NYC's Language Access Service Needs Callout Map

Interactive Map: NYC's Language Access Service Needs (2024-N-2)

Objective

To determine if the New York City Department of Health and Mental Hygiene is adequately serving the needs of individuals with Limited English Proficiency, complying with State regulations and local laws, and providing sufficient oversight of Language Access Services. The audit covered the period from January 2019 through December 2024.

About the Program

The New York City Department of Health and Mental Hygiene (DOHMH) is New York City’s (NYC or City) public health agency. DOHMH’s mission is to protect and promote the health of over 8 million New Yorkers. With an annual budget of $2 billion and over 7,000 employees, DOHMH provides a broad range of services including inspecting food establishments, conducting studies of health inequities across neighborhoods, and operating low- to no-cost health clinics. Currently, DOHMH operates 10 City-wide programs as well as 21 facilities across four of the five boroughs—Manhattan, the Bronx, Brooklyn, and Queens (see Exhibits A and B).

Language Access Services (LAS) are pivotal to DOHMH’s work because hundreds of languages are spoken in NYC. The 2023 American Community Survey conducted by the U.S. Census Bureau estimated over 1.7 million NYC residents speak hundreds of languages and have Limited English Proficiency (LEP). DOHMH established its comprehensive Language Access Policy in 2016 to eliminate language barriers and ensure meaningful access to DOHMH services for clients with LEP. The Language Services Unit, within DOHMH’s Office of External Affairs, is responsible for creating and disseminating LAS resources to all public-facing DOHMH programs, training staff, and evaluating LAS. DOHMH uses over-the-phone, video-remote, in-person, and American Sign Language interpretation. DOHMH also translates vital public documents such as consent forms and legal notices and facilitates other document translations upon request by programs. The Language Services Unit has in-house translators and vendors that provide translations.

According to Local Law 73 of 2003, DOHMH is one of four City agencies required to provide free LAS to clients with LEP. In 2017, Local Law 30 expanded this requirement to include all City agencies providing direct public services or emergency services and outlined additional details for the implementation of LAS. City agencies subject to Local Law 30 are required to provide services such as telephonic interpretation, multilingual signage, and document translations, and create a language access implementation plan. The language access implementation plan must, among other things, designate a language access coordinator, incorporate an evaluation of the service population’s language access needs, and include a process to monitor and timely respond to public complaints regarding language access. Telephonic interpretation must be available in at least 100 languages, and on-hand translations of key documents must be available in the top 10 designated City-wide languages—those spoken by LEP individuals likely to be served by NYC agencies: Spanish, Chinese, Russian, Bengali, Haitian Creole, Korean, Arabic, Urdu, French, and Polish. All public-facing DOHMH programs are required to provide LAS upon identification of LEP needs.

Key Findings

We identified numerous deficiencies in DOHMH’s administration and operation of its LAS that led to potential non-compliance with relevant standards and local laws as well as other LAS issues. For example:

• Although required to maintain records of the LAS it provides, DOHMH does not have a centralized system for recording and tracking LAS. Therefore, LAS requests may be underreported. The absence of a standardized system for documenting and monitoring LAS data can result in incomplete information regarding the needs of LEP clients and the services provided, which hinders DOHMH’s ability to deliver effective services and support to these individuals.
• DOHMH officials are unaware of the number of dropped calls and instances where an interpreter could not be found.
• DOHMH has a required fluency assessment, but there are uncertified bilingual staff providing clinical services in a non-English language. DOHMH also inconsistently reports the number of bilingual staff who have completed the fluency assessment. Fluency assessments ensure effective and accurate communication, which is vital for client safety, and ensure that people with LEP have meaningful access to City services.
• DOHMH conducts inspections of food establishments in the City, many of which are owned or staffed by workers who may have LEP. Our survey of 50 restaurants and food establishments and our review of food inspection data found that many owners and workers were unaware of available LAS resources or the Business Owner’s Bill of Rights (which states the right to LAS during inspections).
• Bilingual and multilingual Office of the State Comptroller auditors conducted an unannounced survey of DOHMH facilities’ phone lines and encountered several barriers such as: 
  • DOHMH staff not attempting to connect callers to an interpreter.
  • Difficulty navigating DOHMH’s automated call systems and voicemails, particularly for LEP clients.
  • Disconnected calls and extended wait times.
  • Missing website translations.
• We conducted in-person site visits to 10 DOHMH public-facing facilities and found:
  • Inadequate or missing signage for LEP to provide LAS feedback and complaints.
  • Installation delays and technical issues with LAS equipment and what appeared to be an insufficient amount of LAS equipment at some sites.

Key Recommendations

• Develop a system-wide database for collecting and tracking clients’ language preferences across all facilities, and collaborate with vendors to gather relevant data on LAS delivery and unfulfilled requests.
• Ensure all communications geared toward the LEP community, including automated call and voicemail systems, LAS signage such as the patient satisfaction survey, QR code survey signage, and feedback boxes are available in the appropriate multiple languages, and are always accessible.
• Ensure all bilingual staff who provide interpretation services complete DOHMH’s fluency assessment.
• Assess the LAS equipment and connection needs for each program and facility periodically to ensure access to LAS.