Regardless of where you live in the United States, several common reasons people avoid visiting the doctor include cost, fear, and lack of time. For others it might be language barriers, concern about discrimination, or lack of trust in medical professionals. To help address some of these issues locally, Cougar Health Services (CHS) at Washington State University Pullman is taking creative, new steps to help make all students feel welcomed, valued, and included.

Key initiatives include providing interpreters for students with limited English proficiency, making modifications to training required of incoming students, strengthening formal liaisons between CHS and units serving underrepresented students, and establishing an access and civil rights coordinator.

Senior Tyren Thompson, a member of the Cowlitz Tribe, is pleased CHS recognizes that some students, whether they be underrepresented or international, are hesitant to take advantage of CHS services.

“These are excellent ideas,” said Thompson. “In the case of Native Americans, we face unique challenges often coming from impoverished communities and being the least-represented minority on campus. A lot of us don’t understand mental health, for example, or know there are mental health services on our campus. Many of us can benefit from them.”

Interpreter at your fingertips

The medical field is widely known for its complicated terminology. Cougar Health Services Medical Director Bonnie de Vries said a doctor and a patient who speak the same language at home can have difficulty understanding one another. Any lack of understanding is not only frustrating for the patient and health care provider, de Vries said it can be dangerous if a patient’s ailment is not detected or treated in an effective manner.

Starting this semester CHS began offering a free medical interpretation service for students who have difficulty understanding or communicating during a health visit.

“When there is difficulty in communication, a doctor might wonder if they are giving the right diagnosis and treatment,” de Vries said. “At the same time, does the patient really understand the instructions the doctor is giving, or are they just nodding as if they do?”

Through a partnership with a private company, patients can be connected in real time to a medical professional that can speak everything from Arabic and Mandarin to Swahili and Portuguese. Even American Sign Language is available.

The interpreter appears on a tablet that is mounted at eye-level on a wheel cart, which allows the interpreter to follow a student from check-in at the lobby, to their visit with a nurse or doctor, and then to the pharmacy, if needed.

The timing for the implementation of this service was good, according to de Vries, as some students have been using it to learn and ask questions about the Coronavirus (COVID-19) outbreak.

“It is also important for students to know that since the interpreters are highly trained medical professionals, their medical information remains private and protected,” she said.

Different comfort zones

All new WSU students are required to participate in educational sessions conducted by CHS. Undergraduates who are under 21 must attend Booze, Sex and Reality Checks (BSRC), and all new students, regardless of age, must participate in the Bystander Intervention Program, which trains students to identify sexual violence, dating violence or stalking, and act when warranted.

The CHS health promotion team conducted surveys and focus groups with students and learned that the training did not resonate as well with some international and domestic multicultural students.

Paula Adams, director of health promotion, said when international students take the training during Week of Welcome, most are new to the United States and have not yet learned the cultural norms around sexual activity and substance use.

“There are so many cultural differences around what constitutes discriminatory behavior,” Adams said. “To require an international student to participate in this training without adapting the content to make it meaningful to them, seemed like a disservice.”

Adams and her team worked with WSU’s International Programs and solicited feedback from international graduate students who have facilitated the training. They learned that adapting some language and incorporating examples that are more relevant to international students and their experiences, makes a big difference in how they perceive the training.

“We are asking them to move outside their comfort zone which is different from culture to culture,” said Ellen Taylor, associate vice president for Student Affairs. “We want them to feel that no matter what culture they represent, they know how to be an active bystander while staying true to their cultural values.”

Adams also worked with the Gender Identity/Expression and Sexual Orientation Resource Center (GIESORC) last August to make the educational sessions part of QHORT, a day-long series of workshops the LGBTQ community attended as a group.

“They had a lot of questions, enjoyed the conversation, and appreciated having the opportunity to explore the topics in a group in which they felt comfortable and safe,” Adams said. “This work extends our longstanding liaison work with underrepresented communities and expands how we are adapting to meet the needs of all students.”

Making key Connections

Thompson regularly consults with a team of providers at CHS that help him manage his symptoms of depression, anxiety, and burnout. He said he receives excellent service and credits CHS for keeping him in school and on track to graduate in December.

When he first reached out for help, he was encouraged by a staff member in Native American Programs to visit CHS. He didn’t follow through until later when he consulted with someone in the Dean of Students Office, who called CHS on his behalf and got him an appointment right away. That call made all the difference for him.

Jennifer Ellsworth, director of counseling and psychological services (CAPS), said her team of psychologists, social workers, doctoral interns, and post-docs, have been more deliberate in serving as liaisons to many departments on campus, including those that focus on diverse student such as the International Center, GIESORC, the Access Center, and Multicultural Student Services (MSS).

“It stems from us wanting to build connections and make sure what we are doing gets communicated more broadly to students,” Ellsworth said.

CAPS Training Director Jane Barga said the intern and postdoc liaisons build time into their weekly schedules to visit their chosen department and get to know the staff and the needs of the students they serve. They also receive guidance from a CAPS faculty member assigned to the same department.

“Based upon what the needs are at that time, they take on more specific tasks to address them,” Barga said. “For example, our recent liaisons for MSS have co-facilitated one of the peer mentor classes where they contribute, among other things, mental health perspectives.”’

Ellsworth said the entire CAPS team takes part in extensive training to equip themselves with knowledge and skills to help them work effectively with diverse populations.

Behavioral Health Psychologist Jeremy Rutherford is taking on new duties as access and civil rights coordinator for CHS. Taylor said Rutherford will serve as a point person for students who raise concerns about access to equitable care. While not an investigator, he will work closely with professionals in the Office of Civil Rights Compliance and Investigation and others to resolve issues.

“Whether or not these initiatives set us apart from other universities, what I’m proud of is we are not just going along with what we’ve always done,” Taylor said. “We are taking time to pause, re-evaluate, and ask ourselves where we can improve.”