- What is health care interpreting?
- What is the definition of a qualified interpreter?
- What is the difference between a health care interpreter and a bilingual individual?
- What is the difference between “interpreting” and “translation”?
- What should professional health care interpreters know to do a good job?
- What types of services should a health care provider/organization provide with regards to language access?
- Is there a difference between qualified and certified interpreters?
- Who pays for interpreter services?
- Is there a law that requires provision of interpreters?
- Where can I find health care interpreters?
- How do I know if a language service provider/agency is qualified?
- Do health care professionals make good interpreters?
- Where can I find training?
- My organization is thinking about starting an interpreter services program. Where should we begin?
1. What is health care interpreting?
Interpreting that takes place in health care settings of any sort, including doctor’s offices, clinics, hospitals, home health visits, mental health clinics, and public health presentations. Typically, the setting is an interview between a health care provider (doctor, nurse, lab technician) and a patient (or the patient and one or more family members).
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2. What is the definition of a qualified interpreter?
An individual who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages, and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.
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3. What is the difference between a health care interpreter and a bilingual individual?
A bilingual individual is a person who has some degree of proficiency in two languages. A high level of bilingualism is the most basic qualification of a competent interpreter, but by itself does not ensure the ability to interpret. A bilingual employee may provide direct services in both languages but is not qualified to serve as an interpreter without additional training. See above for the definition of a qualified interpreter.
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4. What is the difference between “interpreting” and “translation”?
In popular usage, the terms “translator” and “translation” are frequently used for conversion of either oral OR written communications. However, within the language professions, translation is distinguished from interpreting according to whether the message is produced orally (interpreting) or in writing (translation). NHeLP has published What’s in a Word: A Guide to Understanding Interpreting and Translation that further describes these differences and how they may impact the health care setting.
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5. What should professional health care interpreters know to do a good job?
The following components comprise a reasonably comprehensive process for initial assessment of the qualifications for health care interpreting.
- Basic language skills. General proficiency in speaking and understanding each of the languages in which the applicant would be expected to work. If multiple languages are involved, it is essential that the applicant’s ability in each language be assessed, especially those in which the applicant may have more limited proficiency.
- Code of Ethics. Recognition of ethical issues, knowledge of ethical standards (a code of ethics) and ethical decision-making.
- Cultural issues. Ability to anticipate and recognize misunderstandings that arise from the differing cultural assumptions and expectations of providers and patients and to respond to such issues appropriately.
- Health care terminology. Knowledge of commonly used terms and concepts related to the human body; symptoms, illnesses, and medications; and health care specialties and treatments in each language, including the ability to interpret or explicate technical expressions.
- Integrated interpreting skills. Ability to perform as required for employment, demonstrated by interpreting a simulated cross-linguistic interview with acceptable accuracy and completeness while monitoring and helping to manage the interaction in the interest of better communication and understanding.
- Translation of simple instructions. Ability to produce oral translations, or, where appropriate, brief written translations, of written texts such as signage, or medicinal labels.
6. What types of services should a health care provider/organization provide with regards to language access?
The U.S. Department of Health and Human Services Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons describes various options available for providing oral language assistance, including the use of bilingual staff, staff interpreters, or contract interpreters. The guidance stresses that interpreters need to be trained and competent, though not necessarily formally certified, and discourages the use of friends and family members, particularly minors, as interpreters.
In order to comply with Title VI, health care providers/organizations that receive federal funding can determine the type of language services, the extent of language access assistance, and the responsibility for translating vital documents by using the Four-Factor Analysis and Safe Harbor as guides.
The extent of responsibility can be determined using an individualized assessment that balances the following four factors:
- The Number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee;
- The Frequency with which LEP individuals come in contact with the program;
- The Nature and importance of the program, activity, or service provided by the program to people’s lives; and
- The Resources available to the grantee/recipient of federal funding and costs.
The following actions are considered strong evidence of compliance with written-translation obligations:
- Written translations of vital documents for each eligible LEP language group that constitutes 5% or 1000, whichever is less, of population served.
- If 5% includes less than 50 persons, providing oral interpretation of written materials and notice of such right.
Additional information regarding the Four-Factor Analysis and Safe Harbors can be found in the U.S. Department of Health and Human Services guidance.
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7. Is there a difference between qualified and certified interpreters?
A certified interpreter is an interpreter who is certified as competent by an accredited certification organization or government entity through rigorous testing based on appropriate and consistent criteria. Interpreters who have had limited training or have taken a screening test administered by an employing health, interpreter or referral agency are not considered certified.
Information regarding health care interpreter certification: http://www.healthcareinterpretercertification.org.
Information regarding translator certification: http://www.atanet.org/certification/index.php.
A qualified interpreter is an individual who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages, and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.
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8. Who pays for interpreter services?
Patients themselves are under no obligation to pay for these services. Thirteen states currently provide reimbursement for language services provided to Medicaid enrollees. For more information, see the National Health Law Program’s publication, Medicaid/SCHIP Reimbursement Models for Language Services: 2007 Update. Some health care providers pay for interpreter services themselves. For more information, see the NHeLP publication Providing Language Interpretation Services in Small Health Care Provider Settings: Examples from the Field (April 2005). This report focuses specifically on promising practices for providing language services in small health care provider settings, including solo and small group practices and community clinics.
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9. Is there a law that requires provision of interpreters?
Yes. The following are key laws and policy guidance concerning provision of services to people with limited English proficiency (LEP):
- Title VI of the Civil Rights Act of 1964
- HHS Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons With Limited English Proficiency
- DOJ Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons
- Culturally and Linguistically Appropriate Services Standards for Health Care
- Executive Order 13166
- Strategic Plan to Improve Access to HHS Programs and Activities by Limited English Proficiency Persons
For an explanation of these federal laws and policies, see NHeLP’s publication Language Services Action Kit (2004). For an explanation of federal laws concerning language access and examples from the field in video format, see the LEP Video, Breaking Down the Language Barrier: Translating Limited English Proficiency Policy into Practice, which can be ordered through www.lep.gov.
For a more comprehensive explanation of language access responsibilities under federal and state law, as well as in the private sector, and recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic Access in Health Care Settings: Legal Rights & Responsibilities (2nd edition, August 2003).
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10. Where can I find health care interpreters?
Professional interpreters often belong to translator and interpreter associations or work through language service providers. For a list of translator and interpreter associations, see NCIHC’s Interpreter Associations page. For language service providers and additional information, see RHTAC’s Resource Guide of Language Service Providers.
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11. How do I know if a language service provider/agency is qualified?
An excellent resource on choosing and evaluating a language agency is How to Choose and Use a Language Agency from The California Endowment. Much of the following information derives from that document. There are a number of considerations regarding quality of interpreting when considering a language agency:
- How does the agency recruit interpreters/translators? An agency that does not maintain relationships with immigrant and refugee communities, professional interpreter organizations, and training programs may have difficulty filling an institution’s needs.
- How does the agency screen interpreter candidates? Although it is unrealistic to expect all interpreters to have a college degree, they should be screened for proficiency in the languages they will be interpreting.
- Does the agency require interpreters to have received professional training in interpreting? While few interpreters will have degrees in interpreting, they should have received some form of professional training. The longer the training, the better, though 40 hours is common for basic training programs. Training should cover the interpreter role, ethics, modes, basic conversation skills, handling the flow of the session, intervening, and medical terminology, and should involve skill building and practice.
- Does the agency require any continuing education of its employees/contractors? If so, how much and what sort of proof do the employees/contract interpreters have to offer? Continuing education is important for active interpreters and may be offered by local interpreter associations, colleges, or other organizations.
- How does the agency assess its interpreters’ qualifications? Unlike in the legal interpreting field, true certification programs for medical interpreters are rare. The situation varies by state, language, and company, but certification opportunities and requirements will likely increase over the next few years.
- What code of ethics are the interpreters/translators expected to follow? The National Council on Interpreting in Health Care created a National Code of Ethics for health care interpreters. Before the development of the National Code of Ethics, numerous agencies and regional associations produced their own codes, the most prominent being those of the Massachusetts Medical Interpreters Association and the California Health Interpreters Association. An interpreter who has gone through any formal training should be aware of the principles contained in at least one of these codes of ethics.
12. Do health care professionals make good interpreters?
Bilingual health care staff are often used to interpret without any assessment of their skills. In the field of language access, they are often referred to as “dual-role interpreters.” In a recent study, a total of 840 dual-role staff interpreters were tested for Spanish (75%), Chinese (12%), and Russian (5%) language competence. Two percent did not pass, 21% passed at basic level, 77% passed at medical interpreter level. Staff that passed at the basic level were prone to interpretation errors, including omissions and word confusion. Thus, about 1 in 5 dual-role staff interpreters at a large health care organization had insufficient bilingual skills to serve as interpreters in a medical encounter. Health care organizations that depend on dual-role staff interpreters should consider assessing staff English and second language skills.
Source: Moreno, M. R., Otero-Sabogal, R. Newmann, J (2007) Assessing Dual-Role Staff-Interpreter Linguistic Competency in an Integrated Healthcare System Journal of General Internal Medicine 22(Suppl 2): 331–335.
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13. Where can I find training?
While there are few colleges or universities that offer programs in medical interpreting, there are other learning opportunities. For a list of colleges that offer general programs in translation and interpreting, see the American Translators Association website www.atanet.org under “careers.” For a list of training providers, visit our Language Services Resource Guide.
For self-guided learning about the profession, see NCIHC’s Working Papers Series, including a Code of Ethics for Interpreters in Health Care and Standards of Practice for Interpreters in Health Care, as well as a glossary of terms. There is also a good description of the profession at Explore Health Careers.
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14. My organization is thinking about starting an interpreter services program. Where should we begin?
Learn as much as you can about health care interpreting, starting with the FAQs on this page. Then, review NCIHC’s working paper, Linguistically Appropriate Access and Services: An Evaluation and Review for Health Care Organizations. You will find a similar tool in a publication by The Joint Commission entitled, Advancing Effective Communication, Cultural Competence and Patient- and Family-Centered Care: A Roadmap for Hospitals and also Hablamos Juntos: Language Policy and Practice in Health Care.
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Contributed by The National Council on Interpreting in Health Care (NCHIC)