Healthcare Interpreting

By Judit Marin

CHIA (California Healthcare Interpreting Association) Vice President Rosario Nevado and Executive Director Don Schinske joined more than 69 attendees for a day-long forum on national certification May 1 in Boston. The event, which was hosted by Language Line Services, highlighted both some of the promise and problems in creating and implementing a universal standard for healthcare-interpreting competency.  The Boston gathering came off only after many weeks of discussions and negotiations. Representatives attended from all three of the main associations—CHIA, MMIA (now IMIA) and NCIHC—plus several smaller ones.

The formal program included presentations from:  

•  Holly Mikkelson, Adjunct Professor of Translation and Interpretation, Monterey Institute for International Studies, who gave an overview of the primary issues facing certification.
•  Martin Conroy, Director of New York’s Bureau of Hospitals and Primary Care, spoke on the likely need for having a certification process in place prior to securing adequate funding for language services
•  Gary Buck, PhD, Test Design consultant
•  Sam Campisi, manager of the Australian government’s national certification agency
•  Demetrio Gutierrez, Office of Minority Health, Oklahoma State Dept. of Health, who developed Oklahoma’s new state certification process.

Small-group discussions in the afternoon helped to define some of the main questions around the development, cost, and administration of a national certification process. When polled at the end of the meeting, the majority of attendees expressed interest in continuing the discussions. However, it remains unclear what path the discussions will now take. Nor is it clear which key stakeholders should work together to give the process some early shape.

CHIA believes there are compelling reasons to keep the conversation rolling:

1)  State policymakers are allowing room for certification. California’s new language-access (SB 853) regulations, which are now being finalized by the Departments of Managed Health Care and Insurance are expected to favor the use of certified interpreters once a certification process is implemented. Similarly, early discussions by the State’s Medi-Cal Language Access Services Task Force (of which CHIA is a member) have leaned toward recommending that a certification process be developed. At the same time, the State of California—perhaps the only entity with the resources to develop and roll out a California-specific certification—has shown no interest in developing certification itself.   

2)  Adequate funding is unlikely to appear without certification. Other states and various health systems have shown great creativity in securing funding to pay for at least part of the language services they provide. However, in an era when healthcare payers are insisting on measuring and paying for quality, it’s improbable that payment for interpreting services would arrive without an accepted guarantee of minimum competency.  

3) Adequate training is unlikely without certification. Opinions on this issue vary.  Some feel that a certification process unsupported by an adequate number of training programs will create shortages that could only be solved quickly  by a dilution in standards. Others feel that sufficient training will materialize almost naturally once the certification standards are announced, and some lead time is allowed before implementation. Regardless, a full supply of trained interpreters won’t materialize without adequate demand for trained interpreters, almost by definition.  And it is hard to see how demand could be fully generated without certification. 

4) Some states (WA, OK) have developed their own certification. Others (OR) are in the process. Some (MA) seem nearly ready. In California and many other states, it is likely that healthcare systems would create their own assessment tools (and many have done so already) or adopt commercial ones, such as Language Line’s. These trends aren’t wrong or bad. In terms of patient care, these changes generally represent an improvement over what has gone on before. But the piecemeal approach can not produce a single, portable standard that would be useful and meaningful for all stakeholders, including interpreters. And it is bound to yield wide inconsistencies in quality.

CHIA’s vision for healthcare interpreting is that it be a viable profession, with a valid certification process that will provide interpreters with the professional standing they deserve and assure their competency to those who use their services. CHIA’s leadership is willing not just to participate, but to help lead a serious push for national certification. 

Don Schinske (CHIA Executive Director)
Katharine Allen (CHIA President)

The Minnesota Panel

For three days between June 13th and June 15th, 2007, The “Expert Panel on Testing and Certification of Interpreters” event took place in Plymouth, Minnesota hosted by the Interpreting Stakeholder Group (ISG) and administered by Century College and the University of Minnesota through a grant from the Bush Foundation as part of a project named the Linking Voices project.

The meeting brought to the table major stakeholders intent on working together on issues of common concern around interpreter certification, and also attracted a local “gallery” of observers from the field. The “invitees” formed an eclectic mix of technical experts in test development and individuals with experiences in a variety of arenas such as designing, implementing, or building a support system for certification process.

CHIA was honored to be one of the “guests” among some of the major constituencies such as the National Council on Interpreting in Health Care (NCIHC) and the International Medical Interpreters Association (IMIA), formerly known as the Massachusetts Medical Interpreters Association (MMIA), together with state government representation from some of the states that have begun a certification process of their own such as the states of Indiana, Iowa, Oklahoma and Oregon.

From plenary sessions to workgroup sessions, the event hosted a variety of activities such as: sharing lessons learned from respective experiences with national or state certification initiatives; describing current efforts and outcomes; and discussing the implications of such lessons for the specific tasks assigned to the workgroup sessions.

State representatives from Indiana, Iowa, Oklahoma, Oregon and Minnesota provided perspectives on their state’s current efforts. At the national level, invaluable recommendations were received from the spokespersons for well-known and established programs such as the Registry of Interpreters for the Deaf, the National Center for Interpretation Testing, Research and Policy at the University of Arizona, and the National Center for State Courts/Consortium for State Court Interpreter Certification regarding the Federal Court Interpreter Certification Program.

At the state level, we heard feedback from the Interpreter and Translator Testing and Certification Program for the Washington State Department of Social and Health Services. CHIA also had the opportunity to contribute, alongside IMIA, our perspective from a state initiative standpoint by sharing lessons learned from the joint certification pilot project between the two associations, which took place in 2003 under the auspices of the NCIHC and with funding from the Office of Minority Health (OMH).  

In addition, a brief overview of three existing assessment tools was offered. Two of the tools in question were proprietary products created respectively by two corporations, Language Line Services and Network Omni Multilingual Communications, while the third tool was considered “vested in the public domain” due to being developed with funding from The California Endowment, by a consortium of non-profit organizations named the Connecting Worlds Partnership.
As the event concluded, a consensus seemed to have emerged from the workgroups with regard to the preliminary steps necessary to move towards the design of a certification test. The consensus called for “an empirical research that includes an interpreter job analysis, a review of existing standards of practice for interpreters, a survey of terminology and a legislative review.”

As an organization committed to advancing the profession of healthcare interpreting in the service of the public, CHIA prides itself in continuously finding common grounds on which to foster and nurture meaningful and successful relationships with its constituents as well as with all partners and stakeholders. To that end, CHIA looks forward to continue collaborating with our counterparts and all other parties in the field in a true spirit of inclusion and mutual support.