Ethical and Practice Standards for Health Care Interpreters in Central Ohio

Ethical and Practice Standards for Health Care Interpreters in Central Ohio

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9/02/02 Version

Please Note: These standards were developed under a grant from Access HealthColumbus, for the purpose of creating community-wide standards for health care interpreters in Central Ohio. The standards are intended for voluntary adoption by health care providers and interpreters and contain a proposed effective date of September 30, 2002.

The Access HealthColumbus Cultural Competency Strategy Team, which oversees this project, requests that health care providers, interpreter agencies and others adopt these standards as applicable to the health care interpreters they use. The team would like to receive written notification from organizations that have adopted the standards.

Please send notification of adoption, comments and questions to:

Cathy Levine, Executive Director

UHCAN Ohio, 404 S. Third Street, Columbus, OH 43215; telephone: (614) 456-0060; fax: (614) 456-0059; e-mail:

*The drafting committee, described more fully in the Introduction to these standards, includes representatives from four hospital systems and several community-based interpreter agencies.

Introduction

These standards were developed under a grant from Access HealthColumbus, a community initiative with the mission of assuring access to health care for vulnerable people in FranklinCounty. The grantee, Jewish Family Services, is part of a collaboration with several immigrant-serving agencies, including Asian American Community Services, Cambodian Mutual Assistance Association, Ohio Hispanic Coalition, Somali and East African Development and Economic Coordination (SEADAC), and Somali Women’s Association, and Universal Health Care Action Network of Ohio (UHCAN Ohio), an organization promoting access to health care for vulnerable populations.

Under the grant, UHCAN Ohio convened an interpreter policy committee. Participants included representatives from the four FranklinCounty hospital systems – Children’s Hospital, Mount Carmel Health Systems, OhioHealth, and The Ohio State University Medical Center, as well as representatives from Asian American Community Services, Jewish Family Services, and the Ohio Hispanic Coalition, and an attorney from the Legal Aid Society of Columbus. The interpreter policy committee worked for six months to develop a consensus draft of the standards. They reviewed numerous medical interpreter standards developed by nationally recognized bodies, in the preparation of these standards.

These standards were developed to assist health care providers in facilitating language access for patients consistent with the intent of Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act (ADA).

Disclaimer: At the time these standards are being developed, there is no national or Ohio regulatory body or professional association establishing standards for interpreters in health care. Therefore, these standards are not enforceable by any governmental or regulatory body. However, these standards are intended to move health care providers toward best practices in the provision of interpreter services to Limited English Proficiency (LEP) patients. These standards have been developed for voluntary adoption by health care providers using health care interpreters and agencies providing health care interpreters.

Table of Contents

Ethical Standards for Health Care Interpreters in Central Ohio4

1. Confidentiality
2. Accuracy: Conveying the content and spirit of what is said
3. Completeness: Conveying everything that is said
4. Impartiality
5. Conflict of interest
6. Conveying cultural frameworks
7. Patient self-determination
8. Professional distance
9. Attitude toward patients/participants
10. Compensation
11. Professional competence and integrity
12. Respect for privacy
13. Professionalism
14. Professional development
15. Duty to withdraw

Role of the Health Care Interpreter7

Overall role

1. Basic “conduit” role
2. Clarifier
3. Cultural bridging
4. Advocate

Professional Conduct Standards for Health Care Interpreters9

Process for Qualifying as a Health Care Interpreter11

1. Interpreter training
2. Components of the assessment
3. Written examination
4. Field training
5. Certificate of qualification
6. Contents of certificate
7. Additional conditions of employment
8. Regulatory standards
9. Continuing professional education
10. Agency records of qualified interpreters
11. Effective date
12. Comment period

Ethical Standards for Health Care Interpreters in

Central Ohio

Note: Throughout these standards, the term “patient” is used to refer to the actual patient, in the case of a competent adult; or, in the case of a minor or incapacitated or incompetent adult, the term “patient” applies to the patient’s parent, guardian, or other legal representative; the term “interpreter” refers to a professionally trained health care interpreter, as further described in these standards.

A health care interpreter is a specially trained professional who has proficient knowledge and skills in English and at least one other language and employs that training in a medical or health-related setting in order to make possible communication among parties using different languages.

The skills of an interpreter include cultural competency and awareness and respect for all parties involved, as well as mastery of the medical and colloquial terminology, which makes possible conditions of mutual trust and accurate communication leading to effective provision of health care services. [1]

1.Confidentiality

Interpreters must treat all information learned during the interpretation as confidential, divulging nothing, except where the law requires disclosure.

2.Accuracy: Conveying the content and spirit of what is said

Interpreters must transmit the message in a thorough, accurate, faithful and objective manner, giving consideration to linguistic variations in both languages and conveying the tone and spirit of the original message.

A word-for-word interpretation may not convey the intended idea. The interpreter must determine the relevant concept and say it in language that is readily understandable and taking the cultural and social context into account. In addition, the interpreter will attempt to assure that patient has understood questions, instructions and other information transmitted by the health care provider.

3.Completeness: Conveying everything that is said

Interpreters must interpret everything that is said by all people in the interaction and they must not add or omit anything, no matter how uncomfortable it may be to the interpreter.

An interpreter's function is to facilitate communication. Interpreters are not responsible for what is said by anyone for whom they are interpreting. Even if the interpreter disagrees with what is said, thinks it is wrong or even immoral, the interpreter must suspend judgment, make no comments, and interpret everything accurately. The interpreter shall make every effort to assure that the patient has understood all written documents, oral explanations, questions and instructions.[2]

4. Impartiality

Interpreters shall be impartial and unbiased. The interpreter is a neutral 3rd party who does not counsel or advise either party or give personal opinions.

An interpreter shall not accept an assignment and shall withdraw from a situation where his or her strongly held personal values and beliefs may interfere with impartiality. In such situation, the interpreter shall inform both parties prior to withdrawing.

5.Conflict of interest

If personal involvement makes it difficult to abide by any of the above conditions, the interpreter shall decline or withdraw from the assignment.

Interpreters must disclose any existing or potential, whether real or perceived, conflict of interest that would affect their objectivity in delivery of their service.

Children or youth should never be used to interpret. Family and friends of the patient, including interpreters, should not be used to interpret in a medical setting, as this could compromise the effectiveness of the services. Use of such persons could result in a breach of confidentiality or reluctance on the part of individuals to reveal personal information critical to their situations. In a medical setting, this reluctance could have serious, even life threatening, consequences. In addition, family and friends usually are not competent to act as interpreters, since they are often insufficiently proficient in both languages, unskilled at interpretation, and unfamiliar with specialized terminology. (from OCR Guidance Memorandum on Title VI).

An interpreter must not receive compensation for interpreting for a family member, under any circumstances.

6.Conveying cultural frameworks

Interpreters shall explain cultural differences or practices to health care providers and clients/participants when appropriate.

7.Patient self-determination

The interpreter may be asked by the patient for his or her opinion. When this happens, the interpreter needs to restate the role of the interpreter to clarify that no personal opinion may be given. The interpreter should not influence the opinion of patients by telling them what action to take, or interfere with the patient’s ability to make his or her decision.

8.Professional distance

The interpreter always maintains necessary professional distance. The interpreter refrains from becoming personally involved in problems or issues related to the patient and/or the interpreting session. The interpreter refrains from becoming personally involved with patient or provider.

9.Attitude toward participants

The interpreter should strive to develop a relationship of trust and respect at all times with each participant by adopting a caring, attentive, yet discreet and impartial attitude toward the participant, toward his or her questions, concerns and needs. The interpreter shall treat each participant equally with dignity and respect regardless of race, ethnicity, sex, religion, age, disability, nationality, political affiliations, or sexual orientation.

10.Compensation

The fee agreed upon by the agency and the interpreter is the only compensation that the interpreter should accept. Interpreters may not accept additional money, considerations, gifts or favors from participants, either directly or on their behalf for services reimbursed by the contracting agency. Interpreters shall not use the agency's time, facilities, equipment or supplies for private gain or advantage, nor should they use their positions to secure privileges or exemptions.

11.Professional competence and integrity

Interpreters should represent their qualifications, training and experience accurately and completely. Interpreters shall only accept assignments for which she/he is qualified, except in emergency situations, in which his/her limitations are made known to all parties and only until a qualified interpreter becomes available.

12.Respect for privacy

The interpreter refrains from contact with either the provider or client outside the interpreter situation. The interpreter refrains from asking personal questions of either party outside the interpreting situation.

13.Professionalism

Interpreters shall be punctual, prepared and dressed in an appropriate manner.

The trained interpreter is a professional who maintains professional behavior at all times while assisting clients.

14.Professional development

The interpreter shall be committed to maintaining and enhancing professional skills by pursuing additional education in his/her working languages, as well as other relevant subjects, through any available opportunities. The interpreter shall maintain professional development according to prevailing regulatory and professional standards and job requirements as stated by the employing agency or provider.

15. Duty To Withdraw

Interpreters should withdraw immediately from encounters that they perceive to be in violation of the Code of Ethics.

Source:This code is adopted from a combination of sources, including the Codes of Ethics from the Hospital Interpretation Program in Seattle, WA; Boston City Hospital in Boston, MA; and the American Medical Interpreters and Translators Association (AMITAS) in Stanford, CA. It has been adapted for health care providers.

Role of the Health Care Interpreter

Overall role: the basic purpose of the interpreter is to facilitate understanding in communication between people who are utilizing different languages.[3] This role contains four elements: (1) the basic “conduit,” who translates literally; (2) “clarifier,” who explains terms, when necessary; (3) “cultural broker” and, when necessary, (4) addressing concerns (advocacy).[4]

1.Basic “conduit” role

Beforehand

• When possible, the interpreter obtains information from provider, clarifies what language the patient uses, the provider’s goals for the encounter, and other relevant background information.
• When possible, the interpreter communicates with the patient to assess the patient’s dialect, communication style, and register (level of formality) of speech.

Introduces self and explains role

• Introduces self to participants.
• Clarifies the interpreter role to both parties, which includes:

a. His/her role to facilitate communication

b. His/her job to interpret everything that is said accurately

c. That confidentiality within the session will be maintained

• Explains that he/she will use the “first person” when interpreting (for example, “I feel” instead of “She said that she feels”)
• Encourages parties to communicate directly with each other.
• Asks if there are any questions about the interpreter’s role and answers questions

2. Clarifier

Ensuring Communication

• Arranges the appropriate physical location of the interpreter to ensure hearing, seeing, and, when necessary, the physical privacy and comfort of the patient.
• Checks that both parties understand what is said.
• Requests clarification when he/she does not fully hear or understand the message.
• Ensures that he/she can be seen and heard by both parties.
• Informs and explains to both parties if cultural or linguistic differences require clarification.
• Acknowledges when there is conflict or tension between the patient and provider and assists the parties in working out the conflict themselves; does not take sides in the conflict.

• Makes sure the patient is clear about next steps and has asked any questions he or she may still have.

3.Cultural Bridging [5]

• Behaves in a culturally appropriate manner, observing the rules of cultural etiquette; adjusts behavior to observe appropriate rules of cultural etiquette.
• Explores whether factors such as age, gender, or socio-economic status will affect the communication process.
• Is proficient at understanding verbal and nonverbal communication styles and cues that may indicate culturally based misunderstanding or miscommunication.
• When appropriate, calls attention of parties to what the

problem might be.

b. Assists the parties in searching for clarity.

• Shares relevant cultural information of either party’s culture needed for understanding a message and which may help clarify the problem.
• Informs either party when a concept or term is untranslatable and assists the speaker in developing an acceptable definition or explanation.

4.Addressing Concerns (Advocate)

• On occasions where the interpreter feels strongly that either party’s behavior is affecting access to or quality of service or compromising either party’s dignity, the interpreter follows hospital and interpreter agency policies and procedures for addressing concerns.

Professional Conduct Standards for Health Care Interpreters

The interpreter does all of the following:

• Is punctual for all assignments

• Provides an explanation of the role of the interpreter

• Explains potential consequences of inaccurate interpreting, if necessary

• Acknowledges and corrects own mistakes

• Completes any required documentation on the interpreting session

• Dresses appropriately

• Communicates empathy

• Demonstrates patience

• Behaves in a respectful, courteous and culturally competent manner

• Adheres to Interpreter Code of Ethics at all times

• Provides agency with reasonable notice, in the event the interpreter must cancel the assignment.

Process for Qualifying as a Health Care Interpreter Under These Standards

All applicants for qualification under these standards as a health care interpreter must complete training through a formalized interpreter-training program and an assessment, as specified below. Each applicant must complete all of the following steps:

1. Interpreter Training

The applicant must complete a minimum of twenty-four (24) hours of

interpreter training. The training curriculum must include, but is not limited

to: Ethical and practice standards for medical interpreters; medical

terminology; interpretation skills; professional conduct; standards of

regulating and governing bodies; and cultural competency. The applicant

must have written evidence of satisfactory completion of training, including:

name, address, and agency or institution of instructor, and topics in

curriculum.

2.Components of the assessment

The applicant must complete an assessment of qualifications in order to receive

qualification as a medical interpreter. The assessment must include the following elements:

a. Oral proficiency: The applicant must pass an assessment of general

proficiency in speaking and understanding each of the languages in

which the applicant will work (may be done as part of the evaluation

of integrated interpreter skills, subsection (e) below).

1. Assessment of ethics: The applicant must pass an evaluation of

his/her understanding of The Ethical and Practice Standards for

Health Care Interpreters in Central Ohio(to be covered in the written

test referred to in Section 3).

1. Cultural understanding: The applicant must pass an evaluation of

his/her understanding of cultural issues (to be covered in the written

test referred to in Section 3).

1. Health care terminology: The applicant must pass a test of knowledge

of basic medical vocabulary (to be covered in the written test referred

to in Section 3).

1. Integrated interpreter skills: The applicant must pass an evaluation of the applicant’s ability to use all interpreter skills in an integrated role. This assessment will consist of a scripted role-play.

3.Written examination

The applicant must successfully complete, with a score of at least 80%, a written test with content areas including, but not limited to, ethics, conduct, interpretation skills, and terminology. The test is administered by, or on behalf of, an interpreter agency or a hospital interpreter coordinator at a FranklinCounty hospital. The agency administering the test may charge a reasonable administration fee. Any applicant scoring less than 80% on the written test may retake the test, but no fewer than fourteen (14) days after the previous test. Any applicant who fails the test three (3) times must repeat interpreter training as described in section (1) above.

Upon a candidate’s request and approval of the testing entity, in the case of a language where there has traditionally been no written form, the written section may be taken orally. In such a situation, the examiner will read the question to the candidate and the candidate will respond orally.