1. 1 California Healthcare Interpreting Association Developed by: California Healthcare Interpreting Association – Education Committee Funding provided by: The Amgen Foundation and The California Endowment 2-2008 Introduction to the California Standards for Healthcare Interpreters

2. 2 Learning Objectives ORIGINAL Identify at least 2 situations in which the California Standards for Healthcare Interpreters may be a helpful resource Identify the2 sections of the California Standards for Health Care Interpreters Identify at least 1 current issue in the healthcare interpreting field Identify the benefits of health care interpreter training Become aware of resources for learning more about the field

3. 3 Brought to you by the letters “I” and “T” Interpreting Translating

4. 4 and LEP Limited English Proficient Individual who does not speak English as their primary language and has a limited ability to speak, read, write, or understand English to effectively interact with health care providers or social service agencies

5. 5 When interpreting, have you ever wondered…? Is it okay to interrupt a patient or clinician so that I can interpret when they seem to go on forever? Or is that disrespectful? Is it unprofessional to ask the clinician to explain a medical term I’m unfamiliar with? What should I do when the clinician asks me to “just interpret everything word for word”?

6. 6 Is it okay to accept a gift of appreciation from a patient’s family to avoid insulting them? What should I do when patients share information about their health with me but prohibit me from telling the clinician? Is it okay to ask the patient if s/he needs more information if they look confused? When interpreting, have you ever wondered…?

7. 7 Should I interpret insulting or rude comments from either the patient or clinician? Is it okay to share common cultural health beliefs with the clinician? Is it okay to share my opinion and advice if asked by a patient who trusts me? When I’m interpreting and I see a patient treated unfairly, what is my responsibility? Do I have a responsibility? What can I do to make the interpreted session go more smoothly? When interpreting, have you ever wondered…?

8. 8 Standards of Practice Support Development of the Profession Health care interpreting is a specific type of interpreting requiring its own standards As with other health care professions, standards of practice establishes expectations about how interpreters work Basis for training, assessment, job descriptions Basis for quality assurance and establishing health care interpreting as a reimbursable professional service

9. 9 Standards of Practice California Healthcare Interpreting Association (CHIA) convened a Standards Committee California Standards for Healthcare Interpreters released in 2002

10. 10 Strategies for Communicating with LEP Patients Bilingual clinicians and staff who deliver in- language care Staff interpreters Bilingual staff who interpret On-call or contracted interpreters Video conference interpreting Phone interpreting

11. 11 Purpose of Health Care Interpreting To facilitate communication between two parties who do not speak the same language and do not share the same culture.

12. 12 Minimum Requirements for Those Who Interpret Language fluency demonstrated in both languages Basic understanding of human biology Knowledge of common medical terms Interpreting skills Ability to apply recognized Standards of Practice related to roles and interventions

13. 13 Guiding Principle As with many health care professions, the California Standards for Healthcare Interpreters is based on the fundamental principle, that interpreters should “support the health and well-being of the patient.”

14. 14 California Standards for Healthcare Interpreters Ethical Principles Guidance on Interpreter Roles/Interventions Standardized Protocols The Ethical Decision-Making Process (Based on healthcare profession model)

15. 15 Section 1: Ethical Principles Confidentiality Impartiality Respect for Individuals and their Communities Professionalism and Integrity Accuracy and Completeness Cultural Responsiveness

16. 16 Section 2: Standardized Interpreting Protocols Pre-Session During the Session Post-Session

17. 17 Section 3: Guidance on Interpreter Roles and Interventions Message Converter Message Clarifier Cultural Clarifier Patient Advocate

18. 18 Treasure Hunt Activity Opportunity to look through the California Standards for Healthcare Interpreters Note down the section(s) and page(s) where you find information that would help you in the situations presented Based on the information, how would you handle the situation?

19. 19 Ethical Dilemmas Situations in which the ethical principles contradict themselves Ethical decision-making process

20. 20 Benefits of Training Learn more about the ethical principles and handling ethical dilemmas Better understand the roles and boundaries of the health care interpreter Better understand your own strengths and weaknesses as an interpreter Learn specific vocabulary and medical terminology

21. 21 Opportunity to receive constructive feedback and mentoring from experienced interpreters Increasing recognition of employers of the importance of interpreter training Become familiar with the standards and protocols in this developing field Benefits of Training

22. 22 Training Resources List on CHIA website: www.chiaonline.org Masters and bachelors degree programs Community college programs and classes Connecting Worlds trainings Bridging the Gap trainings Work-based trainings Extension offerings at universities and colleges

23. 23 Family and Friends as Interpreters Ad hoc interpreter –Typically untrained and not tested –Often a family member, friend, or volunteer

24. 24 Current Issues Certification Implementing Senate Bill 853  Section 1300.67.04 of the Title 28 of the California Code of Regulations issued by the Department of Managed Health Care (DMHC) California Department of Health Care Services Task Force developing recommendations for financing of Medi-Cal interpreter services

25. 25 Current Issues Certification NO California state certification for interpreting in typical health care encounters –In California, medical interpreter certification is limited to the Medical Certification of Court Interpreters who interpret for workers compensation cases Efforts underway to establish national certification of health care interpreters

26. 26 Current Issues What is Certification? An objective 3 rd party ensures an interpreter has the knowledge and skills to perform interpreting at an widely accepted and consistent criteria Involves a rigorous process utilizing assessment tools with established validity and reliability

27. 27 Current Issues Not to be Confused Many healthcare interpreter training programs offer a Program Certificate upon completion of their training program Some academic institutions offer Certificate Programs in healthcare interpreting BUT these are not the same as certification or a certified interpreter!

28. 28 Current Issues DMHC Language Assistance Program Regulations Effective Jan. 1, 2009: All California health plans must have a Language Assistance Program Who must comply? All health plans regulated by CA Dept of Managed Health Care (DMHC) and the Department of Insurance

29. 29 Requirements –Accountability –Oral interpreting services –Written translation in threshold languages –Training of staff qualified to provide language services –Assessment of language needs and demographic profile of enrollee population http:www.leginfo.ca.gov/calaw.html Current Issues DMHC Language Assistance Program Regulations

30. 30 “…The Department will accept plan standards for interpreter ethics, conduct, and confidentiality that adopt and apply, in full, the standards promulgated by the California Healthcare Interpreters Association (CHIA) or the National Council for Interpreters in Health Care (NCIHC)” (Section 1300.67.04 - H (iii) of Title 28 of the California Code of Regulations related to Language Assistance Programs, issued by the Department of Managed Health Care (DMHC), wwww.dmhc.ca.gov) Current Issues DMHC Language Assistance Program Regulations

31. 31 California Healthcare Interpreting Association GoalImprove the quality and availability of language assistance in health care VisionHealthcare interpreters and providers working together to overcome linguistic and cultural barriers to high quality care MembersInterpreters, educators, healthcare providers, bilingual healthcare staff, hospitals & clinics, language agencies, government policy makers

32. 32 Become a CHIA Member! Network via chapter activities and committees Reduced registration fees at the annual conference Access to online job listings Quarterly newsletter and updates on events and developments in the field Educate policymakers and influence policymaking. Online registry of interpreters, either as an interpreter or a purchaser of interpreting services Enjoy knowing that you are working toward improved healthcare — and better health — for millions of immigrant Californians

33. 33 Contact CHIA! Executive Director: Don Schinske Phone: (916) 444-1506 E-mail: dschinske@chiaonline.org www.chiaonline.org

34. 34 Funding Gratefully Acknowledged from The Amgen Foundation

35. 35 CHIA Education Committee Katherine Allen Teresita Bautista Carmen Castro-Rojas Susan Choi Lourdes Cerna Danielle Dibie Nora Goodfriend-Koven Elizabeth Nguyen Linda Okahara Jesus Oliva Don Schinske Tatiana Vizcaíno-Stewart