individual speaks (e.g., language identification flash cards or “I speak” cards) (
  • Use trained and qualified interpreters to facilitate communication, including services for individuals who are deaf or hard of hearing, blind, have limited English proficiency, or have intellectual or cognitive disabilities (…).

Standard 6: Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

  • Determine the content and language of notices and decide how to communicate or provide notice to individuals.
  • Decide where to provide notice to individuals about the availability of assistance.
  • Train all staff in how to interact with individuals with LEP, as well as individuals who are deaf or hard of hearing, blind, or have intellectual or cognitive disabilities.

Standard 7: Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

Standard 8: Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

  • Issue plain language guidance and create documents that demonstrate best practices in clear communication and information design (
  • Create forms that are easy to fill out and offer assistance in completing forms.
  • Formalize processes for translating materials into languages other than English and for evaluating the quality of these translations.
Related Resources 

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