Medical Interpretation Resource Guide

A Tool to Assist Health Care Organizations to Meet the Needs of Limited English Speakers

Funded in Part by the Endowment for Health and the Healthy
Communities Access Program

New Hampshire is a state experiencing increasing racial, ethnic and linguistic diversity. These differences enrich our society in many ways such as contributing to the arts, food, and economic development. The challenge we face is how a primarily English-speaking state can provide adequate health care access to those with limited or no English speaking ability. (Click on title for appropriate resources)

Risk Management
Health care organizations that want to provide quality care to patients regardless of their ability to speak English must assure that there is a model of interpretation available, whether it be face to face, telephonic, or another mode of delivery. Trained interpreters convey information between the provider and the patient. Not only is the trained interpreter proficient in English and the target language(s), but s/he has been educated about the role of the interpreter, and the constraints of that role. "Only people adept at representing common health complaints in a clinical setting should be allowed to do this work. The subtleties of interpretation can be lost by the less skilled interpreters and the patient can easily be misrepresented and then misdiagnosed." (Medical Interpretation: An Essential Clinical Service for Non-English -speaking immigrants, Chapter 4 Handbook of Immigrant Health, edited by Loue. Plenum Press, New York, 1998.)

Data Collection
Disparities in health care exist and are reported nationally. However, if data is not collected on an organizational, local or statewide basis, then it is difficult to develop interventions to minimize these disparities. The Institute of Medicine Report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health" recommends data collection and research as well as cross-cultural education as strategies for overcoming health disparities. (Click on title for appropriate resources)

There is no one model for providing language services that will work for every organization. Health care organizations serve various populations and have different levels of resources. All health care organizations, however, should have a plan for providing access to people with limited English Proficiency (LEP). The plan should be structured with written policies to assist staff in understanding expectations and providing guidance on how to meet patients' needs. Assessment of language needs and organizational resources is a key first step in developing a plan. Once the results from the assessments are compiled, action steps can be prioritized. (Click on title for appropriate resources)

Organizational Structure
The structure for providing language services will depend on the organization and the community it serves. Facilities need to think about whether they want to deliver services using in-house staff (make) or outside groups (buy.) Based on the organizational assessment, the organization will identify how best to meet the needs of its patients depending on the variety of languages needing interpretation, the frequency of interpretation needed and resources available. The Office of Minority Health's Culturally and Linguistically Appropriate Services (CLAS) standards reinforce the need to have plans, policies and procedures to assure successful delivery of language services. Standard 8 states; "Health Care Organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanism to provide culturally and linguistically appropriate services." (Click on title for appropriate resources)

A culturally competent workplace will demonstrate respect for the beliefs and traditions of its patients and its staff. One way to let people know that you value other cultures is to have visuals depicting people of other races, ethnicities or religions. These could be paintings or sculptures representing a variety of cultures, posters providing information in a number of languages, or health education materials in languages other than English. These activities are supported by the Recommended Standards for Culturally and Linguistically Appropriate Health Care Services (CLAS) developed by The Office of Minority Health(Standard 7). "Health Care Organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area." One of the ways to assure a culturally appropriate environment is to evaluate the physical space to determine if things need to be done to make people who do not speak English feel more welcome. (Click on title for appropriate resources)

The debate about providing medical interpretation services would not be so conflicted if there were available resources. Many health care organizations struggle with providing quality care to limited English proficiency (LEP) persons due to costs. Right now there is no easy answer. NH is one of only 10 states in the nation where Medicaid provides reimbursement for interpretation services. In NH we have found that organizations were not aware of their eligibility to bill on behalf of interpreters. A pilot program to enroll interpreters as providers in Medicaid is showing promising results for those organizations to recoup some of the costs associated with providing interpretation. To be eligible for reimbursement, interpreters need to enroll as Medicaid Providers. They can then receive payment directly from Medicaid or can be reimbursed by the health care institution, which in turn, will bill Medicaid on behalf of the Interpreter. This simplifies the billing process for interpreters. However, the reimbursement rate does not cover actual costs in most cases. Medicaid can not be the only answer, as many more individuals who don't speak English are uninsured. Some facilities have obtained grant support to assist with providing direct language services. Others have developed relationships with volunteers in the communities. Those organizations that offer interpretation resources currently fund interpretation as part of their operating budgets. (Click on title for appropriate resources)

It is important that organizations consider the qualifications of the interpreters providing service to their patients. Although NH does not currently have a certification or licensure process for interpreters, there are ways to assure the interpreter is qualified to perform services. Language proficiency testing in English and the target language(s) is crucial in determining whether the interpreter has the linguistic skills required for adequately communicating health information. Some organizations have developed hiring processes which incorporate a written and oral language proficiency assessment with role-play scenarios to determine an interpreter's qualifications. Training programs that incorporate elements of triadic communication, ethics, and medical terminology will best prepare interpreters for working in the medical setting. Ongoing professional development opportunities would also reinforce interpreter's competence. Sign language interpreters complete national certification exams and are licensed in the State of NH. (Click on title for appropriate resources)