interpreters and translators in health care wilma alvarado-little, ma national council on...

INTERPRETERS AND TRANSLATORS IN INTERPRETERS AND TRANSLATORS IN HEALTH CARE HEALTH CARE

Wilma Alvarado-Little, MAWilma Alvarado-Little, MA

National Council on Interpreting in Health CareNational Council on Interpreting in Health Care

April 25, 2007 April 25, 2007

New York State Conference on Increasing Language Access to Healthcare:Toward Effective State and National Policies

Increasing Language Access to HIncreasing Language Access to Healthcareealthcare

• How to determine if an interpreter or translator How to determine if an interpreter or translator is qualifiedis qualified

• Certification, testing and educational programs Certification, testing and educational programs for training staff as interpreters and translatorsfor training staff as interpreters and translators

• Criteria for contract interpreters and translators Criteria for contract interpreters and translators • How to effectively utilize community-based How to effectively utilize community-based

interpretersinterpreters• The role of the National Council on Interpreting The role of the National Council on Interpreting

in Health Carein Health Care

INTERPRETERS AND TRANSLATORS IN HEALTH CAREINTERPRETERS AND TRANSLATORS IN HEALTH CARE

Increasing Language Access in HIncreasing Language Access in Healthcareealthcare

• Staff interpreters:Staff interpreters:

on call, contingency, bilingual employees, sign on call, contingency, bilingual employees, sign language language

• TelephonicTelephonic

• Agency Agency

• Community based organizationsCommunity based organizations

• Volunteer: employee Vs. non gratuitous staff Volunteer: employee Vs. non gratuitous staff




INTERPRETER CODE OF ETHICSINTERPRETER CODE OF ETHICS

CHIACHIA IMIAIMIA NCIHCNCIHC BRIDGING THE GAPBRIDGING THE GAP



Some roles of a medical interpreterSome roles of a medical interpreter

– ConduitConduit– ClarifierClarifier– EducatorEducator– Cultural BrokerCultural Broker– Advocate Advocate



Different name for a role, similar role!Different name for a role, similar role!

Don’t be afraid to askDon’t be afraid to ask!!

Increasing Language Access in HIncreasing Language Access in Healthcare ealthcare


How to determine if an interpreter or translator is How to determine if an interpreter or translator is qualified:qualified:

• Educational Requirements Educational Requirements • Oral and/or written assessment Oral and/or written assessment • Experience in the medical fieldExperience in the medical field• Training in Interpretation & Medical TerminologyTraining in Interpretation & Medical Terminology• Ethical dilemmas and the awareness of the Ethical dilemmas and the awareness of the

different rolesdifferent roles

Increasing Language Access in HIncreasing Language Access in Healthcare ealthcare


Certification, testing and educational programs Certification, testing and educational programs for training staff as interpreters and translatorsfor training staff as interpreters and translators

Translators Translators • Expertise to conduct written translationsExpertise to conduct written translations• Knowledge of the culture of the population Knowledge of the culture of the population

served served • Cost - i.e per word, editing, formatting Cost - i.e per word, editing, formatting



Criteria for contract interpreters and Criteria for contract interpreters and translatorstranslators

• Insurance Insurance

• Training programTraining program

• FlexibilityFlexibility

• Awareness of population servedAwareness of population served



Criteria for contract interpreters and translatorsCriteria for contract interpreters and translators• Language InterpretersLanguage Interpreters• Qualifications/TrainingQualifications/Training• Experience in the medical field?Experience in the medical field?• Rates... Additional fees i.e. Late emergency fees, Rates... Additional fees i.e. Late emergency fees,

travel fees, evening fees, weekends/holidaystravel fees, evening fees, weekends/holidays• Availability i.e. Requests in advance at least 24 Availability i.e. Requests in advance at least 24

hourshours• Immediate availability?Immediate availability?• Contracts?..i.e. Per event, annual (#of minimum Contracts?..i.e. Per event, annual (#of minimum

of hours per month)of hours per month)



Criteria for telephonic interpreting Criteria for telephonic interpreting • Rates- Increments vs flat feeRates- Increments vs flat fee• LanguagesLanguages• ContractsContracts• Equipment – double receiver vs cordless vs portable Equipment – double receiver vs cordless vs portable • Tracking of calls – monthly vs quarterlyTracking of calls – monthly vs quarterly• TrainingTraining• TerminologyTerminology• Style- consecutive vs simultaneousStyle- consecutive vs simultaneous• Customer ServiceCustomer Service



How to effectively utilize community-based How to effectively utilize community-based interpretersinterpreters

• Community-based organizationsCommunity-based organizations

• Mutual understanding of rolesMutual understanding of roles

• Compensation for servicesCompensation for services

• Dual role Dual role



The role of the National Council on Interpreting The role of the National Council on Interpreting in Health Care in Health Care

The NCIHC is a multidisciplinary organization The NCIHC is a multidisciplinary organization based in the United States whose mission is based in the United States whose mission is to promote culturally competent professional to promote culturally competent professional medical interpreting as a means to support medical interpreting as a means to support equal access to health care for individuals equal access to health care for individuals with limited English proficiencywith limited English proficiency..



The role of the National Council on Interpreting in The role of the National Council on Interpreting in Health CareHealth Care

MissionMission

To promote culturally competent professional To promote culturally competent professional medical interpreting as a means to support equal medical interpreting as a means to support equal access to health care for individuals with limited access to health care for individuals with limited English proficiency. English proficiency.



The National Council on Interpreting in Health CareThe National Council on Interpreting in Health CareGovernanceGovernance

•2 Co-chairs of the Executive Board of the Council2 Co-chairs of the Executive Board of the Council•SecretarySecretary•Treasurer Treasurer 2 co-chairs for the 5 committees2 co-chairs for the 5 committees

–Membership Membership –Organizational DevelopmentOrganizational Development–Outreach Outreach –Policy and ResearchPolicy and Research–Standards, Training and CertificationStandards, Training and Certification



The NCIHC website:The NCIHC website:

http://www.ncihc.orghttp://www.ncihc.org

It provides valuable information regarding:It provides valuable information regarding:• Monthly updates involving the interpreter professionMonthly updates involving the interpreter profession

• Language access resourcesLanguage access resources

• Policy InitiativesPolicy Initiatives

• The NCIHC Working Paper Series The NCIHC Working Paper Series



• The National Code of Ethics for Health Care The National Code of Ethics for Health Care InterpretersInterpreters

• The National Standards of Practice for The National Standards of Practice for Health Care InterpretersHealth Care Interpreters



References:References: Fernandez, A. Schillinger D, Grumbach K, Rosenthal A, Stewart AL, Wang F, Fernandez, A. Schillinger D, Grumbach K, Rosenthal A, Stewart AL, Wang F,

Perez-Stable Perez-Stable EJ. Physician EJ. Physician Language Ability and Cultural Competence: An Language Ability and Cultural Competence: An Exploratory Study of Exploratory Study of Communication with Spanish-Communication with Spanish- speaking Patients. J Gen speaking Patients. J Gen Intern Med. 2004:19(2):167-174Intern Med. 2004:19(2):167-174

Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, Hart EJ. Errors Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, Hart EJ. Errors in Medical in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Interpretation and Their Potential Clinical Consequences in Pediatric Encounters.Encounters. Pediatrics. Pediatrics. 2003;111(1):6-142003;111(1):6-14 Johnson RL, Saha S, Arbelaez JJ, Beach, MC, Cooper LA.Johnson RL, Saha S, Arbelaez JJ, Beach, MC, Cooper LA. Racial and Ethnic Racial and Ethnic

Differences in Differences in Patient Patient Perceptions of Bias and Cultural Competence in Health Perceptions of Bias and Cultural Competence in Health Care. J Gen Intern Med Care. J Gen Intern Med 2004: 19:101-110. 2004: 19:101-110.

Flores, G. Language Barriers to Health Care in the United States The New Flores, G. Language Barriers to Health Care in the United States The New England Journal of Medicine. July 2006, 225-231England Journal of Medicine. July 2006, 225-231



References:References:Working Together to End Racial and Ethnic Disparities: One Physician Working Together to End Racial and Ethnic Disparities: One Physician at a Timeat a Time

www.ama.assn.org/go/healthdisparitieswww.ama.assn.org/go/healthdisparities

Proceedings of the 2005 White House Conference on Aging Mini-Proceedings of the 2005 White House Conference on Aging Mini-Conference on Health Literacy and Health Disparities, American Conference on Health Literacy and Health Disparities, American Medical Association, 2005 Medical Association, 2005

www.ama-assn.org/go/agingwww.ama-assn.org/go/aging

Language as a Barrier to Health Care for New York City Children in Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives. A Report Immigrant Families: Haitian, Russian and Latino Perspectives. A Report of the Division of Health Policy and the New York Forum for Child of the Division of Health Policy and the New York Forum for Child Health The New York Academy of Medicine, May 2006Health The New York Academy of Medicine, May 2006

http://www.ama.assn.org/go/healthdisparities

http://www.albany.edu/cemhd/albastrogatzdiabetesreport.pdf



RESOURCESRESOURCES• HHS- Office for Civil Rights HHS- Office for Civil Rights http://www.hhs.gov/ocr/lep/http://www.hhs.gov/ocr/lep/. .

• The National Health Law Program The National Health Law Program http://www.healthlaw.org/langaccess/fedadmin.htmlhttp://www.healthlaw.org/langaccess/fedadmin.html or or http://www.healthlaw.org/langaccess/promisingpractices.htmlhttp://www.healthlaw.org/langaccess/promisingpractices.html#interpreters#interpreters

• http://www.healthlaw.org/langaccess/stateactivities.htmlhttp://www.healthlaw.org/langaccess/stateactivities.html

• Language Services Action Kit produced by NHeLP and The Language Services Action Kit produced by NHeLP and The Access Project. It can be downloaded free from Access Project. It can be downloaded free from www.accessproject.orgwww.accessproject.org

http://www.hhs.gov/ocr/lep/

http://www.healthlaw.org/langaccess/fedadmin.html

http://www.healthlaw.org/langaccess/promisingpractices.html#interpreters

http://www.healthlaw.org/langaccess/promisingpractices.html#interpreters



References:References:Working Together to End Racial and Ethnic Disparities: One Physician Working Together to End Racial and Ethnic Disparities: One Physician at a Timeat a Time

www.ama.assn.org/go/healthdisparitieswww.ama.assn.org/go/healthdisparities

Proceedings of the 2005 White House Conference on Aging Mini-Proceedings of the 2005 White House Conference on Aging Mini-Conference on Health Literacy and Health Disparities, American Conference on Health Literacy and Health Disparities, American Medical Association, 2005 Medical Association, 2005

www.ama-assn.org/go/agingwww.ama-assn.org/go/aging

Language as a Barrier to Health Care for New York City Children in Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives. A Report Immigrant Families: Haitian, Russian and Latino Perspectives. A Report of the Division of Health Policy and the New York Forum for Child of the Division of Health Policy and the New York Forum for Child Health The New York Academy of Medicine, May 2006Health The New York Academy of Medicine, May 2006

http://www.ama.assn.org/go/healthdisparities

http://www.albany.edu/cemhd/albastrogatzdiabetesreport.pdf



References:References:Vasquez, C., Javier RA. The problem with interpreters: Communicating Vasquez, C., Javier RA. The problem with interpreters: Communicating with Spanish-speaking patients. Hospital and Community Psychiatry. Feb with Spanish-speaking patients. Hospital and Community Psychiatry. Feb 1991, 42 (2) 163-1651991, 42 (2) 163-165

Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, D.C.: National Academic Press; Disparities in Healthcare. Washington, D.C.: National Academic Press; 20022002

Centers for Disease Control and Prevention. Office of Minority Health-Centers for Disease Control and Prevention. Office of Minority Health-Eliminating Racial and Ethnic Health Disparities. Eliminating Racial and Ethnic Health Disparities. www.cdc.gov/omh/AboutUs/disparities.htmwww.cdc.gov/omh/AboutUs/disparities.htm or or www.cdc.gov/omhd/[email protected] www.cdc.gov/omhd/[email protected]

Karliner LS, Perez-Stable EJ, Gildengorin G. The Language Divide. The Karliner LS, Perez-Stable EJ, Gildengorin G. The Language Divide. The Importance of Training in the Use Importance of Training in the Use of Interpreters for Outpatient of Interpreters for Outpatient Practice. J Gen Intern Med 2004:19(2):175-83Practice. J Gen Intern Med 2004:19(2):175-83

http://www.ama-assn.org/go/aging


INTERPRETERS AND TRANSLATORS IN HEALTH INTERPRETERS AND TRANSLATORS IN HEALTH CARECARE

• National Council on National Council on Interpreting in Health Care Interpreting in Health Care (NCIHC)(NCIHC) http://www.ncihc.org http://www.ncihc.org

• Diversity RXDiversity RXhttp://www.diversityrx.org/http://www.diversityrx.org/

• The California EndowmentThe California Endowment http://www.calendow.org/http://www.calendow.org/• National Health Law National Health Law

Program (NHeLP)Program (NHeLP)http://www.healthlaw.org http://www.healthlaw.org

• Health and Human Health and Human Services Office for Civil Services Office for Civil RightsRightshttp://www.hhs.gov/ocr http://www.hhs.gov/ocr

• Office of Minority HealthOffice of Minority Healthhttp://www.omhrc.gov/http://www.omhrc.gov/OMHRCOMHRC

• New York State New York State www.dos.state.ny.us/info/www.dos.state.ny.us/info/register/2006/sep13/pdfs/register/2006/sep13/pdfs/rules.pdf>rules.pdf>

• American Translators American Translators AssociationAssociationhttp://www.atanet.orghttp://www.atanet.org

• California Health Care California Health Care Interpreting AssociationInterpreting Associationhttp://chia.ws http://chia.ws

• Massachusetts Medical Massachusetts Medical Interpreter AssociationInterpreter Associationhttp://www.mmia.orghttp://www.mmia.org


Thank you!Thank you!

National Council on Interpreting in Health Care National Council on Interpreting in Health Care

270 W. Lawrence Street270 W. Lawrence Street

Albany, NY 12208Albany, NY 12208

[email protected] [email protected]

Wilma Alvarado-Little, MAWilma Alvarado-Little, MA

[email protected]@walvarado-little.net

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