Category Archives: CLAS

Interpreting Certification Compared (Spoken Language)

Spoken Language Interpreting Certification in the United States: a comparison

Competency-based assessments are the foundation of credentialing in many professions, one of which is interpreting. According to the National Commission for Certifying Agencies, an assessment instrument is any one of several standardized methods for determining if candidates possess the necessary knowledge and skills related to the purpose of the certification. Professional certification is therefore a voluntary process and is bestowed by an organization granting recognition to an individual who has met certain eligibility requirements and successfully completed a rigorous assessment based on a job task analysis.

Interpreter certification is akin to licensure in many other professions such as psychology, occupational therapy, social work, professional counseling, architecture, or nursing. In the United States, there are three certifying bodies for medical interpreters: NBCMI, CCHI and DSHS/LTC (see chart attached). In this chart we are also including the Oregon Court Interpreting certification for comparison purposes because interpreters move from one field to another in their scope of work on a regular basis. Interpreters will have to choose which certification to pursue based on their working languages, the availability of testing sites, the delivery modality (on-site v. remote interpreting) and the applicable federal and state laws and regulations. In the State of Oregon, the Oregon Health Authority is the government agency responsible for regulating medical interpreters.

The following table compares the different certifications. These certifications meet the requirements of the Federal government on this page.

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Teamwork in translation with Tuality

I just finished working as a team with a client. It’s been awesome to help Tuality launch their website in Spanish! Check it out!

When we started working, we went over this worksheet. We have been faithful to those principles in every project we have done together.

Here is the Spanish site.

Here is the English site.

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ASTM Interpreting and Translation Standards

This presentation was prepared for two school Districts in Oregon. Recently, some Oregon school districts have made the news because they have had multiple Title VI complaints. The  language access principles presented here should help school districts implement policies that enable them to use their funds effectively and avoid these problems.

Schools base their language access service on Title VI, which prohibits discrimination on the basis of race, color or national origin in any program or activity that receives Federal funds or Federal financial assistance. This page from the U.S. Department of Health and Human Services and this page from the United States Department of Justice refer to Title VI in more detail.

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Children and other family members as interpreters

CLAS Standard 7: Competence of interpreters – Use of untrained individuals and/or minors as interpreters should be avoided

According to CLAS 7:

Untrained family, friends, minors, and staff often do not possess the necessary skills to provide meaningful language services. Moreover, given their relationship to the patient, the use of friends, family members, and minors may compromise the autonomy and confidentiality of the communication (AMA, 2006; Diamond & Jacobs, 2010).

Why not work with trusted family members who are bilingual?

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Bilingual staff as interpreters – CLAS 7

CLAS Standard 7: Competence of interpreters – Use of untrained individuals and/or minors as interpreters should be avoided

The use of clinical and nonclinical staff who speak a non-English language but who are untrained in medical interpretation can pose potential safety risks (Regenstein et al., in press). Research has shown that when clinicians speak a non-English language, or when untrained bilingual staff is available, an important set of potential barriers can arise and hinder the effective and appropriate use of trained interpreters (Maul, Regenstein, Andres, Wright, & Wynia, 2012).

All those who provide language services should be held to the same standards, regardless of their place of employment.

In other words, based on their needs, organizations should use a combination of bilingual employees, contract interpreters and staff interpreters, but they should all be held to the same standards:

  • Have the necessary language skills to understand and speak the languages in question.
  • Have the necessary skills to transfer meaning from one language to another accurately.
  • Have the necessary training in terminology, protocols, ethics and standards of practice to provide appropriate services in the setting.

As an interpreter, I have seen medical practitioners try to apply their Spanish skills a few times. In some cases, their Spanish was truly not sufficient to communicate effectively. As an interpreter, I established my role promptly and professionally, and provided my services so communication was accurate and effective.

The desire to have direct communication is commendable, and it is appropriate for some levels of communication. As I traveled in foreign countries as an interpreter, I have certainly observed that people who made an effort to introduce themselves in the language of the other person were more effective in making a personal connection. However, when it comes down to the medical interview, when a diagnosis is at risk, a professional interpreter must be allowed to use their professional skills to avoid the risks of misdiagnosis. This risk can happen early on in a conversation!

See “Foreign Language for Doctors?

I recommend that bilingual staff who intend to use their foreign language professionally be tested by LTI for the skills they are expected to use. If they are expected to speak the language, they should take the oral proficiency test. If they are expected to write the language, they should take the writing proficiency test. The industry standard for professional proficiency is Advanced High on the ACTFL scale or ILR 3. Not everyone who graduates with a Bachelors in a foreign language achieves these levels. See this post for more information.

Communicating at various levels of formality

CLAS Standard 7: Competence of interpreters – Ability to communicate in all registers and at varying levels of formality

What is a “register”?

The “register” is the variety of the language we use in a particular social setting or for a particular purpose. For example, we speak differently at a doctor’s office, our friends’ living room, or when we want to express approval, anger, respect, or insults.

This may seem obvious, but some of my students have found it a challenge when they learned that some words they use are actually considered unprofessional in some places, or when we have discussed how to interpret insults. They’ve been frustrated, and wondered how to pick up that register they are missing. It seems such an impossible task! So… we give up and say it can’t be done.

Why bother? As interpreters, we must interpret not just the words, but the words in their cultural context: the linguaculture. The register reflects the cultural aspect, the social and cultural aspect of the encounter. When we alter the level of formality, the level of casualness or even refrain from interpreting insulting language, we are changing the interaction.

To do this, we must read many types of material continually. I read the following types of material:

  • The Merck Manual for Home Health both in English and in our non-English working language
  • Cuban short stories
  • Chilean short stories
  • The newspapers of the countries our patients come from, online

As we develop this variety of registers, the people we interpret for will become more comfortable in the interpreted setting and will be able to express themselves more confidently, knowing we can express their messages accurately.

What skills should a medical interpreter develop?

According to the Cultural and Linguistic Appropriate Services Standards, published by the Office of Minority Health, US Department of Health and Human Services, in April of 2013, Standard 7 says: Ensure the competence of individuals providing language assistance.

The skills listed are:

  • Active listening: Interpreters must listen more intensely than anyone else, in order to faithfully render the message.
  • Message conversion: This skill involves analysis of the message and how to find equivalent ways to express it in the target language. High levels of language proficiency in the source and target languages are a prerequisite for this skill!
  • Clear and understandable speech delivery: To develop this skill, interpreters may need to work outside of class, listen to each other for clarity, focus on diction, critique each other’s clarity of speech, etc.
  • Medical terminology: Anatomy, physiology, diagnosis, prevention, treatment, management of illness and disease. Participants need to develop research skills in their non-English language to see how these topics are discussed in that language, beyond the simple use of a bilingual dictionary. Participants will be able to develop their own terminology database, write their own short articles on medical topics in both languages, and give short presentations on medical topics in both languages on short notice.
  • Sociolinguistics: The following areas are very complex and a short class can only introduce these topics.
  • Familiarity with regionalisms and slang in both languages
  • Ability to communicate at various levels of formality
  • Understanding of colloquialisms and idiomatic expressions in all working languages
  • Key concepts in health care: confidentiality, informed consent, patients’ rights. Legal concepts are beyond the scope of what a 64-hour class can cover in depth, but this course does provide an introduction to these topics.

In a 64-hour course, we must assume that students come with strong language proficiency. In class, we will be able to teach problem-solving strategies for all these areas, but will not be able to teach all the answers to any of them! A successful class will be one where students leave with the tools to continue learning with partners and colleagues, ready to continue studying in future workshops.

These concepts are introduced through lectures, readings, and occasionally guest speakers, student presentations and videos. They are reinforced with homework, role-plays and class discussions.

Interpreting role-playing is practiced in every session! Students gradually become confident enough to evaluate each other and interpret several sentences at a time, consecutively. Students ask questions by email and in class. Some of the discussions lead to blog posts! Sometimes the students write blog posts.

“Please speak directly to each other”, vs. “Please ask the patient to…”

The Minnesota Department of Health gives these recommendations for working with a healthcare interpreter.

As professional interpreters, we often introduce ourselves telling the provider… “and please speak directly to each other. I am simply here to be your voice in the other person’s language, saying exactly what you say.”

Often, doctors inadvertently lapse into this type of conversation…

Dr: Please tell the patient to sit down.

Interpreter: The doctor just asked you to sit down.

[Patient sits down.]

Doctor: Please ask the patient why she came.

Interpreter: The doctor would like to know why you are here.

Patient: Interpreter, what do you think I should tell the doctor? I don’t really know how to explain this…


 

Now, picture this conversation:

Doctor: Mary, good afternoon.

Interpreter: Good afternoon, Mary.

Mary: Good afternoon, Doctor.

Interpreter: Good afternoon, Doctor.

Doctor: Please sit down, Mary.

Interpreter: Please sit down, Mary.

[Mary sits down.]

Doctor: What brings you here today, Mary?

Interpreter: What brings you here today, Mary?

Mary: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…

Interpreter: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…


What differences do we see in these conversations?

  1. The interpreter is much more unobtrusive in the second one. The interpreter can stay out of side conversations effortlessly.
  2. The message conversion is much simpler, and therefore much more accurate!
  3. The patient is much more respected. The patient is treated just the same way as any other English-speaking patient. This helps the patient participate in his/her own decisions and avoid leaning on the interpreter for decision-making and security.

To encourage this direct communication, interpreters may use a variety of strategies:

  • Gestures, to remind the parties to communicate directly with each other
  • Visually positioning themselves so they are in the line of sight to encourage direct communication between the parties: people address the person they are looking at, so interpreters position themselves in a way to avoid neck strain on the part of the speakers.
  • Maintaining the register and the tone of voice, so the conversation is a true conversation
  • Interrupting the conversation as little as possible: using note-taking to allow the parties to express as complete of a thought as possible before interrupting the flow of their thinking.
  • Wearing clothing that does not attract attention to the interpreter.
  • Stepping out of the room every time the provider steps out of the room: when there is nobody who does not speak a language the patient does not understand, the interpreter is not needed. These may be good moments for the interpreter to clarify issues with the provider, if needed.

As interpreters, our goal is, as the Oregon Court Interpreters say, “to put the non-English speaker on the same footing as an English speaker”.

According to CLAS Standard 5, one of the purposes of language assistance is

  • To help individuals understand their care and service options and participate in decisions regarding their health and health care

The Oregon Law states that interpreters must follow the Standards of Practice of the National Council for Health Care Interpreters. On page 13, Standard of Practice #12 states:

The Interpreter promotes direct communication among all parties in the encounter.

For example, an interpreter may tell the patient and provider to address each other, rather than the interpreter.

Related ethical principle: Interpreters treat all parties with respect.

Memory skills!

CLAS Standard 7: Competence of interpreters – Providing effective and accurate communication between individuals and providers

To be able to accomplish this, memory skills are essential! An interpreter must be able to let the speakers express two or three sentences at a time. Why? Because people need to be able to express a coherent thought without interruption to be able to communicate effectively.

How can we do this?

In consecutive interpreting (turn-taking), taking notes is essential to be able to keep track of the details of the conversation. However, we do not take notes of everything that is said! We take notes of just what we need to keep the picture together. We might write down phone numbers, spell names, draw simple sketches, or use abbreviations. Whatever strategy we use, the goal is the same: to be able to express what the speaker said accurately and completely.

(See this post on the use of notepads)

How about in simultaneous interpreting? Do we still need a good memory to be able to interpret simultaneously?

Certainly! Interpreting isn’t just taking words from one language and repeating them in another language! Each language has its own word order, its own structure, which may be totally backwards from each other depending on the message being transmitted. We often delay our start significantly to accommodate for this! However, just yesterday I was speaking with a colleague who was asking me how she could explain this to a judge… How often do we, as interpreters, just go ahead and get started, and do a lower quality job, because of the pressure to perform in a way that the English speaker understands? But I digress…

To be able to restructure a sentence in a second language, we have to listen, analyze the content, structure it in a way that sounds smooth in the other language, speak it in the other language, and continue to listen to the material in the source language at the same time. In some ways, it’s like singing a round without knowing the music ahead of time. This is why we work with a partner! Simultaneous interpreting requires taking turns every 20 minutes or so to avoid losing too much quality. This applies to the very best interpreters in the world!

See this article, which is a report on an article by AIIC, the International Association of Conference Interpreters, on the subject.

Purpose of interpreting (CLAS Standard 5)

CLAS Standard 5 says:

In this post, I will quote the CLAS Standard 5 in normal font, and will give the Gaucha TI response in italics.

The purposes of offering communication and language assistance are:

  • To ensure that individuals with limited English proficiency and/or other communication needs have equitable access to health services
  • To help individuals understand their care and service options and participate in decisions regarding their health and health care
  • To increase individuals’ satisfaction and adherence to care and services
  • To improve patient safety and reduce medical errors related to miscommunication
  • To help organizations comply with requirements such as Title VI of the Civil Rights Act of 1964; the Americans with Disabilities Act of 1990; and other relevant federal, state, and local requirements to which they may need to adhere

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Skills and Qualifications Required for Interpreters per CLAS Standards

CLAS Standard 7: “Ensure the competence of individuals providing language assistance”

The Cultural and Linguistic Appropriate Services Standards published by the Office of Minority Health, US Department of Health and Human Services in April of 2013, are closely followed by many hospitals.

These standards have been written to reduce health inequities. Projections show that in 2050 the US demographic will be 29% Hispanic, 9% Asian. Currently, approximately 20% of the US population speak a language other than English at home.

As interpreters, we are part of the solution. Standard 7 focuses on the competence of individuals providing language assistance.

The skills mentioned in Standard 7 are critical. As I teach them to interpreters and I explain them to clients, these are my thoughts.

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CLAS Standards

This week I was reading the CLAS Standards. CLAS stands for Culturally and Linguistic Appropriate Services. I went to the Blueprint on the CLAS site, and downloaded the Blueprint. The full Blueprint is available for download here. EnhancedCLASStandardsBlueprint

Standard 7 reads:

Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

It was tremendously exciting to read the Standard, published in 2013, and find that everything I’ve been saying in my blog, to my students, to my clients, to the media, and everywhere else has been totally consistent with CLAS Standards.

Here are some slightly paraphrased examples:

  • Use of untrained individuals and/or minors as interpreters should be avoided.
  • The use of friends, family members and minors may compromise patient autonomy and confidentiality.
  • The use of trained interpreters resulted in reduced return rates to the Emergency Department and lower lengths of stay.
  • The use of clinical and nonclinical staff who speak a non-English language but are untrained in medical interpretation can pose potential safety risks.
  • Interpreters (“individuals providing language assistance, in CLAS 7”) should be trained.
  • The language ability of interpreters should be assessed according to the ACTFL/ILR scale (Language Testing International is the exclusive licensee of the ACTFL.)
  • Organizations may provide language assistance through a combination of bilingual staff, dedicated language assistance, etc. The important thing is that the language assistance is provided by competent individuals.

I have written blog posts about several of these issues. Hospitals are expected to follow CLAS standards. This should not be viewed as an unfunded mandate. When trained and qualified professionals do the work of interpreting, it enhances the quality of care without adding to the cost. Working with trained and qualified medical interpreters is a good business deal!