30+ Years of Community House Calls

Being a patient can be overwhelming: Someone already feels sick, is in a strange environment, and is confronted with unfamiliar terminology. Add in speaking a different language than their providers and/or being part of a culture their providers aren’t familiar with, and being a patient can be even harder.

That’s where the Community House Calls program at Harborview Medical Center comes in. Founded in 1994 with initial funding from a Robert Wood Johnson grant and formalized as a program under Interpreter Services in 1996, Community House Calls ensures immigrants and refugees in the Seattle area receive equitable and culturally humble medical care.

Interpreting cultures as well as languages

The program works in partnership with EthnoMed and is run by Asmeret Tesfalem, MSN, RN, manager of program operations. Tesfalem leads a team of 12 caseworker cultural mediators who cover nine different languages: Spanish, Vietnamese, Somali, Dari, Cambodian, Amharic, Pashto, Tigrinya and Farsi.

The caseworker cultural mediators do most of their work at the hospital, assisting both outpatients and inpatients, focusing on patients whose cases are more medically complex or emergent. They also make house calls for individual patients, though given the demand for their services and the number of patients the team serves, much of their work is community-focused to reach as many people as possible.

Interpreter services are just one of the team’s offerings. One of their main goals is to ensure patients have the support and knowledge they need to care for themselves once they’re discharged. Caseworkers help patients secure referrals, schedule their next appointments, organize reliable transportation to follow-up appointments, coordinate with Medicaid, refill and understand how to take medications and more.

“Caseworker cultural mediators, being bicultural and bilingual, serve as trusted contacts and advocates for patients of similar ethnic backgrounds,” says Tesfalem. “While medical interpreters play a vital role in the healthcare system, additional barriers beyond language hinder effective communication, treatment adherence and timely discussions. Consistent contact with a cultural advocate results in higher levels of confidence that the medical team is making correct treatment decisions.”

The program is also heavily involved in our local communities, partnering with local organizations like Vietnamese Seniors, the Latinx Health Board, the Cambodian Health Forum and Ethiopian and Somali community groups to provide patient education opportunities and meet with people to learn about their needs and health goals. The team uses input from these communities to improve the program and further align their services with community needs.

Expanding access for all patients

Since joining the team two years ago, Tesfalem has seen the continued need to add more staff and grow the program even more. She has overseen the hiring of a fifth Spanish-language caseworker cultural mediator and another who specializes in Tigrinya.

She’s hoping to get approval to hire additional Spanish-language and Somali-language caseworkers, as well as an additional language caseworker who speaks Tigrinya or Amharic.

While it’s important for all healthcare providers to be aware of language and cultural differences among their patients, it would be impossible for every individual to understand so many different languages and cultures in depth. That is why caseworker cultural mediators are needed.

“The services caseworker cultural mediators provide are vital to mitigating length of stay, decreasing medical complications and streamlining nuanced sensitive discussions,” Tesfalem says. “This model also encourages judicious utilization of medical services, reducing unnecessary ED visits and potential lengthy in-patient admissions by reiterating the importance of preventive care.”