FAQ - Healthcare Professionals

Information about providing language access services

What is healthcare interpreting?
It is interpreting that takes place in healthcare 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 healthcare provider (doctor, nurse, lab technician) and a patient (or the patient and one or more family members).  See comment above.

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.

What is the difference between a healthcare 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 of the qualifications 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, without additional training, is not qualified to serve as an interpreter.

A qualified interpreter is a person 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.

What else should professional healthcare interpreters know to do a good job?
The following six components together comprise a reasonably comprehensive process for the initial assessment of 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.

What types of services should a healthcare provider/organization provide with regard to language access?
The US 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…

Four-Factor Analysis

The extent of responsibility can be determined using an individualized assessment that balances the following four factors:

1. Number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee 
2. Frequency with which LEP individuals come in contact with the program
3. Nature and importance of the program, activity, or service provided by the program to people's lives; and 
4. Resources available to the grantee/recipient and costs.

Safe Harbor:

Actions 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 the population served. 
• If 5% includes less than 50 persons, providing oral interpretation of written materials and notice of such right.

What can I do if there is a problem with interpreting services?
Many hospitals and health care organizations have an Interpreter Services Manager who is responsible for seeing that qualified interpreters are being provided by their organization. If there is a complication, the Compliance Office should be contacted.

Some interpreters say they are “certified.” Is there a difference between qualified and certified interpreters?
A certified interpreter is an interpreter who is certified as competent by a professional 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.

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.

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’s 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.

Is there a law that requires the provision of interpreters?
Yes. The following are key laws and policy guidance concerning the 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). $100.00 ($65.00 for nonprofit advocacy organizations). To order, go to www.healthlaw.org

Where can I find healthcare interpreters?
Qualified interpreters often belong to professional associations or work through language service agencies. For a list of translator and interpreter associations, see NCIHC’s resources page at www.ncihc.org. For language service providers and additional information, see NHelP’s Language Services Resource Guide (2006).

a) How do I know if they’re 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 the 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 healthcare interpreters. Prior to the NCIHC code, numerous agencies and 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.

Dual-role interpreters:
b) Do health care professionals make good interpreters?
Bilingual staff is often used to interpret, without any assessment of their skills. 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 the medical interpreter level. Staff that passed at the basic level was 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.

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 programs in translation and interpreting, see the American Translators Association website www.atanet.org under “careers.” For a list of training providers, see NHeLP’s Language Services Resource Guide.

For self-guided learning about the profession, see NCIHC’s Working Papers Series (under “Resources”), 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. In addition, NHelP’s Language Services Resource Guide (2006) contains multilingual tools and resources, and a glossary of translation and interpreting terms. There is also a good description of the profession at Explore Health Careers.

Where are we on certification? 
See FAQs under the Certification tab.

What is the difference between “interpretation” 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).

My hospital is thinking about starting an interpreter services program. Where should we begin?
Learn as much as you can about healthcare interpreting, starting with the FAQs on this page. Then, look through the NCIHC resource page for a working paper entitled, 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, “One Size Does Not Fit All:  Meeting the Health Care Needs of Diverse Populations.” (www.jointcommission.org)