|
|
1.2 Interpreter Practice
1.2.1 Role and Practice Standards
Achieving quality in interpreter programs depends on
a commitment to using qualified interpreters. At this point, there is
great variation in job descriptions and roles of interpreters who practice
in health or social service settings. Court interpreter definitions are
becoming increasingly clear as states and federal agencies specify required
skills and/or certification. But in health/social services, the interpreter
can be anyone from a family member to the housekeeping staff to a college-educated,
certified interpreter. With a few exceptions, each agency defines interpreter
(or translator, as they are often incorrectly called) as it sees fit.
More commonly, they don't define the position at all and simply grab the
most available, apparently bilingual individual.
The application of sociolinguistics and discourse analysis
to the interpreted medical interview by linguist Bruce Downing
dramatically reveals what can go wrong between clinicians and patients
when the interpreter is not adequately skilled. For example, a close analysis
of an encounter between a nurse practitioner, a Russian-speaking patient
and his son acting as interpreter, uncovers the following list of miscommunications
by the "interpreter" in a conversation of only 25 exchanges of information:
the interpreter failed to understand the provider's question and did not
seek clarification - four times; the interpreter interfered with the flow
of the interview by having to ask for a paraphrase or for explanation
of particular words - four times; the interpreter misinterpreted because
of lack of understanding of particular words and idioms - five times;
the interpreter responded to a question himself without any attempt to
interpret the question or his English response to the patient - six times;
the interpreter volunteered his own opinions or information concerning
the patient - five times; the interpreter's failure to interpret the question
led the patient to try to guess what the question was and attempt an answer
- four times; the interpreter failed to interpret an answer offered by
the patient - six times; the interpreter seriously distorts the message
in the process of interpreting it, by adding information (twice), omitting
information (four times), or changing the meaning (seven times); the reply
that the nurse practitioner received from the patient through the interpreter
was the answer to a different question than the one she asked, but she
didn't know it - two times. This example dramatically illustrates the
potential of misdiagnosis, appropriate treatment, and liability for the
provider when untrained interpreters are used.
Assuring quality in an interpreted encounter depends
on commonly accepted definitions of role, interpreter training, and competency.
Clear and consistent definitions of role and practice standards are critical
for organization managers and interpreter directors who want to ensure
the harmonious integration of interpreters into a clinical or administrative
encounter. Staff who interact with interpreters need to know what they
do, what they don't do, and where responsibility lies for different aspects
of communication. Medical interpreters themselves are now working to clarify
the definition of medical interpreter role and to specify practice standards
and codes of ethics. Pioneering work by the Massachusetts Medical Interpreter
Association (MMIA) on practice standards for medical interpreters
has provided a foundation for discussion and adoption by other interpreter
groups nationally. The MMIA standards address issues of interpreter skill,
behavior, linguistic and cultural knowledge, and ethics. These standards
of practice were based on extensive research, focus groups, and a formal
analysis of a wide sample of practicing interpreter job responsibilities.
Another group, The National Council on Interpretation in Health Care,
has held 5 meetings since 1994 to discuss and move towards consensus on
role and practice issues, and has formally endorsed the MMIA standards
of practice. A new group, organized through the ASTM, is attempting to
develop and adopt national standards for interpretation generally, including
specific guidelines for medical interpretation.
1.2.2 Skills Assessment, Competency
Testing, Certification
Because the practice of using interpreters is still
largely ad hoc in many settings, frequently little attention is
paid to the skills and competency of any given individual called on to
interpret. Where skills and competency are addressed (i.e., in the model
programs cited in section 1.1.4), each organization typically uses its
own instrument to test individuals who may be selected or hired as interpreters,
or to test individuals for ability to undergo interpreter training. Assessing
competency is critical to assuring quality, and standardized tests for
medical interpreting skill and language competency can give providers
a necessary tool in this process.
Unfortunately, basic skills assessment is frequently
overlooked in the rush towards certification for interpreters. There has
been increasing pressure to develop both national and state level certification
programs; in fact, the MMIA is currently engaged in developing
a certification process for Massachusetts. However, two state certification
programs (California and Washington) have been very controversial for
a number of reasons: minimal adaptation of a court interpreter test for
use by medical/social service interpreters; bias/irrelevance for non-written
language groups; low passage rates by interpreters from language groups
other than Spanish; high cost of testing as a barrier for freelance community-based
interpreters, etc.
Certification is ideally an endpoint in a continuum
that includes widespread consensus about role definition, practice standards,
standardized curriculum elements, and standardized competency assessments.
While much progress has been made in each of these areas by the MMIA
in Massachusetts and the Cross Cultural Health Care Program
in Washington, additional development and dissemination, and the convening
of a national discussion to seek consensus is necessary. Some propose
addressing these issues on a state-by state basis. But given the intensive
effort to properly develop these elements of the continuum, this process
could be inefficiently replicated over and over without much agreement
for many years. In the meantime, national policymakers are already attempting
to develop linguistic competency standards for federal reimbursement and
national accreditation programs. In the absence of standards and testing
developed by interpreters, policymakers concerned about quality but uninformed
about interpretation could make unworkable policy that is confounding
or ignored, much as is California's certification process.
Meanwhile, one possibility is to define a minimum level
of competence in language proficiency and performance of basic interpreter
skills necessary not to compromise patient care. From there, additional
levels of responsibility and role could be added with additional training
and achievement in higher levels of testing. This graduated approach would
address some of the concerns expressed on the behalf of community-based
interpreters from smaller ethnic groups (ie. Cambodian, Hmong, Somali)
that may have very few potential interpreter candidates, and many without
formal education or training opportunities.
1.2.3 Professional Development
Because the field of medical interpreting is still
emerging, and the concept of medical interpreting as a profession is growing
but not universally understood, ongoing development of professional standards
and organizations must continue and be supported. This is critical, not
just for the advancement of medical interpreters themselves, but also
because policymakers are increasingly recognizing the need for quality
interpreted encounters. As they continue to make policy around improving
language access to services, they must have access to consistent definitions
of quality interpreting and qualified interpreters. Several government
and private agencies have already attempted to make policy that addresses
quality--but without recourse to the appropriate definitions (HHS Office
of Civil Rights, Washington Department of Health and Social Services,
Massachusetts Division of Medical Assistance, The National Committee for
Quality Assurance). Organized groups of medical interpreters should provide
these definitions.
Moreover, advances in standardization and accreditation
of medical interpreting, as well as continuous professional development
will serve to increase the standing of interpreted in the eyes of the
health professional community. As has been the case with many emerging
health professions, a formal professional category with attending educational
and performance standards can lead to greater respect and opportunities
for appropriate reimbursement.
Most professional development activities have been taking
place at the state level. As mentioned previously, the MMIA has
been the leader in terms of professional organization, and the development
of standards, training, and certification activities. Along with interpreters
and language access advocates from around the country, the Cross Cultural
Health Program of Seattle has also been involved in the formation of the
National Council on Interpretation in Health Care. This group will
be looking closely at policy development in all the areas discussed above.
Other state-based interpreter groups include the California Health
Interpreters Association, the Medical Interpreter Network of Georgia,
Multicultural Assn. of Medical Interpreters of Central New York, and the
Society of Medical Interpreters of Washington State.
The impact of the MMIA in Massachusetts on all these
areas has been significant, and offers an excellent model for other regions.
It must be acknowledged, however, that MMIA's groundbreaking work in these
areas has been largely accomplished through donated time and expertise,
and the organization, despite its membership of over 200 members, struggles
to even return telephone calls and respond to requests for its standards
of practice. It has no paid staff and only limited dues-income. Supporting
professional development activities is not a typically grant-funded venture;
however supporting the development and activities of these kinds of groups
could speed up the development of standards, the organizing and professional
awareness of interpreters, and general awareness of the issues of quality
in language-mediated encounters.
Summary Recommendations for 1.2
- Facilitate the further development and adoption of consensus-based
role definition, practice standards, standardized curriculum elements,
and standardized competency assessments, especially for small language
groups.
- Build awareness about the relationship between quality and clearly
defined interpreter roles, responsibilities, and competency among health/social
service professional organizations, provider organizations, and policymakers.
- Support professional development activities, especially those that
address the two recommendations outlined above.
Contacts, Resources, References
1.2
Bruce T. Downing, PhD
U. Minnesota, Ling/ILASLL
190 Klaeber Ct., 320 16th Ave. SE
Minneapolis, MN 55455
612-624-6552
bdowning@maroon.tc.umn.ed
John Nickrosz
MMIA
34 Longfellow St.
Dorchester, MA 02122
617-636-5212
Julia Puebla Fortier, Board Co-Chair
National Council on Interpretation in Health Care
8915 Sudbury Road
Silver Spring, MD 20901-3832
301-588-6051
RCCHC@AOL.COM
Cindy Roat, Board Co-Chair
National Council on Interpretation in Health Care
c/o Cross Cultural Health Care Program
1200 12th Ave. South
Seattle, WA 98144
206-621-4472
training@pacmed.org
Ms. Linda Haffner, Director
UCSF Stanford Health Care
Interpreter Services
300 Pasteur Dr. Rm H1134
Stanford, CA 94303-4232
650-723-6940
Cornelia Brown,
MAMI-CNY
10 Williams St
Clinton, NY 13323
315-853-7711
Susy Martorell
MING, Medical Interpreter Network of Georgia, Inc.
1006 Clifton Rd NE
Atlanta, GA 30307
770-536-7304
Martine Pierre-Louis
Society of Medical Interpreters
Director, Interpreter Services
University of Washington Medical Center
Box 356167
Seattle, WA 98195-6167
206-598-4663
martine@u.washington.ed
next >
|
